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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS (}WN':N BI JII,DN:R Dfi ,CAIIATI{IN
<br />I hcreby rmrm utrdcr prtrolly of p.rjury th.t I anr cxcnu rirm thc C.nlncl{s l-iccnr Lnr ror rhc tull.si'rg rcNon (Scc.7011.5
<br />Br\ines and Pmfcssion C.dc) Any Ciry or Coury ,tich rcqunc! , Fnnir ro snrtu.r. rh&, nnpruvc. dcnmlth or rcPrt otry
<br />nfldur., prd h ir\ hnrn.c. ako Bquncs rhr alpli.rtrl for $.h pcnnilto lilc, siSrcd (otcnEnl lhal hcorshc n liccnscd lursor
<br />ro rhc fovisions ot thc Connacbls Liccnscd Lrw (Chrprer s. Conmcncins qirh s.crioi 7(r0o .r Divrion I oI thc Busincs and
<br />tmtcsrion\Codc)orrhrin€orsh.i\crcnDrlh.rrtr,na.drhchtr\htorrhcrlhlcdcrnDri(,n.Anyrnn.lionolScclionT0:ll5hruy
<br />,mlicnnr foi, Frmir \xbr..lsrhr rtpli.dnl ro acr!,lpcn.kyornor morcrh!tr fivc hundrcd dollaF(S5Oo)
<br />-1.
<br />n\ o*ncrotrhcpiorcnr, {nmyc ,phtrs wirh trrgcsr\rhcir v,lc.o ftnsrrn)n. silldo th.tolkrklllrc (nErut is nol
<br />i, ctrddl or ollcrcd itr d. (Sc.7O'1,1. Ausincss .nd ProLslions Code Thc Contu tn ( Liccn{ lj* d{Es mr aprly h an o* cr of
<br />rhc pmp.dy *ho hrilds or nnproksrlf,fr)n, urd wk,d{rs{ch*inthin,\.lr.rhcil.lf.rrhi.ugh ht or hcr owtrcmDloyccs.
<br />lrovidcd rh0r ru.h irnfm\lrBnh m mr inrc rdorofl.ru tr\dlc ll. howovci rhc trikliry or nqrorcnEnt sll*iliinoturdr
<br />of.onfldion. rl[ Ouh$ Buildtr willhrvc rhc bud$ uf ln,line rlrr hr or shc rlid mr huikl or inprntr $c lhrFty nr rhc puqi&.r
<br />-l
<br />[trk eluillmoinruin oCerrificrrcoiConrcnr ro Scll lnsurc for q$k.6 c.n,p.nsarn'n, ,\ ttuvidcdlbrbysccrion]TlDoirhc
<br />Lrhor Codc.lbrrnc pcrlo.nuncc oflhc work rbr whlch lhc l(irnii k nsucd
<br />ihc sork lnr whiI rhi\Fnnir i\ i\{ucd Mtw.rk.'\'...rtc \rridr i'ruhkc.Uri$rtrd Friey nurhcr irc
<br />-lenilyrhltinrhcpcni,rnuDceorrhcNo
<br />fff {hich rhn r.nnil h i\sucd.Ishrll i.r .nfkry ,iy I.Ntr in,nymlnnct
<br />e, sl t) hr.o,ft suhi.r lo rhc Nork.n .omFns,r i.n hws of CuliLrni{ ,nd +N r har if I should h.{orE luhjd lo rhc
<br />w.rkc*.onf.nsariontmvisionsorsNrbnl7u)ofrh.Irhtrcdd..I\hdl,LdhwirhcomplyBirhrhocpmvtions
<br />IvARNINC: FniluE lo $curc $ortcrr compcn\lrbn Nurl8c i\ unh*n,|. and shall \xhi.i ar ctrDhtcr h ciminnl pcurri$ and
<br />civil fincs up lo om hutrdren lhousaftl dollun lS IOO-Om). i. lndiln k' rlt co{ or.on1P.n\arion. d,nmgcs,s 0rovidcn lor thc
<br />S(rii.n \U_6olrlE LJhl CoJc. rlrc'cr !rd rno'rc) . lrc.
<br />Dale: Appli*nll
<br />r rt:rmen cor,trrr,lcron
<br />DECIAf,AIIAN
<br />I h.rcby trfllrmundf p.nalryofp.rjurylhd I rm licctrkd uMo fovishn ofChnDrcr I (comnf,ncin8 *irh Ssrion 70fi)) of Divhi,n l
<br />ol rh. llu\iics Did Proacsn n\ Codc, kl nry liccn{ is in fullfrrcc Md clTc.t
<br />CQNIIB]J.(:IIONIEIDINGAAINCI
<br />I hcEby rlfinn undcr Fnrllyotpcrjury lhll rhcrc t ! onslructhn lcndin8 lscicy ror rh. p.tronMm. olrh. *ork ior which lhn lcmrir is
<br />is\u.d (Sc..lO97.Civ C ).
<br />AITLICANLIECLANAIIAN
<br />I LFby lfllmundq F.rlty ofFrjury onc.frhc lollowing dc.ldDrnnN:
<br />Dcmlition Pcrnih Albesr.r Norifiornnr Federdl RcEuhrn,ns (firlc 40, PrnO
<br />-Rcquiad
<br />Lcrrcr.l fioritic,ri,n
<br />I ccnrlirh.r rhc r.dcr.lrcEUr.rions rca{rdirs ushc(os rcnroulrrc norupplicahlc io rhi\ pnjcci
<br />lccniiyrhrrlhbrcrcxJrhi\rntli.dnrn.idnrtihrrrh.xlr,vcirlnnn iotr N..iiccr lrEr.iracoDplysirhrllCirtrndc{)!nry
<br />odinrnccs 4d Stic lik-s rcldirg b hildin8 .on{tucr ion. rid hcrhyiurhorik r9r.\c.trrivcs ollhis Cilyinn Cornry ro.nr$ qrnt rltc
<br />shovc nEnln'ncn pn,ti.dy tu insp$l ion puqxxc\
<br />Applicml or AgcDt SiaMlum
<br />Set Backs A.
<br />Forms/Steel/Holdowns a-204tr YNL\A
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/l nsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/ason rY
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />En gineer Final Report
<br />Flood Zone Certif .
<br />FINAL
<br />Certificate of Occupancy
<br />Notes, Remarks , Etc.
<br />-L
<br />0sowncr.irhc pmlEny.0m cxclusilcly contracriry eilh licctrscd connoclosroconslrucr rhc nrcJccr (Scc 7044. Bu\inus
<br />and Frtr,i:\bo Codc: The Conrr,.kr's t-iccn\c t-!w does nor lpply tr !n orn(.rF,pcny who brilds or impr.res ricr@n.
<br />dnd who cotrhcts ror such,tujccls with, cbntdJis) li.cnkd punuam ro rnc Conlrcdois Liccnsc L!w).
<br />I n.x.mnt undf S*rion .B.&PC fdrhtrca$n
<br />DrlP Orn.r
<br />lrratrr&5:"louPiNtaloN
<br />DSq.AAANON
<br />I hlrdl,y amrh undcr pcnalry of pcrjury oft ol rh. folb*iis dc.harnrn\
<br />Licensc Class:-Liccnse Numbcr
<br />Drl. ('onrreclor
<br />I
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