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BUILDING. INSPECTOR RECOBD
<br />SITE.WOHK DATE ID/SIG.COMMENTS oWNER tII]II,DER DI]I,CARATION
<br />I hcrchy,lltD u cr prmlry olFrruryrlu I dn cxctrU fnnn rh. CDnr (trr Ltctrs hs ior lhc lnllowire rcAsotr lSLr7r):ll5
<br />lJusircs aftl Profcssion Codc): Any Cily or Counly which rcqutc\ 0 ncnnir t,, con(rucr. rk5, i'np'orc. cnn,lish or rcPrn dny
<br />{rucrur.. nri$ io i6 tsdatuc, rlso rdquncs rhc rrplirinr for sdch Fnnir t) lil.d si8trL{ {drcnrnr rhir h.orshc i! liccnscd pu^trrnl
<br />h lhc provnions oi rhe Conllrcloil l-iccnsd l-a+ lcnrptcr q- Commncins *ilh Sccrl.n 7000 oi Divnion .l oi rhr Bu\inc$ lnd
<br />Prof.s(n,ns Gdc) orriar hcorshc iscxcnfl rhentonand rhc basn fffrhc allcscd cicnDrion An, vi',hrn,norsccri.i 70.115 by rny
<br />tplicrnrf(trrlcnnir\rbjcchrhcapllica t,aci!,lpcnalryolnortu)rcrhrnfivchxndrcddollnr\lS5(X))
<br />-1.
<br />ar owrEr ol rhc popcny- or my cDpk'yccs * irh wtr3cs 6 rhct nnc conll.n\rrn'n, will do rh. soA ind lhc rrtrrurc i! nol
<br />dcndcd oiollcicd forslc(Ss 7041. Busircss !trd Profcssi,)nsCd. lhc Contrmtn\ Liccnsc bw des mt lplly lo an ou rcr .l
<br />rhcF)p.d, sho buildr ui irlruEs rhcrc.n. trnd wi(' d*\ (kh woik hnnscllor h.rrcltor rhrcueh hn or hcr owtr cmpl.yccs,
<br />p,ovidcd rhll {ch i provcmnrs arc ml inlcndcn oi oficrcd rhr $lc. ll howevc!. llE ttritliry or iqrotnrnr is mll sirhin om ,!d
<br />olcoiDlcrion. rtEOwnq Buill].r *illMr! rhc hurdcn ol prolnE lh.r h{ or shc did nor hild or in,F)vc rh. rtuFny r.r rtr puqb$ or
<br />I.a\oqD*ofrh.l,ot rly.r cxclusivcly.oftnrirU*[hli.ci\cdconrrrr.rshon\rrucrrhcprn]:d(Scc7(!i.Bu\i,'c\
<br />rnd lh'fssnnC.d.-IhcContrtn\l-icclrcl-!wdocsnorapplyhrnorncrofprt,r. y sho brilds or improt$ rh.ic.n.
<br />.otrr.J.rsfdsuch pmrc.ls wirhaC. nkron!)li.cnscd lursu.r rorlrCir rrcktr's Licensc LNI
<br />-o n
<br />DECLABAIII}N
<br />I hcrchyrfllr undor ncn.lrl ofrcriuryotrc ofrh.lilhNnl! d..lurri.rs:
<br />I hrvcnkl srlltrui ifl.ccniicnrcolCotrsctrrtrSclf-ln\urciorworkcn'conpcnsurio..r tmvidedlorbySccrt,n]?0Oofrhcljtrn G e. ftn rhc p$ln'tunt .r rh. work ltrwhichrhc ncnniri\ n\!Ld
<br />-l h.vc.nd willmrinlrin workcB compcnsarion in{mNc. ar r!'quicd hyS.crion.l?(X)ofrne l-ahorCodc. tur rhc ,.iirmrtrt or
<br />lhc wo turshi.hrht pcmir is hsu.{ My sork.6 nnnFnsarion io\urancc crri.r ud p.licynumh.r e.l
<br />P.licyNum$cr------Elpnc\
<br />I ccnify rhar in rhc pcrfonnrn.c ofrhc aoik f{x whi.h dlis r.rmir is hsucrl. I \hrll nor cmtloy nny pcnon in any manicr
<br />v, s
<br />'o
<br />hconrrc subjd lo lhc *ortc.s' .onpcn\ll io! lass ol Califimir- 0nd rsN I h,r ir I qh,old b.to r suhlcd ro rh.
<br />sorter! compcn\rlionpovi\n,n!olSNrn,n.l7(Xl.frhclf,txtrC{nlc.lshrll.n,nhwirh.oitlywirhrho*!rovisions
<br />lV laNlNc: F lurc ro kcurc *or*cn comnctr ro. covcrilc k unl.sfur. lnd lhrll (uhicr an cmploycr ro aihinrl frMhics Md
<br />civil tincs up I. otrc hund,cd lhousand dollm (Sloo.Otx,). in 0ddirion r. rhc cod orconrFnB'ion- damalcr rs proviicd ror rhc
<br />a
<br />Sccnon Jt,76!frh. titDr CoJc. inrcrc{anrl rorrcv s les"".:,- it-; i: 6: ^*-":" il/t2rr^ c r'o l/ t(.-,
<br />LI( ENSf I) C('(TRACT(IR
<br />IIECI,AAAIION
<br />I hcrby aifiirnundcr lcnillyofpcr)ury rhar I0m liccnsn undcr Fovhion ofChuflcr I (.otmking wnh sdir. Tootl) olDivisi l
<br />or Ihc Busimcs aM Pblcssions Codc. dt my liccnsc is h lull loEc ad cflc(l
<br />Co Eclor:
<br />laNSIf,IJCIlON.LlilIIlG.tr{iEN(I
<br />I hcrcby alltm undcr pcnallyotrcrjlrr rhnr rh.rc n a.onnndk'n h.dins U.fty ru thc |).rformMcc oirhc wo.k rhr *hich rhi\ p.rnir i\
<br />issucd(se :1097. civ. c.)
<br />A.IIUIAIiLDECI,ABAIIAN
<br />I lrrbtaltlnhuM$ pcn hyof F-rjuryonc ollhc lollow,ngdc.hariotr\:
<br />lr:molilion Pcnnils Alhcslos Norifi.l ioi F.dctxlRcs!lurtrns ('lilb10.I'rd6r
<br />-RL\tukcd
<br />t lrs oiNoliric ion
<br />I ccnilyrhrr rh. lcJcrdl r.8ula..trs rcgrdinE Nhs.s rcniovrlr'c n.l ipFlic$lc ro rhi\ Ir+cr
<br />_lccrriiyrhllIhMrudrhi\rppliclrn,nx'rlnrr.rhrrrhc!h'vcinrorm i,nr i\cotu.r IagrLrro.onlrlywirh0llCilyrndG)unry
<br />ordimnccs ond Shrc trws rUrins ro huildins coosrrucrn'n- snd t{rc}'ydrhorna nJ,r'cnrarikr orrhis cily,nd Counrylo cnrcr uPonrh.
<br />,6ov. nrdnincd l,(,lxny ror iiNtNrn'.,
<br />,\l,t,lir trtor \srnl Sirn hru c
<br />E
<br />Z>
<br />Ct-a
<br />*ab.'P€'/8'
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsu latio n/E ne rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Ceflif .
<br />. .. /-\'
<br />FINAL -i -tK-tK X JV+)U
<br />Certificate of Occupancy tJ v
<br />Notes, Remarks, Etc.
<br />L './10
<br />tf,ndca. NonF
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