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BUILDING- INSPECTOB RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNIiI' BUILDIiR DI]LCARATION
<br />I h.Ehy alnrm undd Irnaky or pcrjury rhar I am crcmlr from rhc Conrrexns l-iens ljw rbr rhc follosin8 r$sn (scc 7D3l 5
<br />Bu\incs !'nl Protcsion C.d.): Any City or Counry *hich icquircs ! !.nnir b .oh{fl.t. rlrcr. inrF,vc. dcRni\h 'r ElJ Jh) .
<br />nrudurc. prior r. irs h.u,i.c.,ho Eqoncsihc rpplicaat for ruch pcrnril h rilc u si8ncd sl cBnl lhol hcorshc is liccnsd Nmuant
<br />t, rfu F,visions.t lhe Conrracrols Liccnscd tr* (Cha,'lcr 9. Connncmin8 with Scclion 7m0 of Division 3 ollhc Busirrs and
<br />Pba.*nni C.dc)orrhnr hcorshe n crrmpl rhcrcflon $d rhcb.sh {or rnc allc8cd cxcnrplion AnyviolllionoiSccrirn?0:ll5byany
<br />applicitrr for ! rciinir subrc.h rh. rtpli.an! b a.ivilp.mlrrolnor nxr. rhan filc hundr.ddolh^ l55m)
<br />L ns .wncr or rhc poltny. or n,y cmnlolces * ili wuecs r rhei. elc conpcns.lion. will do rhc q,.rk and ltE (Rruc n ml
<br />inrcnlcd or oficrcd for klc (Se 7(},l1. Busircss ,nd PnnB\n,ns C.rlc: 't hc c( r k,\ l-icn\r L'w do.s to, drpl, ro utr ownn of
<br />rhc F,p.n, who brilds or i'n mrs rhcmn, rJd wIF dos such $ork hiDscll or h.sclf or rhnugh ht or hcr orn cmphy.cs.
<br />Fmvidcd rhd such improvcnEnls {rc mr inrcndcd or oltd cd nr sb Ii how.vr. rhc building o. inlnrvcmnr is sold *ihh onc tld
<br />ol coml,lctiotr,lL ONNr Bnildd willhaw thc budcn ofpn*ing dnr h.or\hc dil mr buiH or in{,m!. rhc pDpcnJ, f{n rh. !!qi,{.l
<br />-1.
<br />a\owncrofthcpmtcnr_, rm cxchsncly.oftd.r i'rB sirh liccn\rd.ontn.h6 b.on{tu.r rh. E(+d (Src 70l,l. Buni.s
<br />.nd E\,fL\si,n Codc ThcC.itDctn s Licem.I-a* do.s nor rpply lo !n o* no oa proFny who huild{or improrc\ rhcrcotr.
<br />rftl ,ho contracrs l'or su(h pml..ts $irh a Coftd.h(s I li.cnscd ,ur\u l r) rhc C.ftdoas Li.cnsc Ldw)
<br />I n,.\rf,t, utr(l.r S..r
<br />Drlc - _ orn.r
<br />UOAf,EBS:.II}MfjNIA.IION
<br />DICI.ABAIION
<br />I hcahy rffirnr undcr lcnrlly ol p.rjury om ofthc r{rlowine dc.lmrtuns
<br />lh.\cudwillMtrainiCcdiararcolconscnrr'Sclflnsurcaqw6rkc6'.onf.nsdri(tdstrolidcdforbySc.rionl?filofrhc
<br />Irhor Ctde, tor rhc prtonuncc ot rhc vork for which lhc pcnnil is issucd
<br />_lhnvclndwillmimainenrtcrs.onp.nsdrn,.in\nrarc,ssrcqutd$ySccrt,nlTmofrh.L?horG)d..forrhcrdfonnam.of
<br />rhc * l for \nrh \ Frnnt r\ r\usl. Mt worlo! .1trGr\artr.n 'n\unfr.,r'.' , pulk., nun.h.r m
<br />...", 44ry$t c.a.\h '1)n€,
<br />".,,,", ",,,,,*,
<br />SN \JCo ( :5ia? '-l 1
<br />-l
<br />ccnily lhd in rhc Frfoaruncc oilhc work lbr shich rhr p.nnir is issucd. I shall nor cmphy rtry ncron i. a.y nr.nrcr
<br />$ !sro h.sm rubj.cr ro iltc worko(.o'np.isrrin ln*\ olCalifomir. md 'l8m ihar ifI \brld hccom sxbFr brh.
<br />qoftcrs .onrricnsarionlmvirions.fSccrnrnlT{Dofrh. Ilbu Codd.l slull rodhwiih.o ll,lr wirh rho$ fovisions
<br />WARNIN(i: Failu,c io s.uc sorkcr smp.nljltu .oter.sc is unlNirl. ind shall \ubicr !r cnulo)cr b rin rl rEnalri\ nnd
<br />.iril lnr\upk).tuhuftlruJ rhou\rtrJ doll n ($llx).(xx)). irr r diri{{ n) lhe con.l.onUxtr\rrnn,. drnrgr\ rs
<br />sL\rilr:l{176ofrhc l-rtttr(idr. i rcr.i rtrd rinnty \,i.\
<br />tr',,",., --.r- 16 2018 ^,,,,,...,
<br />I hcftby Df6rnondcr Fnalry oa rcrjurr rhar I am liencd lndcr pmvisio. oiChllts 9{mnrmrcins wilh Secion 7o(ro) otDirhion:l
<br />of lhc Ausincs !.d Pmfe$ions Codc. ard my liccnsc i in full for( k].frc.r
<br />LOo"1(51,
<br />D.tJUL IS J{ l+ c..,-"'.", Eabt*.
<br />IONUAI]CIIONIENDINqAqENEI
<br />I hcrchy atfirm !trdc, Fnahr of pcrj!ry rh lhcrc is3onsrru.rion lc.din8 lgcrc] {or rhc pcrforurcc olthc work forwhichrhh pcrmir t
<br />hsuql(Se. 3tD7. Civ. C.)
<br />AtIllrANLDIi!]JAIIll.)Ii
<br />I lrnlry rrIrDuftlcr,.ndliy.f t)fi.Jury onc of rhc rall,'winS Jcrlr3rnnN
<br />Dc i)lnn P.rnn\ A\b.!o\ Mnificrrbn Fcdcnl RcguLarioF (Tirlc,10- P!n6)
<br />Rcqurcd Irtor.r Ndifi .rrknr
<br />-lccnifyrhd
<br />lhc lcderal rc8llr! ions rc8rdin8 asli.sol mnbvalu. nor,pplknbk ro rhis pmr..l
<br />Hxmu.*,:r.ll htlpplicaliona.d(!rc rhullhc rhorc innnn ion hcorar.I lgre ro conrdy $nh all Ciry and Counr,
<br />brnr8 n, huildin-q con(nrcrn,n. rrkl hcrcby Nrhorizc rq ol'lhh Cilyand Counry x, cnrer unon rhc
<br />llt$vc nrDriotrcd trepcny n" irspc.riotr Iurthscs.
<br />ApDliunl or AI.nl Signelur.JrlLL6 2018
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />724/c 5Dfl
<br />lnsulation/Ene rgy
<br />Q4rwall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />va/(r > b1fr
<br />Certif icate of Occu pancy
<br />Notes Remarks, Etc
<br />Forms/Steel/Holdowns
<br />Framinq
<br />FINAL
<br />I cnda'. Addrc!:
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