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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS oWNI]R BUILDI]R DEI-CARAIIoN
<br />I hcrhy lffirm undcr pcnllty of perju'y rhrr I on crcnlnr irom rh. C,'ntrcntre l-t.nr ltrw f6' rhd lnlbwjnS 6Nrn rS( 70:ll 5
<br />ausir.ss rnd Piorcsion Codc)r Ant Ciry or Couflty ehi.h rcquir.s r Nanir ro ..nsrrucl, oltci imnlovc. dcmolirh or Eplt any
<br />sruclurc. prior h ns nnrincc.ols requnc\ rhc ot'Iliinnl for su.n Frmil lo fih a sirred (arcrmnr rhar ltor shr ii li(nk{ Putsudr
<br />r. rll.jr,vkioh! oarh. Coit0c(x\ Li..n$d taw lchaprfi 9. Comm.n.inA wirh Sc.lio. r00O ol Divilnrn 3 ofrhc 3u\idcs\ Dnd
<br />Pmicssions Cod.) or rhat hcorshe ncxcmpl rhcrcironond rhchash lor rhc olLscd cxcnflion Anyvn rrion or seri,r ?0:l l 5 ht trny
<br />!pplicrtrlior tr pc,nil suhJccclhc aprlicanrlo0ci!ilpcnollyoiholnnclhrnfirchuidrc!d.lhr(19500)
<br />-l.
<br />rsoqncroirhc pm|xny.0mcxclNivclyconraclins qnh licctrscdco rrcb6 ro con(rucr rhc pnriccr(se.7I}14. Eunne$
<br />n l"nfssi)nCodc: Thc Conrrackr'\ I-ic.nsc tj$ docs nor aplly ro an osncr ol fopcn, *ho huilds or mpruvcs lhcrcfln.
<br />rod who ..irtu Brorruch frcjcch*ithi(tr ncu(s) liatr$i pu^u.nr h, th. Conl.{crois Licctr{ l-rw)
<br />l. rcxcnr unddsNrnn .a &P( forr[hrcijotr
<br />lrxle ()rner
<br />rvoRKafstoM PNs,{r x )N
<br />I)ICIAAAIIQN
<br />I hcrehy rll_rnn undcr penrlry ol Frjur, onc of rh. folbwing dcclarurions
<br />-l
<br />hulc xl$ill EinrrinaCcnincrrcofcotr*lrx,Scllltr$rcli'rworkc'fc.nrcnsdion.$ providcdtubyScclio!37(r)olrhc
<br />trbor Codc, 6r rhc pcrfonwc ol rhc uork for shi.h nE Fnnir is isq'cd
<br />I hrr {trd $illm{inhin workcrr con|{tr$rior itrsrancc. $ rcquncd hySftrn,n:l7lx).frh. blnt Codc. liir rhe p.rfornunccof
<br />,t
<br />frr r insurlnft cmif .nd rolicy numbcr @
<br />\i a
<br />u,,,,.,*,,,,,,,", $$;-9V99!X{I@19 t
<br />_l ccniay rhar nr ihc perforotr.. olrhc work fr whi.h rht Fnnir is rsuci. I shrll nol cmFloy rny pcrv,n in lny man'.r
<br />s N to h.o f, suhr..r fu rhc wo*cs conrrcn{r r io. li ws orcalifornir. otrd osN rhar ifI \h.uld ttcom iuhjtcr h rh.
<br />qoIkcn' .otrr|ctr$rion provnions of Sccr ion 37(xr oi rhc titnr Codc. I snlll. ion h*irh mrply wirh rl*,$ tovisn'.s.
<br />WARNING: Frilurc b qur. wmkcN'.on{.ns i.n.ovcrrgc is unl.wtul.0nd shlll suhjNr an c'lplo}tr tu ciminrl Fn ras rtrd
<br />civil ircs utr ro otr. hundrcn rnousand nollan (SIOo.(Do). itr 0ddirnn, io rhc co{ orco
<br />sccrion 1076 nlrhc Ghor aL'.lr nrr!.n Jn(Lrrr c\'\ li!\
<br />2018.,,,,,,.,'"dlJil 11 Il(rflrD_(Dt&lllaB
<br />DECjJBAfII]N
<br />I hcrcby alit'n u cr pcnulty oI pcrju,y that I ao liccn{i utrdd lmvision or Chrprs 9 (.onrmn.,ng wirh Sstiotr ?0(()) of Dilision l
<br />of rhc Bnsirs a.d Pofc$iohs Codc. {M my liccnk n in tull lirm ond ctlccr.
<br />G tt,o?l%1
<br />.JUN n illmr
<br />-!. / contmcn'r W,Lq:tq.
<br />CANiIBIJI:IIANII,NDING.AGENCI
<br />I hcrchyafiiflnu cr !.nity.tpcrjurylhar lhcrc h a $n(ruclioi kndins lgcn.y lbr rh. pcfornrncc ollhc sort ror *hi.h rhis rdmir i\
<br />tru.d (Sdc :1097. Ci! C )
<br />ITIUCANIDECI.AAAUJ}N
<br />I hcdry alimr uadcr lcnall, of I,crrlry oft of rhc followins delurr ioBl
<br />Dcmlition Pcrmic-AstEslos Nolificalion Fcncral Rcs!,ariotrs (Tnb 40. Pd6)
<br />-Rcquircd
<br />Lcllcr of Norilrcalion
<br />I ccnily rhar rh. f.ncral rcglllr ions rc8edin8 ashcslos rcnmval orc mr apdicabk ro rnk phj.{'
<br />.t2fdify rh,r t tuvc rcad lhis !,rplic.rk n od srlre rhar rhc abovc infomrnD Lr co6cc. LCre lo .onDly wilh sll c , lnd Colnty
<br />onl rrncc\.nd st.lc tlws rlnritrr ro huildirs co
<br />;@tn .r/ &?r\'
<br />.frhis Ciry dnd Cotrrtyn' cnlc! upon rhc
<br />,",.,.jtl!N I f ?n.n
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathing
<br />F raming b/ f?./,'s 3\6-6
<br />lnsulationi Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />l\ilasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil
<br />FINAL 7lzlt 5,>a6
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />I. ns ownr ol rhc tiolf,ny. nr my cnrfl.yccs wrh wrgcs !s rhcir src .oD[cnsnrion. will&,lhc r.rk nl rhc (duc h nor
<br />irrcndcri o!o,fcEd i.r slc lse 7014. Blsinc$ onn Profcsions Conc:Ihc Conrrrk, i Li.cnsc Law docs n.r q)nly to rtr o$ncrol
<br />rhc pm!.dy wh) hxilds.r irr{,rovcs rh.Nn, oxl qh.d*s!u.h*or*hinrsclforhcrcliorrhmuehht or hcr oen cmpk,y.cs.
<br />,n,vidcd rhrr such i'npmvc'tunt d nor i'rc.d.{l or ollcrcd li,r \rb ll ho*ckr. rh. 6rikli'E or inlro!.,m[ h s.U withn .nc )cnr
<br />oi con{,htiotr. lhc Owrcr suiklcr qill hN ltE hurdcn ol pnvitrE rhor }rorrhcdil mr Lild or iqto\r rhc pbp.n, n rh pu{$$ol
<br />I rnJ.''. AJd'c$
<br />rhir. nrDrnnr.,l tn)t--nv fitr irtrloi
<br />Applic. orAa€nlSiguluB
<br />Prmile nrm. (prinl )l
<br />Erection Pads
<br />Shear Wall
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