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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf looriVenVlnsulation
<br />Roof Sheathing ?/ttt/rv 6mam ./v)-
<br />Shear Wall I
<br />Framing
<br />lnsu lation/Enerqy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL rhkl/k ,7416-/l,A /M
<br />Certificate ol Occupancy v-- -T w I
<br />Notes, Remarks, Etc
<br />oWNIIR BT]II,DER DEI,CARA loN
<br />I hcrchy !,nrn uMcr p.tri lty of Frjury rlmr I mr cxc lpl lhrn rh. ConkicroN l-i.cnE h* n, lh. Iollo*ins rraen (sm 70.r 1 5
<br />Busincs and ltoli$i'0 C{xlc): An, Cily or Coutrry *hich rcquim\ r pcrmir t, conntu.r. rhcr. i'npti)vc. dcnn'lish o. icp(r rtry
<br />!fl.rur.. prnrtu irs i$uM.c. {ho toluirc\ rhc rptli.Mr lnr!u.h pcnnn b [hr {i8trcd sarcnrcnl thtrt hcor fi. is ]iccnscr pufiuani
<br />ro rhc pnvhi{,ns ,i rhc Conrracroi\ Licensd lj* lchrprcr 9. Comm.K-.in8 sirh s.crin 70($ .r Divtiotr :l ol thc Businc$ .trd
<br />Prolc$i{,ni CoJ.).rrtur lrorshr kcxc rpr rhcr.fio m't rhcbi\i for rhc rllc.lcd cxc rJ)liotr. ny vioIrionol Sdion Tl).]l 5 hyrny
<br />aptlritrrlor |rnnir suhlc.h lhc l|tli.anr lo,civilncn,llyornor nFrclhM fivc hundrcd dollm ($5tx))
<br />-1,
<br />rsow.crofihc pn'lrny. an.rchrivclyc.nlracrirrs Nirn lienscd conrrrcror\ ri, coinrud rhc pnt.r rsc. 1044.8usinc$
<br />s,i th,ldisi,nCddc Thd Contr.tn i Liccnsc I-awdo.s orrtpLyromown.rolpro!.rty*hobuildsorimrnvcsrh.rcon,
<br />rnd sho o nch rar such pmJccls wirh n Conrmdo(s) licensd prsurrr ro rhc Contacttr \ Lic.n\. tjs).
<br />-l
<br />{ncxcmfl undcr Sectio
<br />IIOBTDBI1;AUIENSAI'I]N
<br />D&qLAEAIION
<br />I h.rcby afirmundcr p{nrlry of P.rllry onc oflh. following dc.hrarion\:
<br />md will ruirt{i,r ! Ccnific e of Conscnr ro Scli nNurc ior workcrf, onlj.nsarn'n, [ovid.dr.rhyscclion]700otlhc
<br />c. for rh. pofornuncc ol lhc so* lo. which rhc pcrmir is hsucd
<br />nrorkcs conrncrsari insumrcc.0s r!.tuired hy Secr ion :r 700 of rlt Lnhor GJdc. ntr rlE lslirnnrkr ot
<br />If,mit t iskd Mysorkcn c,ri,r, insu'rtr.ccrri.r rdF,li.y un$cr rtc
<br />o
<br />I c.dilyth r h rhc!.rlonlBn.cofrhc work fd whi.hlhis pcflnit is h{ucd.l sh!llnor cnDl,'yanypc6on in aiy mrnnfi
<br />s os ro h.conr subFr h rh. *orlrc^' onrp{.sri,n los\ "f Cllifonia, lnd sSrc rhrr ir I strrl], tt.otrE sbjcd lo rhc
<br />workc.{conDcnsarionpDlisi{,nsnfSccrionl7c[,oirhrlf,borGxlc.l!hll,lonhsirhcomPlysirhrhocPmvtions
<br />lorcr o nimimi |rmlras a.d
<br />drmBcs os rirovidcd lnr lhccivil lincs u! r, onc hundrcd lh.usrn'l nollan (Sl(-4
<br />I hcrcbyniin u cr pcully oltcrjuly rhlr I !m liccnsd u Cluprcr I (comnf,n.i'rB *iih scction 70ur) oil)ivirion.l
<br />of rhc au\in.s rnd Px,rc\\nm\ Codc. drd nryli.cisr n i'r lull nrcc rrkl cff.(r
<br />-D ln rfrY,tzu
<br />I hcrcbyrlllrruMcr pctrrll!olrcrj rthd hcrc isrconirucliotr lcnlir-q rscmy ltr rhcpcrtun nccorrh.{ttrknnshic[lhi\|ENilis
<br />i\skd (Scc 1097, Civ C.).
<br />n&otr n corccr I agE ro comply wirh rll Cny rnd Counry
<br />horiTcrc'lc\cfldnc\olrhn( iryand Cou ryro.nh' rtin rrr
<br />?-6/Z
<br />Erection Pads
<br />-l.
<br />r\ owncrolrhctmlcny.ornrycnrlorccs withwagcs!s lhct elc conT.nsrri{ , silldo rhcwrk: lihcsffiluN is trol
<br />inrcndcd or ontrcd for sh (Sm 7044. Busitus\ and Pnncssn,ns C{dc: Thc C.ntrh\ Li.ctr* tiw docs rot 0pdy r{, m owncr oi
<br />rhc pqrrry *k) tdild\ or i'qrovc\ rhc@n- !'xl who d,f,s $-..h worl hinncllor hc^clfor rhmuEh hh or hcr o*n cDPloy.cs.
<br />trov cn rhrr {kh imFtuvcnEtrh m mr d.rki or ollcEi for srlc li h.*rvcr. rh. hu ill]iry or i'rproknrnt G $U sirh,n oN lta
<br />of coEpttn)n. rh. O*icr Brildcr will havc rh. hid.n of pn,ving rbtrr h. or thc dxl Dor build o! inprorc dc ,mtEny tir rhc nurriNd ol
<br />APIIICANLDIiCIAAA!!)!
<br />I hnt y drtrfl undcr p.trdlly ofp.rjury one ollhc lollowin8 dNl.rurions:
<br />Dcnmliril)n Pcrmih Ash.sos NoliUcarion kdcralRcSul ions (Tirlc,l1). Purl6)
<br />Rcqtrircd Lclrcr olNorilicotiotr
<br />-.1ccdiryrhd
<br />ihc lcdc'rl rc8tfuri,n,\ rgxnln,g a\h.no\rcflMlrr trorqrnli.rhfu t) lhis |)r icr
<br />t-l--
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