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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OWNER AUILDTJR DELCAi TION
<br />I lrrcby trfltn undcr p.nrlly of pcrjury lh l onr cxcml fn.r rhe ConrE.lr'6 l-iccn* liw ior rhc rolk,*ing mistr (Sc..?0]1.5
<br />0usincss urxl P,on$ion Codc): Any Ciry o! Courr, *hich Eqoncs a I.trir kr cnnslrud. altcr. inrDrcvc. dcnmli\h or rcnri rn,
<br />dtucrurc. pritr lo i( i\suan.c. Lho r.quir.s rh. lprlirm( ror\n h lj.rn ro tuc a si8trcn slalcflEnt rhar hcor3hc n lianscn ,uNur.l
<br />lo lh. provision. oflhc Contruckn s tjccn*d L!, (Cnlprcr 9. Connncki'rg wirh s..rion 7uD of Divisbn I ofthc Busincs and
<br />Pmfc*nrns Corlc ) or rh hrorsh. iscxctrrpr rhcrction dlld rhcbusk for rhc dllcgcd cxcnr/ion. Any viollrionolSdrk'n70.ll.5 byan!
<br />appli.,d ro p.mir subjcck rh. itplicant io !civilFc.a,tyofnor morclhM fivc hundred dollars($50o)
<br />_1. r\ osnc. of rh. pmFny. {n nry . ,!lo}c.s wirh s rgc\ r\ rh& qnc .ont*tr{liotr. will do rhr work $d rhc (rmluB i\ tror
<br />i' cnddl orolTcdd f.r sJc (SR...7t!,r, Busirc$rtr'l PrclcssionsCelc lhc O)nrrr.kn l l-icrn$ t.rwdoc\ nor rlDlybMo\ncroi
<br />rlrcImMy wno huil& or nnprcv$ rlErrn,, fll $ho d{f,s \uch *ork hi'n(clfur h.rsclfor rlrcDEh hi\ or hcr own crphycc\,
<br />ptuvidcd rld such nntornr h m nor inrctud, d offc'.rl tor ek ll. h.trctrr. rh. buikling or in{'rov.nrDl i\ \nd *irhnr o c )ur
<br />ofc.n{krion- rlx O$,Nr BuikLr *illh!\t rh. btrrdcn of!r,!in! rh r h. or \hc dil Nn b!,U or iiqy.lt rlr pr)pd1y tur rlt ru.Fr{ ol
<br />t. * owncr of rhc F,p.ny, am cr.lusircly .onr,clinS qirh licctrrd conrrncn'n ro con{dcr rtE ,r&cr (sc 7tx4, Bunrc$
<br />.rrl EoLssi,tr Codc ThcConracbis Liccnsc L{w docs nor ryplyr{' !nownrr ol pn,pciiywho builds or improvcslicrcon.
<br />and sho conrracrs tq s!.h Pn&ck wirh , Cb.h.nn(, licn*d puru tu rhc Conhdols Ltcnsc L,w).
<br />I Jmcxcmtr unJcr Sccrnnr B & Pa lor rhn r.rsont-4a4loLvD.l.:-
<br />I h.Eby a,nrn n.dc. F.,hy ol
<br />N()R(rRS (r)NtPtNS fl(rN
<br />Dfrl,^x ua!
<br />l hav. rftllill nuinr raCcniicarColCotrsnlhSclf.lNurciorrorkcrsconrpcnsrrion.rsrn,vidcrlLrhyScclionl?U)oflhc
<br />Laktr C{xL. f.r rhc Ii.rformncc Dl rhc sork for whi.h rhc Frnrir is irsuLt.
<br />lhrvc rdd wili rinr r sorkcrr conrEtrsrriotr inqrimc. rs rcquircd hySe.rnn,1700olrhc LrborCudc. tur rhc pcnnnniiccol
<br />ihc sork for trhichrhi\ Fnn[ is isrucd Mi *orkcrf.onrlf \rrior ir]\urMcc.rricr u(lF,lir, iutrth.r tu.
<br />I ccn'ryrhr i'r rhcFrronnrnccolrhc solk tor whichthi\ Flnrir is issucd.l \hrll oor cnPluytnyprrqnr in any mrn(r
<br />\o s h hcconE Nbjcd ro rh. wrkqi conpcnsd nrn hws .f Calinrnia. rtrd nsrcc lhdl il I sh)u ld bcdnm suhicd t, rh.
<br />workcrs co.rncnslrn'n lrovhionsofSccrion.lT0O orrhc ljtxr Cdlc.l \hnll.lonhLvilh comPly wiih tk,s F)vtn,ns
<br />WARNIN(; I'rirurc ti \..trrc *orkcr'i,r.orcrrg. n unlx{tu]. rnd \hxll irl,j(.r tr ctrDlov.r n, (ri'ni',,'l |rl ir'.\ rd(l
<br />.trrl llD.\ trD rn o\: hn i,ri rh.u\rnlJr $lOO.lXx)). i', ddirnnr t, rhc.o{ .i.omp.Nrtnr da DEcs $,'orid.d li)r rh.
<br />Sc.rid,.\l)76.1 rlr I rlxtr (itrl!. if r
<br />n4r,,,rt-
<br />ULIL.!A:\-IjQI
<br />I hctohy ll,llrD und$ Ntr{lry ol pcrjury I Irmlnrn{dutrd.rnrcv(i{iiofchrflc9l.o nrf,rcirewirnS(rion7(x }otDilisbn:l
<br />of d1. Busiftsr rtul PmLs(iorr Codc. md my liccnsc is in lull lore aDd cfc.r
<br />AIIUCINI.DES,AAAUON
<br />I hn{y finm undcr pcnally olpcrjury om olrhc ['lL*ine dc.lnorion\]
<br />D.ndirion P.rnrir$Asbcsos Nolificoriotr ttdcral Rquhrn,n{ rl irlc.lO- Prn6)
<br />-Rcquncd
<br />L.rlcr ol Nori[c,rlm
<br />h onnly wi'h al! Cityand Counly
<br />frfih Cny md Counrr ro..lcr uFotr lh.
<br />*,", qlzsltS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation t lh
<br />Roof Sheathinq ffi a t,/rl / t* -?MShear Wall /tv/vt/'-7-\
<br />Framing
<br />lns u lalion/E nerg y .. -
<br />Drywall
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certil.
<br />FINAL lplslLxTil,n^^-dt '2.-9
<br />(
<br />Notes, Remarks, Etc.
<br />Ext./lnt. Lath
<br />tCertif icate of Occuoancv I
<br />l'.lr.a Nur'l^{
<br />-I
<br />frc. .
<br />CAX$f,I]EIII]N.LENIIIN(j.AIiENCT
<br />I hcrcny ofatrr undcr lrnolryofperjlryrnal rhdc i! a o.ntudb. LndinS tg.ncy for thc 0.rlbrmncc oflhe worl rn *hi.h rhis !.nnil i\
<br />issucd (Scc.3097, Civ. C.)
<br />tjiJc''\ Nr'tu _
<br />tf,ndcir Addrs(
<br />-
<br />Nrrnscs .+-
<br />4l,4tu44
<br />NT4J4 fR*AI
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