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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE COMMENTS OWNER BUILDER DEI,CAlr^Tl()N
<br />I hc6hy rrfirni undcr pcn,lry of p.rjury rhrr Ln cicmpr ircm rhc Conrnclon Liensc trs lor rhc iollowinA rclbn ( Slr ?0:1 1.5
<br />lrusincs nd Proltsion Codc,: Any Cny .r C.unr! which rcqunc\ a Fmir i, .r.ndcr. trhcr. iry)ro!., dotulnh .r tol3n uny
<br />{tucrxrc, nrio. lo ils hsumre. ako rcquncs rhc al)nlic.nr for Nu.h ,).flnir h filc . siSncd edc.trnr rhrr h. or shc ii li.cnscd puisurl
<br />h rhc trcvisiotrs oi rhc Cbdmctols Liccnscd tiw (Chlpr.r 9. Cohtun.ing qirh Serioo 7O(X) oi Diliion.l.frhc Brrin.s ond
<br />Pmrc\rn,n: Codc) or thsr hc or \he i\ crcnlti rhcrclrom,nd rhc blsis lor rhc lllc8cd cxcmptn,n. Ary viol0iionofScclhn?0115 by lny
<br />apnlicanlrb.apcrnrirsubjirsth.trp!lic{nrtor.ivilpcndliyofnormoErhanrie.hunitrcddoll$lS5(x))
<br />l. ns o*ncr oi rhc popcny. or my cnployes wiri wascs rs thct slc .onD.nsrion. will do thc "oi( uxl rtf, stnrrurc is mr
<br />idcnd.d or oftcrcd f(r slc (Sd 7lxi. Bxsincs nnd Pmfcxio!\ Codc'lhc Conkacttr s l-iccnsc ti$ doe\ nor +pl, t, tri owncr of
<br />th. tmpcny {ln tuilds or iryr)ve\ ltE on. lnd qtF dtrs su.h w)d( hinsclfor hcsclror lhtuuBh his or hcr osn.nploycci
<br />providc<l rhjr such npmlcnEnh m mr iincndcd .r ollcrul forsk ltl ho$c\{i rhc hiliing or tnprorcm nso within,,nctur
<br />ol'.orq1hri.n. thc Own$ Buib.r willhivc rh( hrdcn ofloving rhd lr o, shr did mr hikl or itrqroE nE pmpcny aor rlE purlncof
<br />-l.
<br />r\.strdol'rhc Pn)txny. a .x.lu\trcl!.ontrcring tr h licctr\.d c.ntrkE !) ronntu.r rhc pnrccr is.( 7{ll.l, Bu!h.s\
<br />rtrd Pn,ftsbnCixt lhcContactr's l,iccf\.1,r$ dr.s trorrJrDlyro rtroqNr 01ltropcnywho builds or imrrcrs rhcrcon.
<br />rn wh. ..ntNhfd $rhfmlNnwihrCnrtu.ktrr\) liccnwl punurnr ri,rtuC.fia.tr\ l-iccnsc lf,qr
<br />-l
<br />uDcrcnu u cr Scctn,
<br />UI]AtrE&IIOIIIIIIAIION
<br />DECI,I36I]ON
<br />I hcr.l,y.fi nn und$ Fn,lr, of |)crjuryonc of rhc rolkrerrs dcclrarn,n\
<br />-l
<br />hrvc dd w'llnai'[r n Ccnil].nrc nf Cotrrni k) Scll lNrc tur *orkcB .onlcns rion. rs prvidcJ tnr 6y S(r i{,n :l?(X) ol rhc
<br />L$or Qxlc. a.r rh. I.rfonnM.c ofrh. work rnr shich rhc p.n.ir i\ is\ucd
<br />_lh.vc ond willmrinl0in workcn co"rtcnsrlion nNunmc. N r.qur.d iyscflion rT ) or lhc tjhor codc, lor lhc Nrioirruncc of
<br />'1...!.rlr.'\1 .h'h.\r,.1tr r \ \,r.J \l\s 1li '.US Free Tosrranc-(
<br />(
<br />I.cdify rhrr i. rlr Ilcrformric. ofrh. $ork f{r which rhis pcmir ir is{cd. I shrll nor cnploy !n, pcrson in rn, nruncr
<br />s, 6 to hccom suhr.r hr rhc qorkcs' .nnwnsri i.n hws of Crlifornia. rid 4nc rhd if I \hould kr..r subt$r h rh-
<br />sorkcrs,.orpctrs!ri(,.l,ovi\iotrrolSc.ridrl7mofrhcIjhrC, c.Islr'll,n hw (h ..nrply s irh ltk,{ ptu!i\nrnr
<br />IVARNINC: Ililurc to $ure worlcr $mpctrsrtiotr cokntc is nrll \uhlr.r x c rdoycr r) .rrnrhl |inlrc( ind
<br />civil ljnci up tu onc htrndr.d Ih.ustrtrd dollrn ($1(x).0ff)). in .o{ of.onrt).nsdion, d.mtcs ar pri,vidud fff Ih.
<br />Codc. i crcslntri rrlortruy \ tcc\
<br />,r", I )
<br />I hcrchyaififln uM.r r.n,hroIt'erj0ryrhd I m lftnkd nndd pi(,!i\nJn olgnrtty 91..'nmn.ing *hh s..ti 7000)ofr)nrion I
<br />or rhc Bu\irc* md Pof6\ion\ Code. ud m, liccn\c n in ftll fore ud ctf(r
<br />DO
<br />CANEIBI]IIIAII.DNDINTi.ACENCI,
<br />I hcrcby (lltmuMcr Fnahrol!.rjuryrhal rlrE h a.otrnncrk,n bndinS nscmy lor rhc pnlorrorEc of'hc wort lor whthlhn lcrmir h
<br />hsucd (Sc.. 1097, Civ C.)
<br />AIIUIANfDEILASAIION
<br />I hdrb! tiqnuftlrr pcnrhy orpfjury om orrh. r(,lbwins dKlrlrion\.
<br />D.rmlirion P.rhn. Asb.n.{ Norin.n(ion Fcdcrrl RcEulnri,,nsl'lirlc4). Pan6)
<br />-Rcqnircd
<br />txxs of Notifrcari.n
<br />-l.cnifyrhur
<br />llrfcdcrolrcsulalions rq{rdirs nshc(o\ rcN,vrl lrc tro' r!!li.a61c r. rhis prcjccl
<br />i.cn'ryrhnl l l \c rcrd r[n n!t)t.rr
<br />trl' k.\rtri s!r.Iru\rl,!ri'f r.hnl
<br />nI.rl r(hcrh\c nr,{nLtr(n,nr.n..r IxlRrt,c.n,flr sirh rll(,r}rid (-(tu j
<br />rDlhori/r roprr\ctr1rriv.\ ofrhn ( iry
<br />xlo\o tr{nrnril tr,tf,ay ,1, i,,;;1";[d'-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenVlnsulation
<br />Rool Sheathinq
<br />Framinq
<br />lnsulation/Ene rgy
<br />D rywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />I\/ ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL 6-<-ls J).161 2(Fi)
<br />Certilicate of Occu pancy
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Shear Wall
<br />n,,.r".,*, ' 4,'\6? 11 2 5 t3 ,,,,,,,".
<br />tlv
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