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BUILDING- INSPECTOR RECORD
<br />OWNDN BUILDER DET,CARATION
<br />I hcrcn, {innr undcr Fmlry ()l pcrjrry rhar I m cr.nrpr rod rhe Cofia.t)F Li.ctr{ bw for rh. follo$irs rc.striscc 70ll
<br />Businc$ {nd Prola$i.n Codc) Any Ciry or County whth rcluncs a pcirnil lo conrlrucr- alr(. impror., ddm,lhh or Enln rny
<br />srncrurc.,rhr Io ns hsunncc. lho rcqutcs rhc $plicanr ror such permir ro lilca \igncd i,'.m.r rhar hior $c i( liccnscd lurs.nl
<br />to Ihc pmvkio s of rhc Cotrlro.kn s Li.cnscd Liw (Chrptcr 9- Connncrcir8 wiln Sccrn,n 7(xl0 of Diviqion :l .fthc Btrsi|cs 0trd
<br />Irof.sri{nrs Gdc) orrisr Lor\hc k.r.rpr rhcrfromaid rlrhssi\ fir rhc rll.gcd cxcnrrri( Anyvi.larionolS(lk'n70.ll5hrnny
<br />ttpli.anr ror a ,'.nnir subjdh rhc aFllicrnr to r civil ,rn0lry or nor mrdh nvc hhdrcd dolhs ( $5m)
<br />-l-
<br />as olrcr of rhc pop€ny. (tr my cmpk rccs sith wasc\ as rhcir $lc .oirFo\d n,n. will do rtr work rxl Itu (NIurc ir nol
<br />inre lcd or oircrcd fir el. (Sm 7(lr.1. Bu\ils\ and Profcssnn,\ Cdlc: Thc Conkrcror's Li.cns tju d€s nor !p y b M .$n$ .f
<br />th. Dmpcny who t{ilds or nl,r.Es rhcB'n. ard wlx' rles sEh *o* himsllor hcrclf o. rhmuph hh or h.r own cmployccs.
<br />piovidcd rhar such i pr.smnrsrru mri crlol.r.tldcd for slc. !l how.vLy.,h. huiBiq.r i,lr])mkmnr h $tl wirhin onc )ur
<br />ol corplcrion. rhc Owncr Brildc. will hrw rhc brid.n oI pnring rhrr hc or \hc dil nor huild or inpreE llr tmpcny for rtu puqr){ of
<br />_1.aro$nerofrhcpm!.ny.r.r.lusiv.ly..nhr.rin!*irhli.cn\cdco r..kiNrocon(rud lhc prlcd (Scc.7(!r:1. Bo\i"c\s
<br />md Pbtr\si Codc ThcC.ntrrnn s Li.cnsc Llwd.cs tror rpt'lt b 0nosncrol pn,Fnywho buildsor nn8rvcsrhcrcon.
<br />and who conrfrcr\ for \uch pmjcch wirh rCodB.trG)liccnscd pu^ur n)rhcCofin rols Liccnr tj$)
<br />-l
<br />!mcxenrfl undcr Sedion-, B &P.C tarrhhr.u$tr
<br />tlt tI{KFRS', ( t( )i\trtin.'salr( )i
<br />DIiEL^Ii^I!1)N
<br />I hcrc6yrfi tDUnJcr pcnnlry.l |[rJUryo .nl rhc f()ll,)sin! d([rrrii \:
<br />lhrlcrnd*illnBinrsinnCcnifi.rlcorCon\cnrr,Sclfln\xtol{trsorrcN(mpcns.ri.tr.!sproviicdfo!t'yS(rion:lTlDofrhc
<br />I ih, Ant. l'or rhc p.rfonnane o I rhc wor( ror *hi.h ric psnrii k isskd
<br />Ihrvcandwillman arn work.ra conrF.srlion in\umk-.c..s rcquircd Ly Sdion:1700 otrh.ltrtnn Codc. fir rhc pcrfonnnrc of
<br />prnn i\ i\(uLrd Myw.ikcs .(Nttrtr\i!'[ r\ur. .c.itricr irkltx)]i.y nun,hcr ar.:
<br />I ccni!th ir thc |xrfonnrrcc of r hc work for whlch rhis pcnnil is i{$ed.l shrllnor rnpl.t rny pcrson inlny manncr
<br />s sro hccom \uhtcd ro rhc *ortcrs omFnsarn,n h*s otCalilomia. d a8rc rhar ifl ihould tEconE suhJerr lolhc
<br />workc.armFosarionFovisionsotSccrn'n]7tnofrhclilnrC,dqIshtrllrdrhw{h.ondywilhrlnr*Frori\t,n\
<br />!vARNING: Failrrc h {.ur. vorkcr ompctrs.rnrn ..vcfl8c is trnh$lul. snd snlll \ul,Jccr an cnlPloy& ro riminal pcnillts ind
<br />.i!il i,rs up to o c hundrcd rhousaM dollan ($lm.our). in rddition lo lh. co{ or conlPcnrari.n. dnmrlcs 0s trovidcd iot rnc
<br />:"iiiN' ii'i'iiiB
<br />DES,AIAIIO!
<br />I hcrcby lfirmu.dd p.ndryofpcrjurrrhd I ! liccns.J undcr t,mvnion of Choprcr 9 (omm(i.8 wirh sc.rion 7001J of Dirision 3
<br />of lh. Busiics rtrd Pbf.ssionr Cod.. afll my li.cnsc s r full LlN md cflicl
<br />K /oa?4./.
<br />,,*duN i. 1-?x1L
<br />gfNlIelrl:IlOIlLfXDlNli-LGCXlf
<br />I hcrhy rflnn u crFnrllyoiNrjuryrhdrhcrcisrcor{nErion[ndin8a8crc,forrhcp.nnrnnr.corrhcso*hrwhichrhisPcrr.ili\
<br />is\ucn rSff .lar97. ( n C)
<br />ttfulANr.aE{jl,a8AuqN
<br />I h.mby dftrm undcr Fnalt! or pcrjury onc oithc lolloqirg dcclrrdlirns
<br />Inn,lirion P.nnns Ashnos N.rifi.ariotr F_cdcral R.Suhrions (Tirlc40. P{n6)
<br />Rcqurcd Ixtrn of Norifi cnrnn
<br />-lccniiyrh
<br />ll.a fcdcralrcgulari{'ns mAarding S.d.sr.frilalrrcnoriftli.ftlcror[isrmrecr
<br />,f/M yrhrlh,(,,rdrh,. trp'(.r nn arl {orc rhnr rn( fir.
<br />i:iJ'naNr.in'l srr'. 1'w! rldtrir rv burlJirE con.ra!r.,,n. md hcrc
<br />I rgrcc k, onlnly wirh.llCiryrn,lC.unry
<br />r rivr\olrhi\Ciy.trd Coutriyro cnlcr trp.rrh:
<br />lh)rc n{nriorcd lmFny fir i'r\pccri.ntuqr'*s
<br />Applie|ll or Aaetrl Si8nrlure
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subtloor/Vent/l nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framino blzt\ts I ufia
<br />lnsulalion/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL 7/Zl,ls ,'tft(
<br />Certificate ol Occupancy
<br />Notes, Remarks, Etc
<br />l lrmm
<br />Pool Fence
<br />F
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