|
BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE COMMENTS OWNER BUILDER DET,('ARATION
<br />I hercby amnn undq pcnally oapdjury rhar I an cre,npl aro,n th. contBcros Lic.ns. Lls forlhc lollo*ins r.adn (s{70ll5
<br />Itusin6s dd P(r6sion Codc): An, City or Counly shich requt6 . FYinir ro constru.t. allq. improv.. donolish ot repan turv
<br />(tuduq ,rior ro ns isu cc, also rertun6 $c applicdr lo. su.h Ff,nn to 6E a siB..d srdftd tbar hc or slrc t licm{rl p6udr
<br />lo rhe FovisioB of fi. ( onlractois l-ic.nsed li* (ChaPld 9. Comenci.s $ith Strlion 7000 of Dilisio. 1 oflhe BurnEss dd
<br />Profdsions Cod.) o! rhal he or shc is crcnpt lhdcfrom ed lhc bsis tor thc iUer.d .r6fliod An! violalionofS..lion 7011.5 byoy
<br />apDlicant lor a p.m 3ubr*tirh. applic.m lo acivilptr.hl otnol oorc rnm 6!c hun&.d dollds (t50o).
<br />I. s o*nn ollhc pmp€ny, or dyenphy6 wnh waSBc lh.ir ml€ comlE sation. {jlldo Ih€ Ntk and thcsn'dm is not
<br />idodol or ofid.d aor sl. (se.7{}.l4. ltusins dd t\or*si.tr Cod.: The ( onlracroi s Licry lr$ do6 nor 4plv lo u ow.6 dl
<br />rh. pnpsly Lvho boilds or inl!,tv6 rhcen. ed who do6 su.h *!* hmsell or h.reel, or llmush his or her o$n cmplor.t6.
<br />providcd rh0t such inrprovools a. nor inrddol or orsen for eL lf, h.w6E, th. hitinr or implovosr is $tl wnhin on. ,@
<br />orcoipl€16n, $.Osnd BnildE *illhait rn hrdd ol po\ins td 6. or s\c dt not hild or idpo.lh. Popsry lor thc ,lrFoeol
<br />L ar ownr oflhc pmD6ly, d .rclGi*ly codl,acrins \vnfi licds€d .ontrelo6 ro codrud
<br />'lE rojcl (Sec. 7044 BBins
<br />and PDEssion Cod€r Th. Conl.aclois Licens. l-3N do6 nol applylo an oNtd ofprop€nywho builds or inPrcvcs lhddn.
<br />and Nho comads for such projcls wilh aCo.tEdoilr lic4d puBu.nl lo lhcconlmcldis Li.G L.w).
<br />I d€xcmo unddsdion-. B. & P.C.lorrhis rc6on
<br />o.tq own€r:
<br />]!aB!!!sllltlltE!sL1!9!Drc! -8aro!
<br />I hcrcbyamnnnnds pcnrhroapquryoneolrh.rolb$mSdLrlf.rions:
<br />-l
<br />hart dd * ill 'minr.i. a ccnific.re o I Co6ql lo Seli l6urc for $ork6i conPensarior, s prcuidcd lor bv Serion 1700 of thc
<br />Labor Cod.. for lhc poromdce oithc sork for *hich thc pmil is istu.n
<br />-l
<br />havc and $ill ,naintain sork€( co,.Fhsarion n$uran.e. s requtcd byss(i{rn 1700 olrlE fah.r ( od€. ror rh. pdlonnaoc€ of
<br />rlr'\.rl lorshi.hlhispcmnr is Nru.n Nl\wollHr lomptudiotr rNu, c.cMd edpolrt nultrbd dc
<br />a8a-f tt -ruw4&o (o-'r
<br />-l
<br />ceniay $at in rhc pdloflmnc. oflh€ wo.k ror whi.h rhis p*mn is issuct- I shall nol on ,l.p^,,;..Q1.;,t*fl$ 6 to krom. subj€l lo lhc $!rk6' .ortP€sal ion laws ol Califomi.. dd agr.e lhar if I should b.conc subje.l Io lnc
<br />worlm' comDosal ion provisio6 oasstion l?00 ollh€ t bor Code. I slEll, fonhrilh conrply vilh I hos lhvisioB.
<br />WAnNINC: railuE lo su. workas' compqsalion cormle it unhwftl. ed sh.ll subjsl d oplord io siminal pduhic and
<br />ciril fincs up lo onc hundied lhoNmd dollm ($1()O.O(]O). in addirion $ rh. con of conpc6alnJn. danases s ptoridcd lor rhc
<br />\('on r0'0olh. Ilbo, Cod.. rnr6d d urdrrn'r ts.
<br />,"", 1l'zL -14 ^00,,-",,x-lv- Va"J nt rz---? ^
<br />I r( fNst!l ( oN rRA(roR
<br />DECI.AIAIIO!
<br />I h@by afrrm unds poalry o I pajury rha I o liccf,s.d undd F.vition of Chapd 9 (cormocifls vilh S..1ion 7000) or Division I
<br />of lhe B6in6s dd PbfsioN Code, ad ny 1i.6. is in aull aora ad.fftr1.
<br />,.",,..,...-B dboy
<br />"""\:Lb :lE c",,."",".,X-I,,. V@ /S
<br />CAISIBUCIION.IEIDI!!.ACINII
<br />I hscby amm undd porlry of Frjury lhal lhs. is a conslrudion lddin! ardcy tor lh. psf.mdo. of rhe wort tur tli.h this pdnn is
<br />issr.d (sd.l0q?. aiv c.).
<br />I cnd.' sAd&6'-
<br />a.tttrcANfD[clAadllo!
<br />I h@tryarmund6 D€.ally ofp6tury oft oalh.lollowin3 del aliots:
<br />D.molilion Pdmits-Asb6los Nolifica ion F.ddal R.auLt ions On L 40. Pin6)
<br />Ratoir.d Ldld oaNotifi cdion
<br />-l
<br />cdrry rhal rh. aaldal r.gulalions rcsedins sb6los rdoval dc nor applicabl. lo lnis p' oj<t
<br />l!(.d'lyrhr I ha. @d rhs apl'caron d s0r.I hd Ih. .bov. infonurioi is.odd IasretocomplywilhallCnvandCounrv
<br />o;di.anc6 md Shrc L5*,s Elari'e ro building consddioi. ard hdcby authortc icfiMral ir6 ollhis Cily dd Couty ro dtd uFn lh€
<br />abov. morion.d pmpdly for iNp€tioD ruiFs
<br />A,p,i.m,qAsd,sa*u*.X-t^ Va^J Ala.--\ -",-11-zc-!g
<br />*.,,U*.,.",n.4,,, K ?-r
<br />Set Backs \I 4 6-\
<br />Forms/Steel/Holdowns )n"Tc ')r..
<br />UFER Ground n tlvqoy4 ,.r)
<br />SLAB Floor 'rb)
<br />S u bf loori Ve nU ln s u lation at I UI
<br />Roof Sheathinq nl-) . -/,)
<br />Shear Wall I I
<br />,.IYTA 4:/
<br />Framing ;1 MMa4{<t t)
<br />lnsulation/Energy WU
<br />Dtywa ll 'l
<br />I b *-g
<br />'ExU/lnt. Lath I >v..fr>
<br />ts-rown Coat I L t(}"i*8\
<br />Ivlasonry I (,, I
<br />Pool Fence
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />lt_a1kl^t fa?{t r1,firlq4 D)
<br />uu
<br />FINAL l,txunew @\
<br />Certificate of O u l
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Erection Pads
<br />ta 1b.t)1i
<br />(I
<br />74 'LA n
<br />T-Bar
<br />Flood Zone Certif .
<br />14 1
<br />I
|