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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUIt,DER Df, LC RATION
<br />I h6ebr aflim undr ,6ahy of prjury rhd I dn .rnu fmm rh. Conlr,cl66' L'..nr. Lrw lor rh. lollo\vin8 rce! (S( 701 L5
<br />B6in6s and Prof6lion Code): Any City or County $hich rcqut6 a pqnit ro .oBrtucr, ahd, inpror., dr.olbh or r.l)at .n,
<br />nruddc piior ro ns issoa.cc. also Equns lh. applicet for such Fmi lo 6lc a sisncd slarsrfll lfill h. or sh. 6 licffi.d puEU.
<br />ro rh. ptuvtioc oarh. Conlrrclois Licenscd tie (Chaptd 9. ComnEn ing $nh Setbn 7000 ol Division :1 oalhe BusinN md
<br />Proa.ssions Codc) or thal hc or sh. is €x6npl thdelioh dd rhc 16! aor th. allcE.d cranplion Atry riolarion oasetion 7011.5 by any
<br />opplica lor atmr subrR-'lrrhe spol'(anr '. a.i'ilo.nrlr).ln.rrnol.rhM fi\c hu1drcddollasl$r00,
<br />&6. a. ,*,. "rrr'. p-p-rr. or my cmplo,6 *{h \aa6 d rhct el. conlp.Mrion, willdo rht \vork dlhentudu.isnor
<br />.iEn.a -.n.tr.isa].ri*.7oai.8;r,;6ddftof*idmcorlcr]lcc;.hcrd.sl.ictu.lrvdo6notarplvrouoMrofrhePllpdly "no hil& or inprovB $@n, dd who do6 ech Nlrr hi'ns.lf or h*lfor throush his or hs oM mploreB.
<br />provided rhal such inFovomb e mr iddd.d d oif6.d for slc I I no\'@, rh. hildins ot iftrFolml is sld *irhin on. ,a
<br />oicompkio[ lh. ()s'n6 lruildq will have lh! hmln of Forins lha hc o. 3h€ did ml tolld or inFovc rh. pmpdly for rhc pu{e ol
<br />I. 6 owncr ofrh prepqly- d .rclusitly contd in! $irh li.ms€d conllacto6 lo consrrud rhc pmjd (SE 7(xt. BEnd
<br />dd Porsi,. Cod.: The Conllaclois Licens€ Larv do6 trol apply h ai ow.d ofpropcnyNho builG or iftprov€s thaofl.
<br />a6d who conlncc lo such projds *ilh a C.it{t.(s)li.etrsed ptruudt lo lhe contr.ctn s License titc).
<br />I anerenrpl undcr Seclnnr
<br />Y^,.tLzt:/Zj*-,
<br />I h€.eby amrm uods F.aIy oalsjlrr onc oalhe follo$ in8 d(ldar
<br />I h.ve ud * ill nai.rain a Cenificatc of (-oBor to Seli-lBrrc lor rvorkdt .onrP.net[n, 6 provided lor by Sdtion :t7u0 o f th.
<br />LaL{r Cod€. forthcpglonnanc€olrhcworl for {hich th. panir b issued.
<br />-lhav.and\villmi
<br />ain workec coD!€nsalior insurancc. as lequftd bysstion 1700ofthe l-abor Codc, lor nE !6fonndc€ ol
<br />(h. *orl lor $ni.h lhis pcnnii is issued. Mywork6! .onD.nsatn,n insurmc. cturicr d policy nuhhd rc:
<br />Policy Nu'nb6-Eipir6:
<br />(C! ccniiyrhd in rhc lBiornmcc ollh€ vork lor \rhich rhis Froil is su.d.l shall nor enplot atry ps$n in tny mmng
<br />$ 6ro b€.omesrbjal Io lhc so*6' comp.trario. la$s of caliaomi., and ost€e lhal ifI should b.{o,n subi(t Iorhc
<br />rorkel compastion previiors ofS..lion.1700oa$€ bbor cod..l shall.fonh*ilh conrpl, rvirh rhokPmvisioos
<br />W RNING: Failur. ro su. s.rleB' co,npdsotion ovcras€ is unlaNiul, ald shall subjal an onploy{ !o ainin6l p6uli6 d
<br />.ivil tinB up b onc huodrcd rhou*nd dollrs ($lC{.000). nr addnion b rlrc cos o I c o'npensflt ion. damagd 6 plorided lo! the
<br />sdrion 1076oalhe t br codc. inlcrsr &d rrn!3 'c,-_ / <.-Y,,,",1/-v/-ltr X"*r rcixi6ionEcrhn
<br />DFCr,r& rloN \
<br />l,,.N.d Jndd nm\sion olchoirG o rc,.mmm
<br />'nE
<br />{irh sdDn'uLtroil)'\sFn J
<br />icose is in lull forc. dd .fidr
<br />I heEby alltro undn pmllty o t Fjurl that I @
<br />of lhc BBins dd Ptuasioro Cod.. and ny I
<br />L,iccosc C l6sr- L iccns€ Nudbd
<br />D.t.r Co ncloi:
<br />COAIIaIJSUIINTEIDIICICENCI
<br />I hd€by arfm und€r Enahy otporury lhd thn iracoN crion lcndins asd.y foi rh.Pefonb ..ofdENtk aor sni.h rhis pdnn is
<br />ilru.d (Ss 1097, Ci!. C.)
<br />AITI.ICANLDLCLAAAIIIIA
<br />I kry amm uodcr poahy otpdjuy on€ ofth. followin8 deltralions
<br />D6.olirion Pdmils'Asb6ros Norilicgrion Fcds,lRcsulario.s(r'ir1.40. Pan6l
<br />-R.quiren
<br />Lett6 olNorifr cdsn
<br />I .dif, rhrl th. f.dqal r.sulaliom Es{dins 6b6ros rooval {r not arplicabl. ro Ihis prordl.
<br />Iq<airr mr r run rma rrris applicarion a*j skre rhar rhe ah.v. inronmiio. is cor€c1 I asrE ro Nmply wnh all cir, and counry
<br />ordin.n.6 ed shr. ti$ Elali,u lo buildi.s coNtruclion. od h6€by ao$ori& Epr6dtdiv6 ollhis City &d Countyto al6 upon thc
<br />abovc Drnriof,ed px,trn, f(n ins
<br />(pricnnr or ,leenr slemrure
<br />1?*.r,**."rr.mo,(
<br />P{D
<br />Set Backs
<br />forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />.ELAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Itlason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL )ha//4 rtlbfl(Dot./
<br />Certificate of Occupancy '"- ttLt
<br />Notes, Remarks, Etc
<br />)
<br />(* )<a*lLZ1:lP
<br />C
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