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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNI]R ITUILDER DOI-CATATION
<br />I hdcby rllirn u.d.r p.ndry ot Nrjry rhol I m cxcnrpl Uo l1[ Contr.t8- Liccns hw l.r lhc follo$ing turi"n lsc( 7O1lr
<br />Bu\ircss JDd Pft,lc\sion Codc) Any Ciry .r C.umy whi.h rcqun$ n ncrn to orrrud. alrcr. inprcvc. dcnmlish or Rpxir rny
<br />\lruchrc, ,trb ilr i\\uri.c. il\, rcqun.s rhc ipt'li.,trr ror such lcrmir lo fikr \igicd ndcftd nrl hcot $e is licc scd N^ultrr
<br />b rh. phvisn N of rhc Conlacrois t-iccnscd bw (Charrcr 9. Comntn.nr! wir[ Scctn'n 7(D0 of Divi{iotr ] olrhc Busitc$ and
<br />Prtsion!Codc)orrh3rheor\hc Ls crcnPt rhcrcli.n d thc brn\ Lrrhc illcgc! crnun)n Any vn,hrionolsecrionToll5 bylny
<br />,rpli.! turdp$xrsuhjccrsrhc{lpLicsort'rciviltcnahyofortrktrcrhitrnv.hundrcddolhn(S50O)
<br />-1.
<br />!s o*Nr of rhr pop.ny. o. m, cmplortcs wirh wiScs as lhcn et cofrP.nqrion, sill do lhc uork ad rtr {tu1uc n nor
<br />,nrc .d or .ftcrcd fr srlc (Ss.704.1. Busircss and ProLsn,n\ Codc: Thc Cinftrclor'\ Liccnsc lis d{{1 nor {ply to on osn.r of
<br />rhc pDpcrry *lD hilds or i'nptuvcs rfuN[ ut who d@s sNh aork him\c]for hctulf .r rhmugh hh or hc. owncmpl,,yccs.
<br />providcd rhrr such i'npmwlmnlsemr irrc ql ffoliercd for sb lt ho*cki dt hiildir8 or iml,nncrEnl i\ q,ld wirhinutrr rtd
<br />of conDbrion. rti Ostur Buikld will hrvc rhc hlrdcn of provinS rhar hc o, shc did nor boiil or iqn,vc rhc pmpcny nr rh. plrlr)* of
<br />l.NowncrofrhcrniDcdy.amcxclu\ir.ly.ontrcrine*irhlicciscd.otuNnr\k,cotr{ndrhrtnojNr(Sc.7(,1-.1.ltus!.$
<br />rd lhni:$hD Codc: Th.Cotrtnctr's Lrc \c Lrw docr tr.ldt) yt, rno*mrolf'.!c yLVh. huikl(or imtrovr\ rhcrcoi.
<br />aM wlr .. flcl\Lr su.h pn+ci\wirhr An r rhin ldrs.d,rur\uinr rolhcO)ntr.kn \l-icci\c l-twJ
<br />I n,rrc rpr 0trd.i Sr.rio
<br />q 1l/212t48-"""..1
<br />D1'CLA,IIAII!)!
<br />I h.rcby afi n u .r Ntrrlryol t)crlui,otrcolrtu n,llo*ing dr.llrrri('n\:
<br />IhataidtrillntrntrrrCcdiltrrcol'Coo\cnrbScllrtxurcfttrtrorkcra.orpcDs$ion.r\PmvidcJntrhySrtri( lr(x)olrhc
<br />l-rtxtr Codc. forrhc p.rf.rnrnr!ofrhc sorr hr whichlhc runnlr n isuc.l
<br />,l harca.d will nEn rin work.^ ..mr.nsrri( nrsutrtrcc..\ rcqutcd I'ySccrnn,:l7m.rrh. tihorCodc. ftrrhc Frrnan!rccof
<br />rhc *ork lhr whict rfii! I)crmir is i\sucrl. My wodcr s' LnnD.trsol ion irluronc.caricr ttrkllolicynumt r ue:
<br />IAISIBIJCUANIINIIIN!;rLQIIN(}
<br />I hcrchy affinnukl.r |t rhy of F-^rjury lhtrr rhcrc i\ r consrtucri,i ktrdin8 rfcNy lm rhe PctlirrnBncc ofrlf, sork i{ \'hich rhi\ pcnnir is
<br />issucd lSc..:109?. Civ. C )
<br />ktrdcr's Nrrcr
<br />-
<br />-l
<br />ccdilyrh, th. r.dcrul rcgulsrions rcs{dins ashcnos rcnn,vslr..or aPPlicabls to lhh proirt.
<br />-l
<br />.cnify rhar I hoE reld rhh atpliarbn and ntu lhal th. atDvc inhrrorn,n n c.dccr L8rB ro onrPly *ilh all Cny ,nd counrv
<br />oldinBnces ond Sllrc Llus El,rin! robuilditrBconslDction. ard hqlchyJurhoriz!Rtrc{nr,!Nc!orrhnC ysnd Cuun(yrocnrquronrtE
<br />rh.vc mnr..n.d pmFn) ld in\ncc,'n!pq,r\ t t
<br />App,i.m,orAE€nrs,Erururc I\ \./LBL--- *,. '! \NE
<br />Psmlle. ,trfre ( pnnl):
<br />-
<br />-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino I *d/"/rvun*-tn/
<br />Shear Wall (
<br />Framinq
<br />lnsulation/Energy
<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 />Enoineer Final Report
<br />Flood Zone Certif .
<br />FINAL //fllr z 'a//z*,/t-
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />DATE
<br />l..niry rhar h rhc p.rfoflmncc olrtE wo,k ior whth rhi\ pcmir ir irsucd. I shrll nor cnfloy any rcNotr in any maoner
<br />h as ro tf,sm sunj.sl l. lhe workds .on{4nsarion lnss ofcllifomia. and x8m hrr irI should bccom suhjecr io rF.
<br />$ortcn conucnsrion pmvtn,ns.fs.dnm 3700 ofrhc tibo. Conc.l shal!.lddhsirh comFly wirhlho$ pmvi\ions.
<br />WARNING: Frilurc ro surc workcis comr.n\arion coreagc ii utrhwtul. and $ell rubrccr nn cDlnoFr ro dini.al Fnhis and
<br />civil fitrcs up lo onc hundred rhouMnd dolldi (Slm,om), In JJd Fn h rh. Ln{ ol carlrcn.Jrtrnr. dd'rugcs rr nR,vid.d for rb.
<br />s.rrntr ru,6orthc titrr Cndc. 'n,c'.q rid r ntry'. h\\ - ----\ il,,,. r1 i,l 7 I >d18 *,13["rr.^k5!&L--l
<br />I hcrcby lInrm !nd* p.nnhy o r Pcrjurr lhar I a'n lien{n undcr poltion orch,Prs 9 icoarnEncina wirh sccrkrn 700ri 'rl)lvi\nr l
<br />oi rhc Busitssund PFrcs\n n.codc, on nry liccnsc h in lirll fora 3Jd clfd'.
<br />Li.cnsc Cl.s:-Li.cnsc Numbcr:
<br />-
<br />Conlnrlor
<br />AITUCANLDICI.dAAUON
<br />I lrrctry ollim udcr pcnalry ot n dury oR of rhc lolhwin8 decl.rd ions
<br />Dc.nlirrn P.nnih-Asbcsros NolificBlion Fc.leDl Rcguhrions (Tkl. 40, Pln6)
<br />-R.quncd
<br />kricr of Noritc2lion
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