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BUILDING- INSPECTOR RECORD <br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BT]ILDER DELCARA'I'ION <br />I h6cby amm unds !.nihy of p.rjlry that I m cxc'.pr rrem lhc Conlraclo6' L'censc l,w ln rh. followins rcen (sa ?011 5 <br />BBin6s Md Profsion Cod€): ny cn, or Coudt shi.h r.gun6 a pdnit ro codruci. ahs. nnpr.rc dcfrolish or ePan ,n, . <br />slruclule Drirr ro irs isudce. .lso rcquts lfi€ spplicdt for such p€mn to fiL a siSncd slardcol rhd h. or slE is li.d*d pduer <br />ro rhc pmvGioB oa thc Conlr,.rois Lic.trscd bs (Chapt.r q. Commcn.ins wnh sdlion ?000 of Division ] ofih. Inisinss md <br />Proacsions Cod.) or lhal h€ or thc is .rmpt lhsciom and th€ basis lot $e alklcd €Gnplioa. Any viol ionoasetion 7011.5 bv dv <br />applicarr for a lEmi subj68 lhc .pplicanl lo a civil poalty of ool not. rlm fivc hundrcd doUds ($500) <br />l. as owns o llhc p.orEny, or 6, .mplorc \dh wss6 6 thet elc compderion. rvill do thc *ott od L\. tuN b dt <br />i.rodql or ord.d for sl. (36.?044. Ausin* dd ProfsioN Cod.: Th. Conrra.rors Li..6. t-aw do6.ol apply o eowndol <br />rhcpoDdly who buil& or inpror6 rhaEn. and who do6sun xB himsclao. hdelf Dr lnrcush his or hd osn cmrlove6 <br />providcdrhar such ihprovoMts e. mt t oded or ofia.d fo! elc. I[ ho{6 d. rhc buildins o! imprnvcMr is $ld wilhio o& }@ <br />ofompl€lion. rh. ol,ns Builds vil halc ln. trdar oaprolinB rnd he or she did nol hlild or imFo\. thc F!F1y for fi. P1aoF of <br />l. d 0r,6 oflhe rtopdly, m exclusiv€lyconlra.lins Nilh lictucd contRclo6 lo c.ostuc! th. prcjet lS(. 7044. B linc <br />and PrDnsion cod.: Th. Contdcroas Li.c.sc Low do6.or applyro anosi6 ofpropeny who builds or inplold lher€on. <br />and who conr.acrs for5u.h pmjdls vith a Conlra.lo(, lic.rEd l)u6Utut ro lh€ (ontra.r.rs Li.eM Law) <br />I lnru\cn,fl u d0 Sc.{ o B &PC aorthisreNn <br />lIOR(!RS' COMPENSATION <br />DECLANATION <br />I hdeby arm undd pa.ny of pgjury o.c oflh. lollo$ ing dftl,mlioN: <br />-I <br />halc d sill mainlain a Cslifical€ of CoBdl to S.la-lButc for sotk6a omP.nsrioo, s prolided for by Sa]1ion 3700 of th€ <br />Labor Codc, for rn pdforlmcc of th. port lor which rh. pmn 6 isu.d. <br />I nave and will mainrai. wotk.ri compcBarioa i6uruce. 6 requirol by sd ion I700 ol rh. bbor Cod. for lh. Fr'nn'n" o' <br />lh. work lor which rhs Dmir ir issucd My worke6' comFNlion idtrece !_ris dd poli.y nombs e e: <br />I cenilylfi inrh.pd hrmarce ot lfic rvorl nn $hiLh lhis pmbn is iss'r <br />$ 6 to bdonE $bjd to th. so.k6 compdBrion lass ofcali .8rcc rld iflshould k{om. <br />*orksl comp..sati.n prev6ioa olsdion 17LDollh€ l-abor IslnlL.lonlN(1,ron,pl) \ h rln,sc l)(n is <br />WARNINC: Irailure ro Kur€ qort6 .onpqsari.n unlanful. ud shall srbi.rr orploys lo <br />nundred rhousd d.llad 1$100,000), in lhe cos ol conP..etio!. danasca <br />€ <br />Dt.;( t,,rR \r (r\ <br />I hftby 6inro ond( Doalty ol p.dury thd I dn lice.s.d undq <br />of fi. BsinN md ProlssioN Cod.. ad ny li.N t in axll <br />ins sn[ Scdion 7000) olDnisbn I <br />I hdeby a.Irn !nd6 pnaly oi p€iury that lhde is a .onsrodion lodins arocy for <br />isued{S(. lCD7, Cn. C.). <br />Frfonnance oflhe*orli lor which rhis pshit is <br />A8IU(ANLDECInISAIIO! <br />I My afinn uads Fnrlry of p.rjury oocoithe follotrinr daldarions: <br />DcnDhion Prmits-Asb6ros Nori,i.alion r.dnal R€sularions ('l nE 40. Pd6) <br />R.{un.d L.llcr ol Nolificarion <br />_l cqrify rh.r rh. adld.l regulalions <br />I cdib inar I lulc rad lhis appli.a! <br />ordina..B md Stal€ Larvs rchti.s ro bni <br />erhat thc ahrve inronn!!i.n is cotr4t asrdro.orply wnh allCnya.d ('oumy <br />oflhi.cily d Counlylo 6la upontnc <br />above mcnrioned p6p.ny for insp.clion <br />ApDlic{nl or lScnl Sig nlur.: <br />pdi,irfr mre(pritrr), n <br />ioBtndion. d n€r.by aurhorizc <br />Forms/Steel/Holdowns tz/tt/B -,Pi4) <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Subf loor/VenUl nsulalion <br />Roof Sheathinq C.A. p"t4 <br />Shear Wall L <br />Framing <br />lnsulation/Energy <br />D_rywa ll <br />1 1 t1 uaitn ,tJ@l/ 37 t",p <br />n Coa t a<-al*-1 I,rri \q ,r4.1r}|o{ {o !,"-^ d A.nh - h <br />It4asonry btz"r r"lp.-l'. <br />Pool Fence <br />T-Bar <br />Handicap Req <br />Deputy Final Report <br />Enqineer Final Report <br />Flood Zone Certif <br />Ir ) <br />FINAL I t\{Jy'71t, <br />Certificate of Occupancy <br />Notes, Remarks, Etc <br />L<(x unl 36 le./ rl bo,-ou(l <br />1l;.-o I v <br />1 I d_t ,^-e.t- <br />t/c4 <br />lr\V1 th^<r,1 <br />e/'v-l A <br />Set Backs <br />., <br />Gx{.llnt. l'ae <br />-;ln I A <br />I <br />: <br />tt <br />I <br />tr@