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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OWNER BUII,DI]R DELCARATION
<br />I hcrcby rfltm undcr nrnaxy.r Fqury rhar I n.^.mpr fDm rhc C{,orEcior' l-iccn\c liw fn rh. tolloai.E r.r$n (s..70.115
<br />Busircss .tu Profcsi(r Cod.): Any Ciry or counrt which r.quito\ a l.rnnr h .ondd.r, ,lrd. imrrort. d.nnnh or ml[tr Jny
<br />srdcrure, I,Ii{nro irs nsu!.e. lho Erluircs rhc a0rlicinr ror \u.h Fnni b filcr silDcd rcnrnt lhal hcor dr h liccnsd puruanr
<br />lo lhc nmrhions of lhc Conracrois Liccn*d kw (Ch.pt.r 9. Conmc.cnt! wirh Sc.rk,n 70(x) of Division 3 ofrhc BusnEs nnd
<br />Pnrcssion\ Codc) or rh!r hcor\hc iscxcmnl lhcrcironr and rhct{sis lor lhc.llcsd cxcnrDrion. Any violuln,i.lSccror?0.115 t'y any
<br />lpplic!nr ror. t n,ir suhjc.rs rhc nttlic,N
<br />'o
<br />s.ivilpcndlrrofnor ntrc ihn fivd hundr.ddolla^l$50o).
<br />l.rsowncrorrh.pn,p.dy,orntycmpl,,ycc\sirh$agc\ rhcir{rccontcn\arnnr,willdolhc*Drkd rhc{turmsmr
<br />inlcnH or oocrcd rd $lc (SN ?(}14, Busircss and Pmrc$,ors codc: Thc (i,nticr.r! L,cctr* tjB des nol afply h an owNr ol
<br />rhc tsrrn! who hoilds or iryn)wl lhcrqD- I who docs \sh wo* hm\clf or hcrscll or thor8h his or hcr orn cmployccs.
<br />nrovnld rhor su.h iq)i.!.nrnr irt tr.r if.toL{ or ofiikxl fin srh ll hNcvcr. rh. buildirg or ir{,nNnEnr i\ v,k] $irhi', .,r ,trr
<br />olcorrykrn,rh.Osn.rBuil&rwilltuNt$en{rdcn!fpmviryrhilEorshcdidrt tuill or ir{rovc rhc Impcny for rhc pulm{ of
<br />-1.
<br />is owrcrol rhc protdy. u,cx.lusivcly conradin! wirh li..is.d .onrdcr.rs h.onnrud th. pnrjcd (S(. 7011. Au\inc$
<br />lnd PnJrcsi,n Codc lhcConrrocroi\LiccnscLa*,doesoorlDnlyhmowncrofproranywhobuild\orimnn,vcsrhcrcotr.
<br />lnd $ho conrmr\ for su.h pmrc.N sirh a Conrn kd\)liccn\cd purrua.r rorhcConra.trtr r Li(.ne tja)
<br />I .'n'crc'nnr u .r S..rl.
<br />D € OE..r
<br />}IAAtrE&UOMIENIAIION
<br />PECLABAIION
<br />I hcrcb, rf,nn utrd$ rcnrlry .f lrrjory onc of rhc hlk,sing dccl*arioi\:
<br />I havc,nd will 'uirlliD a Ccrl ill.arc o! Cotr*trllo SclrlDsurc fttrworkc$ cornEnn iotr.os prcv .dlnrbyScdn'nlT0ooirhc
<br />LlborCodc.li,rlhcpcrlormrccoilhcuolkfortrhichrh.p$nrir irirsucd.
<br />-l hivc.nd willnri aineorkcr'.onrncnsdioni,Fxft.c,r\rcqoncJhyS..ri.h:l?(Xlofrh.trh.rCbdc.lirrh.ncrfotrurEcof
<br />rhc rorklor qhth lhislEnnir is nsucd. M,aorkcn .dnrrcn\arion in surd..c .dri$ and poli.ynumbn trcl
<br />c""i", ' 5TAT€ dD^^P
<br />1zr \d o1 - Zc, t . /z-31^ /8
<br />lc.niar rhar in rhc pcrr'olnmmc oirhc Nork for $hich thn !.rnrir is issucd. I shall nor cryl.y any ncrrctr in rny manncr
<br />\o !s b h..om suhj.cr ro rh. work.^' .omicnsar n'n hw\ ol California. rnd lgnc thnr ir I lhoxld br.om {hi.d ro 'lrwol&ss' conwn\.rbn ptuvisn ns or S&rt,n lTtn .f rh. tjtxtr C{d.. I shrll. fonh*irh .ontly wirh rlk)s ttuvat N
<br />WARNINC: !:ilurc lo sccurc wortcn (nnpctrsdn,n.o!cn!c r( unhwrul. , $ill subjccr d. cmtlorr lo dmin,i pcMhts rtrd
<br />cilil fitrcs up ro onc hutrdrcd lhousrtrd dolhB (Sl(n.oo0). nr ddd(ion b Ihc.oI or conrp.nsnri.n. drmr8cs 0r providcd lor rhc
<br />Sccrio! 3lr?6 olrhc Lltu Codc. i'rlcrcsr 0nd !rloirEy s lccs
<br />- 9.-G-(S
<br />I hercby amrnrufrls pcnnlty olrcrFry lhir I nn liersd ufrlcr fmvhon.{Ch.lrs 9 (coNrrtrnrr wrlh Sccli.n 70u)) olDirhio 3
<br />of rh. Bu\incs\ ,nd Piolcsion\ Codc. md d, li.cn\c t in tull lnc aJxl .flc.r
<br />r.i..n.(.11.\ -CE[E=E. B qq 23aA
<br />q - L -16 ..,,*","., )( 5Ec+--, t {o.v c-s
<br />Al4Aa C.;s.*---\';T
<br />IONiIAI]qII)NIENDING.AGENCI
<br />I hcthy diirto!&lcr pcnllry ofrcrjuryrh lncrcisocon(ruclionkndinsoscNyforrhcpdformancc.trhcwor*lo.whichrhistBnirar
<br />isslcd (Scc.:109?, Civ C.).
<br />AITII9TNLDECIABAIIA!
<br />I hnby dJrim nndcr pcnulryolpcrj!ryonc ofrnc follo*ins dr-^UBrions:
<br />Dcmolirn,n lcrmirs'Ashcnos Norificrlion FcdcralRcgulltn r (Tillc 40. Pd6)
<br />-Rcquncd
<br />Leucr ol NolilKllion
<br />I ccdify rhd rh. fdlcrrl Egularior dganling ssh.srix rcnx'ularc nor{pplidbh ro rht p6j.cr
<br />:Ll ccnrry rha, I hdrc rcarl rhF rtpl'.arrtr rd qrrc rh,' rhc rhrvc inrardiotr h cutrccr.I agre rosnplywilh allCilyotrd Counly
<br />irdinomc. and srdc tjw. RraInB r.hurldrngconirudnn., hcrcbyaurhoriz. rctr.*nrarivcs o{rhk Cily0trd Counlyro ctrlq trInnrhc
<br />rln,v. rnrrnro,l rm|arr t, lnr n\|t.riinr rtrrrnc\
<br />nnr,,--, *^*"ra,*.rr-[- _$
<br />',,",.1-4-t*t
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor ,/--n
<br />Sublloor/Vent/l nsu lation l0t) /")\
<br />Floof Sheathing ,(-tl- tO attl +a /*Ylap ( L/D/
<br />Shear Wall f -..V
<br />Framing J.s(., t - c s
<br />lnsulatio n/Energy
<br />D all
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />tlandicap Req.
<br />De puty Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL a-7;?-lE ClPot )
<br />Certificale of Occu pancy
<br />Notes Remarks Etc.
<br />-+
<br />UFER Ground
<br />-T------
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