|
BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS owNF)ta BU ,OEta Ut:t,c"1kATION
<br />I h.ftby ,tImr urd.r p.iahy of p.rjury rhar I rm.r.mpr f6m IIE Conrero^ Lic.nsc L.w for rhc lollowiry Eaion (Sa.7011.5
<br />Blrinc$ ld P.olcsh. Codc): Any Ciry o. Coudv which rcAtrirc. a ,Emn r. connru.t, alrs, inrprovc. dcmlirh or Rpan ,ny
<br />srdduE. pio o irs !$urec, at$ Eqlic! tnc upplicld for su.h p.nir ro iL a riged n,r.Enr rhnr h. or $. ir l,c.(ed pusur
<br />ro rh. tmvisions oI rh. Conracror'r Liccnscd liw (Chapicr L Cornmcrcing wnh Sccrhn 7(xx) oll)ivision ] ofth. BusiEss aDd
<br />Piofcssions Code) or rhar hc or shc ir exenpt rh.r.hont rfll rlE bass lor tlE ullqed exenll,rion. Atry viol i{ofs.crion7031.5hyaoy
<br />lopli..nrrorrp.nnirsubj.ccrh..oplrlmroicivirp.mh!orroirmr.rhinlivchondEddollos(15{D).
<br />_1. i\ o*nc. dl rh. pr.tiny. .r my c'nolrlrcs wnn r.g.s .s rh.ir rr! c.mp.ni.ri.n, *ill d. rh. w.* ad rtE nMUrc n mr
<br />inE, ai or ofi.r.rl for ul. (Sa ?l)1-1, Busims Md Pmf.$ioN Co,.l. Tk Contrdo/s Li.Di L!* rlo.s nor .pply ro .n ovM of
<br />the lopcdy wlD bnild! or inIIoEs rh.N[ and *ho does srh wrl himclf or hersl, or rhmush hir or her own employ*],
<br />pr.vid.d ihar such in,'FvcmnN arc m( inrendcd or oll'cEd lor $L li how.vei rtE buildins 6, urpo*mn' is $U *irhin om y.d
<br />ol.onqlhin (lE Oqrcr Bui&r will h!v. rh. burdcn ol tmv,rs thd lE or sG dil rct t uiu o, inpo€ lrl pbpory rdr rtr lurFls oa
<br />I. uso*ncroIrh. pn,p.dy, rm.rdusiv.lyconhcrint wnh li.ci*doirmtoBrollNttucr tlt prcjcct (S@.7041. BuliEar
<br />a Pitrl.sion Cod.] The CoMdol r License Low do.s nor arply ro a. owner of prop.ny who builds or inrprov€s rhcrsn.
<br />md 'h. co.kacN Lr such pr+crs wirh a Cnnkmro($ li.ctrs{d puN.n'
<br />'o 'r* Codr&'ols LieN riw)
<br />I lnexcn\n tr cr Sainr ,B &PC rar rl$ r.an,n
<br />l).re:- Oln.
<br />l!a![!B!:co!4rrNsa.r.!QN
<br />I2EC!A3A!.QN
<br />I hrr.by altirmund.r p{n.lryof|l.rjuryonc olrhr tulhwin8 d&lrdn)tu
<br />I hov. and wrll minr.in a C.nif{!i. of Cooscnr b s.lanNuc ttr rorliqr lon{f,N,rion, as ,'ovi,l.d for hy serih 1?00 of rlE
<br />llhor cod., aff rh. pdtD@(c drrh. *ort fd rhich rhc pcrnir i{ i\su.d
<br />I h,v. rnd will minrdn work.6 c.rbp.6.riotr nr{ranc.. !s requiBl hy Senon 3700.f rh. kb*Cod., for rh. F.fo,]ljm. of
<br />rhd wort for whih rln I)tmi ir n$di My sorkc( omp.tufton 'nrurdce orid dl I{lEy numtE ecl
<br />Polic, NrNb.r:_1.:\pn.r
<br />I ceniiy rh! inrhc pednrnBNc oiilE wort Ior whichrht Frmir ir isiued.l slEll not.mploy my l).uon in any nd*r
<br />s s r. hecor {bjcd ro rlE si(cB'comp.neri.n l2w\ or Calif.mia. and a8r. rhat if I rh.uld h.com subl..r ro tlE
<br />*oA.h.ontEr$rE!pFvtiotrsotS..non3?00oIrh.L.bor(od.,ldull.rodhwnhconplysirhrh.ipdvisions.
<br />WARNINC: Foilure ro $curc wortcrj ompcosurn,n coveragc is unldwtul. ud $!ll subFcr m cmplotrr to 6inin trtuhis mrl
<br />ovil fin.s uI ro onc huMrcd rh.ustrd dollar ($l(X),(Xx)), in iddirion io rhc con olcomp.n.Aliotr, damrg.s * provid.d for rh.
<br />Serin 1076 of rh. tahor C'od., ,nr.Ei rd anotuy s f..!.
<br />UCENSED-(I]!trB I1aA
<br />!Eg!a8AfIO!Ihcrt.hy,lJinnu.'Fnrhy.lr.rjuryrh:tIa'nliccnkrlundcrtftvisioi.lCh.rts9(..'nmni.gwhSccri,n7lr($)oll)ivisDrl
<br />of rlE Busncss rtul Pof.si.ns OnL ad nry licen* ir m tuU ntre axl. iicr
<br />Li.cnx. Chsr-LiaN. Numb..l
<br />CONSTRT'CTION I I:NDING AC}:NCY
<br />I h.Fby .flirm unler p.nalty of Friury th.r rh@ is ! con(ru.1ion knding 'g.E-y tor rh. p.rfom'E of rh. mlk for rhi.h rhis pdnjr b
<br />i*!rd (Sc. 1097. Civ C.).
<br /> PPLICANI DECLARATION
<br />I
<br />'ftby
<br />lflm urd.r p.tralry ot pcrjury otr. olrh.lollowin8 dshr.riors:
<br />D.nrlirion P.rn,irlAsb.nos Norifi. ion F.d.ml R.Buhrions Gnl.,l0, Pfi 6)
<br />-Rcqun.rl
<br />lrncrof Notif{.lion
<br />_l..difyrhd rlr fed.nlr.s l"rions rcgddin8 rsbeios rn{vd & nor,r'tli.!bld ro rlris pojecr
<br />C2-r ..niry rhar I h,E @d rhis adl niG rhar rh. $.v. infom(ion n corer. I at.e ro conDly wirl, lll airy rDl Couniy
<br />,rln,xNe\trndSrrr. Lwr cobhditr a'rl h.Eby rlDrir Eprce rrr'v.rrf rhir Ciry ond Counry ro cNer ul)o! rlE
<br />rtr)vc nrnrnrn.d pftrp. y n ns 2-/7. 2.),\pflionl or Alm! sixn!
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />[/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certif .
<br />FINAL Va/z,o llt.xur\,-/,fr,z )
<br />Certilicate of Occu n
<br />Notes, Remarks, Etc.
<br />Bev. 08-07-2015
<br />lr"r. ('ontrrfu,
<br />t ndcir AddE$:
<br />-
<br />Brown Coat
|