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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubllooriVenVl nsulation
<br />Roof Sheathinq /...-k lE,))kLt rta
<br />Shear Wall
<br />Framinq
<br />ln s u lation/E nergy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Itilasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FINAL /--/2 -/r'././,.124 {r)
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
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<br />OWNER BUILDER DEI,CARATION
<br />I hMcby,lltrD und.r pcmlly ol Frjury lhrl I m excnfl from rhe Conrrs.k,^ l-i.cns. Liw for rhc follo{in8 rcren (Scc.7o.]l5
<br />Dusi.css oRl Profc$ion Cdc): An) Ciry or C.dnry $hirh rcqtrnd r ,rnnit lo con(ruci, alla. imtroE- dcmolish or rcrrdt m,
<br />nrudlrc. prin lo ils nrudcc. rl\o (qun6
<br />'h. {plic, br u.h pcirnir fu filc tr siSNd slalcarcnt lhal he or shc n li..ntd ll^unr
<br />tu rhc pn,virions ol tlt Conhcktr s Licctrscd Lnw (Chtrflcr 9. Comncncins wirh Seclioi 7sI) of Div(xrn I ol rhc Businc$ rnd
<br />Pmlcsions Codc) or rh h.orshc h cxcmpl rhcrcliomand rh.l'!sh iolhc aucEcd cxemptn'n Any viol,rio olsccli,tr70.11.5by$y
<br />0ptlicmt lor0Frmir sunjcclsrhr arrplicunr ro trcivilp.nrlryotnor frncrhM nvc hundrcd dollffs ( S5m).
<br />L N .wtrd or rh. proJErly. or my cmlloles wilh wrses is thcn st onlp.n\drion. will do rl'. wrk 0d thc slml!rc h [n
<br />inlcndcd oroficEd for slc (S( 7044. B!sinc\\ rnd Pmfcsb.\ Codc Thc aonra.rois l.iccnsc tn! docs nor mlyio.DoqEroi
<br />rhc pmFny who t{ilds or impror( rhcmn. arn sho d{E\ \uch $(,rk hnn\cll othcrs.lfor lhou8h hi\ or hcr .wn ..!roy.cs.
<br />rovidcd rhrr $.h impm€rnrs m tut inrcndcrl or .lTcmd fo. sdc Il howcvci llE huiklire or ir$ftNtmnl is q,ld *ilhin orc ]{d
<br />of.oirq)!:rion. rltr owftr Buildcr Bill h.vc lhc hardcn ol Frvins tttrl tu or shc did nor huild or i'q'm\t inc ,mtsy lbr lh. puqrs ol
<br />-1.
<br />aso*rcrol rhctmpcnr. shcxclosivcly.ont rintsnhli.cn*d..nlr lorrocon\rrucrrhcpmjcct(Scc l(}l,1. Busirrcn
<br />rll B.f.$bn Codcr Thc Conlr.clols Liccnsc Las docs mlllplr ro on ownc. ofprt,!.dy who builds ot inutotcs thcrcon.
<br />and who conrr!.h l'or such l),(*cls lirh a G,na,cbrl\) lt.nscd !r ulm i, rhc C-onr0ctois Liccnsc L!s)
<br />-lrncrcnrplutrd.r
<br />Sc.li,)n .R &l)C nnrh\'cr(rr
<br />Oqne.:
<br />IlonKlas:laul&Nt rlJr
<br />DXCLA.BAIION
<br />I hcn hr_ nliirnr uracr lcnrlrlolpc'lu'yon. or itu rdLo(iirg lorlrrxri,rN
<br />Ihav.nidwillminraih,ccnifi.atcolC.nscntroSclf.lNlre!o!\'o.ke^d,mpenqrkr.nspovidcdfo.byScctionl70Oolrh.
<br />L!h.r Codc. for rhcIlstunun d.frhc wolk lor which rh. p..mir h hsucd
<br />uc.fld *illDrinrlnr eorkcrs' co'npcnsrion in\u.rncc. a\ rcquired hysd.rion lTlI)ollhc lrlbor Conc. ntrrhc p.rfornmcc of
<br />Filnir h issu.n Myworksa conrpcnsart,n insutuncc.rtricr md p.licynumbcrm
<br />t-)C
<br />-l
<br />ccnify thar in rhc lcrforhrm. or rhc work for whi.h rhi\ pcirnir h nsucd.l \hnllnoi.trfh,y iny P-ison inunr$rnncr
<br />\o isro bcconr subi.l
<br />'o
<br />lhc *trlss ompcnlarion lr*\ orCaliromia. rnd +mdh.t il I slnu[l tcom subtd ro rtt
<br />*1,*.rl .onr,lcf\rritrtrcvi\iotrsoiSccri{n :l70Ootrl[ l htr lL nrlh{irh con$ly trirh rhoR Irovilion\
<br />WARNIN(j IriLr,. k) w..u'. uo'kc'\ rn t{ \ rnl hjcrr rn $lPlo).r t,oi'niml Nnilri\ r
<br />cnil finc\ up k, onc hutr,lrd I ihc cosr olcnnrFn.arn '.
<br />d,m,!c$s providcd lor rhc
<br />Il(rilliulluN-t-<Lutr
<br />I hcnhr rfitn, un{lcr p.DrhyottEjury r
<br />DECI,ANAIION
<br />udcr Imririon ol'Ctaprcr 9 (.ndDn.ine wnh Sdion ?m0) oiDilhion:l
<br />ol rhc tsusirlcssand Pmicsions Codc. od my licn{ is in full Ii)r.c md cfldtc3
<br />b ,{
<br />I h.rchyrin nuM.r pcnrllyoipcrjlrrrhar
<br />(sucd lsc. 1097, Civ C.)
<br />n{ .rtnr hndirga8cnc} lorlhc pclioruncc ofihcsolt roruhichrhi\ Frm n
<br />AIEUIAN:LDECIABAIION
<br />I rrtby dfim u.dq I'cnrlly.ipcrjury onc ol rhc nnbsin[ dcclarrion\:
<br />Dcm)lirn,n Pcrmis \h.ios Nolin. ion rcdcralR.Aulrrionsll [lc 40- l'rn6)
<br />R.quncd trn.i of Norili.rri,n
<br />I rcsulniion\ .cg,trJi'u i\h.no\ '.nn,vaLrr. ior rt)!li.rhl o rhi\ t'n)j(l
<br />*rt urr rh, ,h^ 'N'p nrtunuriof h corNr I a8re t' c. rrly trnh ill Cny rnd C.unry
<br />scnrdn$ ofrhis Ciry d.d County I{, c.rcr opon rhc
<br />\).1
<br />Flood Zone Certif .
<br />t ndcls Addr.s\:
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