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BUILDING- INSPECTOR RECORD
<br />COMMENTSDATEIDiSIG.SITE-WORK
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulalion
<br />tlRoof Sheathin
<br />Framin
<br />lnsulation/Ene
<br />allD
<br />Ext./lnl. Lath
<br />Brown Coat
<br />N/asonr
<br />Pool Fence
<br />T-Bar
<br />Handica R
<br />Final ReDeU rt
<br />En ineer Final Re ort
<br />Flood Zone Certif .
<br />FINAL
<br />Certiticate ol Occu nc
<br />Notes Remarks EtC
<br />o1\Nl)l tr Ir.l)l:R lrll.( \R,\l'
<br />I hcrcby umrm trndcr ledlry ol Pcrjury rh l anr excmpr fiom rhc C'nrractos Lkcnsc ljs for rhc followi'8 tca$n (Sa?0ll5
<br />Busi"c$ and Proicssi;n Corlc) Any Ciry or Coumv which rcqutcs 0 Frnil ro co!{tu't llls inPrcvc- dcmlish or nyan anv
<br />srocrrrc, rhrro nr hsuamc. ako rcquircs rhc +llicanr lor \tch |]crmn ro nba sisn'd sitlcmnr rh'l hcorsh' $ lrccnsd Dus rr
<br />ro lhc 0m;nio.s oi rhc co Ecroir Lic.ned Llw lch'plcr 9- comDEmins wirh sccrion 7o0o oi Division I6r$c gusin*s tnd
<br />Pn,tu;ionsCodc)orrharhcorshciscxcmnlrh.rcrionandrh.hdsisf.rrhc'lk8cdci'n1pLon'A'vviolllionorSatio'70:ll5bvonv
<br />{tlicanr lor a p.nnn subj(k rhc arllicrnr ro icivilntMhvolll(n mrcrh'nfiv' hundr'd dollais ($5(r1)
<br />-1.
<br />!r owncr ot lhe poFny. or dy.mltolecs wirh sa8cs u\ lh'ir elc onlxnsion' will do lhc so& rd lhe sdN is n(n
<br />i,r",,ta -.n".a i"i *r 16* 7o;4. B;si;$* and pmrc*i"ns codq Tnc conrEcroi s r_iccns L.w does nor applr r. an osncr or
<br />rh.nnmflv whubu ds oomomlcs rhcmn erlPh'{ucsschw ni.$clfo!hcrcllotlhoxghhisorhdoqnemlloyccs'
<br />"'"irl i'i,, ** mnrcwmtu arc nor mkndrd .r !ffcts! for slc.Ii howcvcr llE huildi4 or in]|,rorcnrnr is v'kl v'lhinok
<br />'urI'i.",,"-ti'"". ,r" .*"ii g,iro", s ill hoE rhc hrrcn nr nrr ins rhd hc or sh. did mi hnild or im0ov' rhc lx)Fn, ror rhc ,uqb{ or
<br />-1,
<br />ds ownq oi rhc popeny. dm cxclusivcly .onracrinr wirh li.cnEd 'onto'los
<br />fu coNhrcr rrt l)nrj'rt (Sc' 7044 Bn\im(
<br />hoG..i, Co& rh" Cn".croi I l-i.c.sc L{q d.cs .or trnnl, ru otrncr rnroltcnv shn hu'ld\'r nnfnrc\lncrstr'
<br />onu $l'o onrBdqr.r$chnrcrr.N trirh ! c"ntrJrtnn'rlren\cJ Nrsusnr r'rhcCn a'n{ ' Li'n!cljsr
<br />I ncrcmpi undcr Scclion-- B & P.C. nnrhh rcasotr
<br />\t( IRKt.:Rs colIPt\sl-l'I(r\r'ljIr \R \ l'Il)N
<br />I heEby alfirm utucr penalry of,,ctju,y odc ol thc following dclmrnns
<br />Ih.rclrdwillminldnacenifi.(cofc.nxcnl|osclflnsuElorwoikgcconFnglion.srPmvnbdldbysslionlT{x).flhc
<br />Libor codc. for rhc Frfo.tu.. ol lh€ 'orl ror whichlhc Pdnir h ksucd'
<br />-l
<br />hurc rtrd will mainrain workcs conEnsaln n insurancc. at rcqut€d hv s"liotr ITLYJ ol ihc khd codc fo' lhc l)crr'rntrcc oi
<br />-irc wo.k for which rhis n rmir is hsu.d M y Norlcs .onlr.\alio' insrran'c caFict dd tblicv nutubtr $c
<br />.)* C.,v-t C\'4
<br />.irninrcolrhc sorl ftn shichll,i\ Pcnnil is h{rd.l shJ!lnor c'rrlovrnyl)clsor in'rvflEnncr
<br />n, N h hcdrB \ubiccr ro rl'i- workcn .a,mpttr\rt ion lx*\ orc-,lifnnia. Md nsrcc rhd i,l should bctoru subFr ro rh'
<br />trorld! .on\^-..\xrirr tnNAi(tn\.1 S.crnnr :17(x)otrh. tjbor Codc. I shall- fonh*irh comPly snh lhr* ,mvhno\
<br />W RNINGT I' lurc n, {.urc sorlcn .uDrp!tr\rr i, (vcnE h unla*i,|. d rhlll sxbj.cl un cmpk
<br />on hufldrcd rhou\nnd d.llar\ (SlU).lxx)r. in Mttirion n) rhc cod of 'onIEnsrr()
<br />Sc.r(nr 1076.frlt Lrtr,Codc. o.{ rtrJ I -.\"
<br />1 Fb*
<br />ol rhc Bu\i'$s0nd t,rofc\si.rN Cotlc. rkl trrv l.ci\c '\ ir lull6rcc 4rdrlli'r
<br />-j c4
<br />CONIIf,!]CIIONIINDINI;.AGDNII
<br />I hceby naftrm und.r FMlry or p,ju'y rt or rtr"iiiii;.riiiilnaia a"mv 16' rhc ,crfo@ncc or rh' work ror shth this l.flnn ir
<br />(sucd lsN. lsr7, CiY C )
<br />Ixndcr's Naml
<br />APPLI(:ANT DECI ARATION
<br />I hq.by.nlmrurdd pctrolry orlcriury onc of rhc follo{ioB thxrio'\l
<br />Dcnx'lirion Pcrnirs A\bcstos Norific.iion Fedrhl R{ulurt,ns (Tiilc4{ Pd 6)
<br />Rcauncd l,ctrct ol Nolifrari.n
<br />-l
<br />cc.lilyrhlr $c lcilcnl dgulalioni rcgardirS ashcsosnmval uc nol ip hablc ro rhi\ t'rojcct
<br />k)o lnlr_*irh ill CirY dnil CounrY
<br />,f rri\ Ciryand Coutrrl ro cDtcr uE rlr
<br />-l.cn
<br />yrh{ lhJ\c'urrhN"0n'trrFnrnJL rrhIrn'r}r'\r'rrr'"tr"nN\'r(r lotrcc
<br />";,.-*;d skk I r*. rc|",,.Ji. t'urttirg.,nrruoi"" Jil h.rchvrurrn'/' Icrr'{'rrJri\L''
<br />;;; :- :ilil:.1"^" ""' zz#, rc LPem,EMme(Dri ,: r Lal@pl ^"1?rltE-
<br />Erection Pads
<br />Shear Wall
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