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BUILDING- INSPECTOR EECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsu lation I
<br />Roof Sheathing 7,///,//1 7 49,t2t)
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/asonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req
<br />De puty Final Report
<br />Engineer Final Report
<br />I
<br />FINAL q/20//tr --'7M a4/-/
<br />Certilicate of Occu panci Tl l
<br />=Notes, Remarks, Etc
<br />OWNER BUILDER DELCAIIAT!ON
<br />I h.r.hy lfirm undcr pcmlry of li.rjuly rtur I an cxempr lmnr rhc ConrrcbG l-i.cn{ lr* fr rhc follosi'rE rciv,n 1S..70:ll5
<br />a!1ir.\s dtrd Porcl\i.n C.dcl Any Cny or Counry shich rcqotcr I Fnnir k' ondflcr. alr.r, inttuvc. dcmlish or tot ir rny
<br />sru.turc. priolo irs issuarN. also rcquncs rhc ipplicmr fn suchFrnirtJ filc. ngnrd slrtcm.i rhalhcor nN ir li.cns.d puFurnr
<br />io rhc povirns of rlf, Cotrtr.nn s l-ic.nscd bs (Ch.prs 9. Com'nuici'rg wnh Sc.rbn 7UD of Divrion 1 .l rhc llnsin.s and
<br />Profcsion\ Codc)or rhlltrorshc hcrcnrpr rhcrcfroflann rhc hlsn for'hcullc8cd cxctrrprion Anyrdarionoasccri,n 7011.5 hya.y
<br />smlicanlf(trdlrnnilsrbjN(rhc.trlicrmbr.ivilFnrlryofnotnkr.rhdnfivchuRlr.ddollrs(S5m)
<br />_l- a\ o*ncr oi rlE pmpcny. or nr, cmnlo)c$ *irh wa8cs {s rltrn sob conrensor i{nr. *ill dr rhc so* utrd rhc {tururc h ior
<br />i lcMcd o! oflcrcd fd $lc ( Sc. ?0,14. Burincs ,nd Profcs\n,ns C{xl. llf, Coikr.(r's t-i.c s tiw do.s nol lPply h atr oqN, of
<br />rhc lnpcdy *ho huilds or inpmvcs rtrren. art1 s,tn' 'le! {ch "nii hnNcrl or nercll or rh,oush his or her ow! cnlployec\.
<br />p.ovidcd rh0t such nnaoEnrnts .E e, cndcd or .ftcal ru \ah Il ln,MRi rh€ huildin8 or numvcnEd is s.ld *irhn' nnc Jir
<br />of.oftrLlidr, rhc O\rcr Builld will hrv. rhc hordcn of prolinA rhd hc or shc rlid rn hrild or irprov. lhc potdy lor lhc puqnr of
<br />-1.
<br />is owrcr of thc lmpcny. im cxclusivcl, conr..r mE s h li.cn\cd cofircrtrs r. coNrud thc pioj.rr (Sa 7lg,r. Busncs
<br />rril Ar,fcssb( Codd Thc Conr&kn s I -icensc tiw docs nor rlply rn m o{n( o r tn,ntn y sho build\ or nnpbvcs rh$con.
<br />ntrd sho contmcls lnr $ch [ojc.ts with ! Crn nct (s) li.dtrscd l[nu0nr h lhc C.ntr.ctr's Liccnrc Lnw).
<br />-l
<br />oDcxctrrpr utrd.r S.crio
<br />Dtrl€ Orr€r
<br />rtOnXUnV Clr,trtPr.-ttSlf ttX
<br />IEII.AIAIIOB
<br />I hcrchy !r'rnm undcr ptnrlry.tpc,jury om olrhc lollowins decl.nrions
<br />Irfi, Ci c, lnr rh. If,rlonMn.c ofrhc {ork rd *hl.[ rhc pqnrir i\ i\surJ
<br />-l
<br />h.re flxl willmainrtrir porkcrs conrricnsorior imumftc. r\ rcqurcd hySccrion ll?00ofuhc lnborCodc. nnr!. Frrorn'rtucot
<br />lhc $o l'or qh6[ lhis p.rn is tnrcn. My workcrs'..Drpctrsrrnr iNuiflrc.Micr 0 rnicy nrnrhc,{c:
<br />P.licy Nunrhcr
<br />-lrrtircs
<br />_lccnilyrhar inrhc pcrformmc olrhc*ork for shich rhirr.rmir is issued.I shnll noi .npk,y any Fr*o i..nymnncr
<br />$ as ro tEom subjLtl lo rhc sork.6 .onrlEnsllio l.ws ofcalifoiria, ffi, l3e Ihal ial should lEom suhF-r k rhc
<br />qoricF compcniarion tmvisions olSdion lT0ooflhc Lltn Code.l +,rll. fonhwirh comlly wirh rhoE provin,nr
<br />WARNINC: Faihrc ro scurc wortes conrpcnsurion covcu!( rs nla*rul. rnd \l'rll \ulClr J'r .nrtlnrtr ro m nnnl lEtroits and
<br />, il finr!uni,iinnchun'lrFrrh.uvnJdollJ,.rSl'n.Ouir,.irr,id."dh..^r"ll-lr{tr.irnr.dxru8c{r!nr.\dcdrorrhc
<br />r. r.n .,oro Jr rtr. t ,tol c"t ,nro*r -,t r,", mr . r"^ (, u/ / ,
<br />,,",., I I (11 lK [:,--. ( ( L/l -'
<br />-T- '-
<br />-y u(ENrErr(aNI8A(Iax/ \ I'EIIJXAIIA!
<br />I hcrchy Jrfirm undcr nculry.f ncrjur rhor\ hen{.Iumlcr 0mlnion otChrprd 9 (connrtuing wirh sc.rirtr 70fi)) ofDivisi.n:l
<br />I rhc B h,m.,ond Pmic.nnrr a,,Jc..md mt lrchc F n lullrorcc r'n,lclfc\r
<br />a L1. o-t \
<br />ri tl (../r\
<br />C
<br />I hceby rflinn undcr F lly.rpcrjury r
<br />i\sucd {Scc .llr97.Civ. C )
<br />i( hndiu rtrtrcy lor lhc JIrlonnn.c olrlrc sor[ kr qhirh rhn p.nni n
<br />AIfIIQAILII&CLAMIION
<br />I trrcby.finn ullc.r F.ah, ofr.rjury onc orlhc lollownre dc.lu.rio.s
<br />Ocflnnnrn Pcrmn$A{b.(os N.rificdtk,n F.dcril Rcgulrrnr* (Tillc 40, Plrt6)
<br />R.!ui(d htrd of Norifi .arion
<br />I rs.e b co ,ply *nh rll Ciryrnd Coutrry
<br />rivcs ofrhn (-iryrndCorir) kJc rcruln rlr
<br />*," 1(t] lt )
<br />-lccn'b
<br />IhJI rhelcdcrrlrc8u',rnns rcsaLlirs r.b({n cnDtnlr. ro' rr?hcJhh n.
<br />6."n,r,,r/**. *,,n. "no,-.'.k "^," d "",",,'1,,,, t,,""*,
<br />ordrlltt]rcc\ 096 sra,c titr\ Ehr,nB
<br />'o
<br />hUM'nE_(.nerydmn and h.rctr'rugr.,c rc|rcrdahNevm,rFr ra,D,rcno(zf.$c u/ ^
<br />Applidrlt ol'{*ol Si*Mrur
<br />""*,d.-.",/,,,, f ,,. t.. L'),,,.\: r.\-\z -
<br />Erection Pads
<br />Flood Zone Certif .
<br />I, n,t.r . {.t.i,c\.
<br />f --T_------
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