|
BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Sel Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Roof Sheathinq
<br />Shear Wall ^\Framinq 7"lz-ls y.v.n0
<br />lnsu lation/Energy
<br />Drywall 7'tz-19
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar /.-r\
<br />Handicap Req Vlz-l(vw6)
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL 7-20 -t{!.\+1'J)
<br />Certificate of Occu ncy
<br />llotgs, Rqmarks, Etc.
<br />tLo *r 'a4 o
<br />lLi/^-ll rrrb
<br />vba-A"J
<br />D44)
<br />//2r'/4/./- A') n@V
<br />OWNER BI'II,DF,R DEI-CARATII)N
<br />lhcEhy ar'lnm undcr |)cmlry olpcriMy lnrr I fln cxcny lNnr thc coffncror'Liccnsc L{* n)r rhc nnk,wirr rclvD (Scc703r 5
<br />llu\inc\\ ul Pnfcssn,n (-r c) An! Ciry or Counry which rcqrtcs ! pcnnii k' connn,.r- rlicr- iDpnrt. dcn,lirh .r ol)an niy
<br />{ .rurc, pritr t, ir\ i\{iaicc, nl\. r.qrt r rhc llrl(nnr fltr such lf,rn,irh filc. \iencd sdcNnt rhar h.or shc n liccrscd Nnu.nr a
<br />lo lhc Fori\n,ns olltE Conlmclols l-iccned Llw (Chrprcr 9. Comnictrcirs *ilh Sccrion 7(r)O ol Division.l or rhc Bu\in.r\ rnd
<br />Pn,rcs\iqrCodc) orthar hror\hc n.rcmpr rhcrctiomand nE h,sn tu rhc lllcscd .rcrflt,n nr!i{nrri(,norSc.r n 70.rl 5 hy iny 'rfflrrtrlfd,rcnnirsuhjc.hrhcrDtlt.rrlt, civillcmlryor.rnxrcrhnnfivchundrcdd.llus($500)
<br />-l,
<br />r\ o*mr ol lhc pmpcrlr- {n nrycnpk'rccs $irh ea8c\ ns lhcir v,lc cotrrrunsari,id, silldo rh. qork md rlf, {Mtrrto i. ,Fr
<br />i' ci.lc.l oroflarod f{n elc (S( 70,1.{. Busi',cs\an,t l)roac\\i,nr Cod.'Ih. CoDk(ntr \ l-i.dnsc l-rwdocs norxpflyloanowncrof
<br />rlr no,rdy sho hlild\ or i'rtlln,vc. rh.rstr. .*t whu ddr such kl* hnnsclfor h.r\clforrhmu8h hNor lrcr owtr cnrloyccs-
<br />lrovidcd rhrr such imluomnr\ m nor inrcnlcd or o[.r.d ilr \rlc li howcrcr- ihc huilding or i'nprorcmnr is sold wirhin,,nc )rJr
<br />orconlnlction.rhcOwncrBuildcrwillhlrrrh.hunknotnn, tErhr ilcnrnicJid mrhoiu or i'npiorc rhctn'Fny i(r rhc NrIi){ ol
<br />-1.
<br />nsoarorofrh- !n{.nj-. r rcx.lu.nllyconrNng s h licctrkd.onr d.nro.on(rucr rhc nnjccr (Scc 701,1. Burrcrs
<br />nnd PFfr:\hn Codq'l hc Coirracrois t-iccn\c l-r*,locs nor atl'ly ro oi owncr otpr.pny wh(, hxilds or im!tuvct rhcrcotr.
<br />rnd n! contrid\ tu su.h p()j&tswirh dCorrkrodI li.ctr{d rurumr rorhc Conrr!.ttr\ t.icc.sc ltrw)
<br />-l
<br />rcxcmrr undcr Scctiotr-. B. & P
<br />f"6tA-v l,ltl\R\ll()\
<br />I hcrchyrtlttrrnrdcrlcn hyolpcrturyorcoilhci.llowirrdcchdlon\
<br />lhrvc dsilltrtrirr dCurrifi.ar.ofcon\cdriSclllrsorcn)rsorkdr.otrrDcisiriui.!s Dknidcdl(thyScclion.lTlr0ollhc
<br />l.rhtr C.Jc.lar rhc J^-narmancc ofrhc work for which(hc p.i,nir i\ i\surd
<br />-l
<br />luvcnnd willmri rin w. cH compcns ii in\umncc. is rcqut d hyscdion:l7rx)ofuhc Llhor Ant. lnr lhc rcrr.ntu ccof
<br />llE work Io,Bnichrhi{ p.rnrir is nsucd Myworkcs coniFns.linn inrumnccctrtricr ad lolicy ou',6cr {c:
<br />,..,- €I 1rrcupe
<br />"".*, l4/<I \2tA1f .{t/17
<br />l.cnifyrhd i'r rhc p.rfoi,Jtri..ol rltr w.rk f.r qhi.hrhis!.nnir is ssu.d.I slrllnor cDployony!.rson in rtrymanm'
<br />s Nro hco'E $hJc.l lo rhc rorkcr' comncn\ nrn hwsofColiforni!- ind rsrcc rhri ifl \hould hc.om suhjccr k,rh.
<br />works comFo\ar bn povnbn\ ot SNt io! lTllo ol rhc l itxtr C{ .. 1 \hrll. fodhs nh co Dly e irh rlrJr m'risnrr.
<br />WARNINC Frilure h *rurc mrkcB' conrFnqtrion covcrr8c is unkrwful. md shlll \trlrj..r !n empk'ycr i. simi'il,l.tuhics rtul
<br />civll rlncs un lo onc hundrcd lhousand dollon ($l(){).0(x)). in.ddirion ro rhc cosr ofcon,r.n\Iion, danblcs as phridcd rd rhc
<br />s..rhn lo7a, olih.lahr aftl. lnrcrc(lndn.r
<br />L-/4- lW no,,,-",
<br />lr!(!.!3.!.tul
<br />I h.rchy ,lfirn u idcr Fnrlry of r.rJury rhrr I am lr.rD{n uM$ flovision ofChqrrcr 9 (coanNncir8 wirh Scclion ?0m) ol l)ivilion:l
<br />ol rhc Busircs snd l'Dfessi(ins Codc. nnd nrt liccn\c ir in tullfi,cc mdcffdcr
<br />@{
<br />.6-t't-t 6
<br />I hcrcby lllirm undcr p..alrt.lr.rjrrylhar rhcrc isIcotreru.rbtr kndir8 .Bc,Ey lor rhc pcrri,nBmc ofrh.w. r(rwhi.hrhisfd ir k
<br />nsucd (Sc. -1017, Civ C )
<br />APPLICANT DECLARAT('N
<br />I lri.by dim u idd Nnrlry.fl$jury onc of rhc folk)winB dc.hraliotrs:
<br />Dcrnolirion Pcrnrih Asli.nos Norificrrion Fcdcnl RcAuhn $ (Tirlc40. Prn6r
<br />-R.{trtcd
<br />l.(cr., Norifi crri,i
<br />I r.nifydtu rh. fr&rrl rlrhril)trs eSnilirg i$c{oi rrtrr,ulrrc ndl|lPplicr},lu t' rhi\ pfttrr
<br />-lccnilylhdIhivcrcodrhisanplicrlionudnrlclhslrhertrrvcintff'ndiii{com.r
<br />IrgrE1o.onDlywirfiallCilyan{lCou y
<br />ordinrncc\ and Slarc Lr*s rclarins ro huillins .ondrucrion- a.d h.rcbyaurh.riz. rcE.sctrr,tivcs of'hn Cny lnd Countr ro cnrcr rton rtr
<br />* 6-.14-rE
<br />gfilg/ifi,1
<br />Subf loor/VenVl nsulation
<br />fn' l'-/
<br />'WC N
<br />L4/0- I
<br />,.,""r."a,^, D
<br />I.I'J,'\ AJJ'r*
<br />nhn\c r.ri.rcd t)n'N,ry{d
|