|
BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.0WNT:R NI III,Dt,:R DEI,(]ARATI(}N
<br />I hcreby atlnn uxlcr pcnzlry (,I Frrury rhdr I0 crcryr lrofl rhc Conlrlck,F t-iccns. L,w lor lh. tillo*ins fu$n (se.?lrrl.s
<br />Busincss and Pn,fcssi{,n Cixlc) Ary Ciry or Counry shich rcquir$ a pcrmil k, con{ru.r. alrcr. imDnvc. dcm.lish or rcl'iir 5ny
<br />rrtuctuE. |nttr b irs h\u,ncc, !k. rcquncs thc aprlicmr lor such pcflnn ro fiLr si8trcd $rcmar rhar hc.r sh. n li.c,scd Pusuoni
<br />ln rhe ,rovi\i.,!\.f rlE Cnntncd s Li.cn$d tiq (Chaplcr 9, Con lcming sirh Sccri T0(XJ oi Divirion :l of thc Busi.c{s !trd
<br />Pmfcs\nnr\ Co&)or rhit h.or shc isexcmpl lhcrclr. !n<l rhcha\i\ turrh. rlleScd excmflion Anyriohrn ofscctioDT0:ll5hytrny
<br />.tllicrnl ror r pcrnit subj(ts rhc rlplic.nrbacivilncn,lryorn.rtrDrcrhofivchundBldou s(S50o)
<br />I. rs owifiofrh. lioFny. onny€mrloyes wirh wagci as rhcn v,b r.mPcnsliotr. willdo rhc sorl d rhc(nnurcisn.r
<br />i ctrtcd or ottrcd lor sk (Ss ?044, Busi*ss md Pn,fu$rns Codc: Thc Contetn r l-i.cnsc he docs nol aml, b an owrrof
<br />rhc pmrcn, whr huilds or nnl,n)v.s rhcNn- ud who Jms such w)rl hinrs.lfor h.sclfor rhouah his o' h.r oln cnDloy.cs.
<br />Droridcd rhar such impormnt m mr idcnd.d d oflaE'd lor sh li: ho$cE, rht bnildin8 or in{'mrtnrnr t s,kl *ilhin om }ld
<br />or6n{,hi6.. rh. owocr auiild sill h!rc ltr tnrdcn ol provins rhd h. or tu dii d toild or in!)6rt rhc l,mFty for th€ Pury)s or
<br />I. 0s owner oI rhc tDl'eny. !m ctclurilclt .onlrr.rnl8 wirh licctrscd .olrl rctF t, roNnr.r rhc lrroiLtr (Scc 7Ol'1. Busrcss
<br />nnd Eofcsir C.dc Thcc()nth.ttr s Liccnsc Llw {n)rs mr atflyt, trioqncr oflr.PcrryNho buildsor irnrrovcs rh.rcon.
<br />rtrd whr) co.rra* lbr such pR*rr( wnh , C-([trrck (9liccnlc(l pur\u]nrrorhtCo trdrtr-s Licensc ltr$)
<br />D{le:-. Ovmr
<br />woR(ERS C(INtpFNSAT(rN
<br />IECI,ABAIIQN
<br />I hcrcby ofirmurdcr pcnahy or pcrjury onc olrh. r(rb*ins dcclrmliotr\:
<br />vc Mi *ill nhnnrh r Ccniictrrc olConsctrr n, Scllln\lrc ntr trdkcr' lannPcn\rrion. rs ntuvidcd lir $ySccrion lTl{) olrhc
<br />sortcrJ conD.ns{idn inruritrcc. $ rcquircd bySednrn rTtDr,ithc L.hor Codc. t,rhc p.rfoirmn.cof
<br />mpcnelim !,NuEnc cdicr &kl policy numhcr uc:
<br />ia
<br />I ccniry rh,r in rh. p.rfolrmme oflhe work for which rhn p.rmir is hsucd. I sn,ll nor c'upl.y any lf,son in aor ddncr
<br />s 6rohlsm xuijd h lit uolkcrs .ulp.nsat ion lass ol Californii. Md 4e rhor ii l\hould tE on. srhlcd rorlE
<br />wo.kcn compcnqrion polisiont orsdi.n -1700 olrnc L$or Codc.I \hlll.lodhwirh conrPly *ilh lh.e !tuvnioDs
<br />:);lTl:l';,,1;
<br />/,// .
<br />snnpcn\rr'otr rorcrrSc 1s u l.yc! b rininrl |f, ha\ rnd
<br />drnnEc\ 3\ !n'vn[d ftr rhc
<br />90' /
<br />I lrcrcby dfiinnundcr Dctrllryolp.ritrry rlinr I in li&trsl uMcr tnlvhion oiCh,prs 9 (.unnmncina wilh Ssrin, Tmol
<br />t hcEby arfn undcr p.ndlyoiFrjurylhai rhcrc n a.tnnd.rbn Lndm8 nScncy lor rhc Frromq.cc olrhc sor[ ror whah rhis lEflni' k
<br />issucd(SN 11197, Civ. C.)
<br />, A.ETLI(^NTD}:q,IAAII!IN
<br />I I ffi) aT if, n un'lc' ncirlry ur r,.!urt onc nf ,hl f ,11,,tr'ng dh h'rri',n\
<br />I L*'*'i'^. e".i,. n.*u"\ \'{ I'cJrrn l crc,Jl Rc(ulJr'nn\' l irl. co. P,dr,
<br />Rcquir& lrlrcr.l Norilic rai
<br />A.d5(-i ilrrlkr rlr fcdcrll rcAtrliri,)n\ rcgtklin! r\h.(osr.morrlJc tr!rr'pflicrbld i, rhi\ fn)ic.r
<br />rh l hrlc rcad rht rptlicrin l i.n iscoftsr. I agE rocomply wnh au Cityand Counr,
<br />trl sturc hssrchrin! n) huildir rq,c{nulivcs oirhi\ Ciry rid Coutrrt ro cnrcr uF)n rhc
<br />$ovc rrtrriinrd [,pcnylor irs ?-sa
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsulation
<br />Roof Sheathino tl4Al&l/,a/l,a -./71 /6-4--
<br />Framinq
<br />lnsu latio n/Ene rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Repon
<br />Enqineer Final Report
<br />Flood Zone Cefiif
<br />FINAL lDlLiltf frr4lhrrry /{z--
<br />Certilicate ol Occupancy
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />Shear Wall
<br />I lDcrcnrrrunncr sccrnr .8.&P.C &rrhnrcr$t
<br />Codr.turrtupc onnnR.ollhcuorkir!hi.[rh.nci,nir i\isnul
<br />ol rhc Busircs.trd Prcfb$ionsCodc, ud nryli.cn{ i\ ir full ror.t Mdcllccl
<br />lxldo\ Addr\
<br />-
<br />I {
<br />-T
|