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GRADING-INSPECTOR RECORD
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<br />APPROVALS DATE ID/SIG,COMMENTS ow..rBu rld$ Delamriotr
<br />I hcEbyliir lndd D. rlry of p.rFry rhot I am cx.nfr fnrm rh. Conl.aclon lic.nr. hw for th. aollo*m8 rca$o (w 70]l 5 Brnn si
<br />snd Prof.ssi.n cod.): Any ciry or Cdr.ry ,hrh r.qurcs a p.mn io odrucr. alrcr. im,rmv., d.nolish or rcpan any (rucrrr.. P'tr ro i
<br />h,uince,sl$rcquncsth.ap, i.a tu N.h l.rnn ro filc a 3ig..d srdt.tr rh.t h. o. fic i lic.nrcd luButnrL,hcpmvhionslfrhe
<br />conhcrol. Liccnsd Lrw (Ch0rter a, Comd.ncins wirh seri.n 7000 of D,ikion I oftn Businsi snd Profc$ions code)o*4 he or
<br />rh. ir.x.n,rr rh.i.f6s a.d rh. hark fo.lh. Dllcs.d .x.mnlion Anyliol.tionolsdrionT0ll.l bylnyapnlicad ftriD.mr ruhicdsrhc
<br />.nplicam lo i crvil,Emllyolmt mr. rnan nv. hundrcd dollsn (3500)
<br />-1,
<br />d owrofrn pmrdty, or ny.q,lor€! eilh wrs., a. th.i. 61. co,p.nsl io( villdo th.*ort..d ih. nrud!rc is mr anl.d.d
<br />6r6rr.rd forol. ( se.7fi4, ausiMi.nd Pol**,nr Cod.r'nE Co reror'. Lic.M Las dod mr apply to s 6{mr ofri. lo,Eny
<br />slh bu,ld. or inpmvB rt{6l! and rto &6 tun vork hin*lf ot h*lf o.llv.usn hh or ls om.tuphyB. lmvitu rn l s.h
<br />inDrcv.md3 ,,c ml hr.tdcd or ofi.Ed for 61.. ll now.!d, lh. blildi.B or impnr.D.nt i. $ld snhin oft ,ra ofoorlerio.. rh.
<br />OuM-Buildr {iU haw ilE b{rd.n of pmring lhol h. or 3h. tul build or inlhv. for rh. purp.c of el.)
<br />l. ar ovM of rlE tmr.ny. ao .xclBiv.ly conrmri.S wnh lic.nrd enlEloh to 6nrl tod lh. |rnFr { S4. ?044. Busi*s. ..d
<br />Prcfcsion Cod. t h. Conrdclor'r Li.d.. Ilw dB mr rp0ly io .n oNEr of nmp.ny wlF l,!ild. or iottbvd lhcron , snd slnl
<br />onlmcrs ror u.h prcjerB *ith a coirftcro($ licci*d pumail ro rhc conlmcrors Li..nr. Lae.).
<br />I m cx.mpl u.dr Sdlbn
<br />!48[EBSl9rrtEBSAI0!-lEClA8AIrc!
<br />I h.Eby amm und6 !.mhy of ,Erjury om of th. lollowin8 &.lomt ioN:
<br />_l h.v.and *illminIain rortd @hlr.Mtion in$6M. s rcqui..d by S*lion l?00 of lhc t ho. Cod., for lh. pdfomne of fic
<br />work for which thi! pnnil is i"iu.d. My worL.d .otlsndio. insrm.c .Mid aid poli.y Nmbd e:
<br />Policy Numbcr_Erti.sl
<br />( l hb.{rio. E.d El h. conpl.r.d if llE n mit is aor On. hundr.d douad l$ l0o) or l.*9
<br />_l c.niayrhrr inrlEprtolm ..f lhced. for h fiir Frnir ir is.4 I .h.ll ml .mDloy a.y p.Mn
<br />'n
<br />any Nnnr $ * 16
<br />t.ca$.subiel lo thc rcrkm' 60rc Califomis. dnd a8e lh.t if I olld b.cod sbid to fi. wo*.F
<br />cohpc.srion DmrisioN 6f Sdtaon 3700
<br />lh<_
<br />wARNlNc ljsrlur.kJ se.unworken co h lnlswtul, rnd shrll lulrcl an .mplottr lo oi6i.0l Fmlt i.i nnd civil
<br />finca uD !o oR hund.ed rhous.d dollaF(Sloo,olDl,in.ddnion to lh. con ofcomr,.n9li.rl d.m8...i Pmvid.d for rh. Sdrion 1076 oa
<br />rhc L.b.r Co&. im.Bt dnd 6norn y s fes.
<br />uct!$olarrMcroBiulclaSarrcN
<br />I h.ftby amm und4 p.n.hyofFrju.ythal I am lic.nsd und.i ,mviridn olcht,)t.r 9 (mmencins wnh scr6.7000) ofDivhion ll or
<br />rh. ABiR"r .id Pmfesio Cod.. .rd ay lac.e b in tull foG ..d .ltdt
<br />I heEby amm undc. pe.ally otperjury lhrl
<br />ks.<l (S(. 1097, Civ. C )
<br />kding .g.ncy ior thc pcrfomncc of rh. w.rk for which lhh n rmir is
<br />a.r&rcaNrtlDetaadJaN
<br />Dcnuniion Pemirs Aa[.no. Nonficarion ld.6l Rqulil ioN ( l rl. 40, Prn 6)
<br />_ R.qun.d Lcll.r oiNolifi calion
<br />I c.nify rh.t fic ,.deml E8!l.l ioN Esadifls tur .t'!lic.bl. lo
<br />'hk nroj.cl.
<br />rlv hn ii corer. l rSra rocohplywilh lllCily.nd Cot y
<br />iv.i ofrth Cirr.d Coumy to6r.r utbn lhc
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<br />Preliminary Soil Report
<br />Fills
<br />Sub Drains
<br />Soils/Geology Report
<br />Statement of Compaction
<br />Compaction Report
<br />Paving
<br />Sub Grade
<br />Aggregate Base
<br />Water Test & Seal Coat
<br />Asphalt Concrete
<br />Soils Eng. Cert
<br />Rough Grading Release
<br />Final Civil Cert
<br />./.4
<br />FINAL lo -l'lK D.Yl,\],)
<br />Notes, Remarks, Etc
<br />Excavation
<br />Buttresses
<br />Flood Elevation Cert.
<br />-l
<br />haveed willnlinlaia a C.rlificll. oiConsn( h s.lf-lns!r.lo. solk. comp.ns'rnrn,6 Dmvid.n hr hy Sdrn'n l?(x) o I rh.
<br />ljtrr Cod., for rnc p.rfolm*. of rlE *orl ror qhich rh. Finn is hs.d
<br />86 gq3
<br />&q N
<br />,","03^Zq^zqb
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