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BUILDING. INSPECTOR RECORD <br />DATE ID/SIG <br />Set Backs <br />Forms/Steel/Holdowns <br />Erection Pads <br />U FER Ground <br />SLAB Floor <br />Subf loor/VenVlnsulation <br />Roof Sheathinq <br />Shear Wall <br />Framing <br />lnsulation/Energy <br />Drywall <br />Ext./lnt. Lath <br />Brown Coat <br />lvlasonry <br />Pool Fence <br />T-Bar <br />Handicap Req. <br />Deputy Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />I <br />2 /// //c/,.12141-at .7FINAL <br />Certificate of Occupancy 7-r '- -L/ <br />Notes, Remarks, Etc <br />OWNER BU!I-DER DEL('ANATION <br />I hftby afiim u.d6 p..aliy of p.rlury rhal I d.x€,qr nom rhc Contractore' Licer* hN for th€ follo*in! tm, (Sc 7031 5 <br />Rusin6s dd ProfNion Codc): Any Cily or Coud, $hi.h requn6 a psril lo .o6rtucl. ahs. improv., dmolGh or rcpan sv <br />srrudue p,ior ro ils iasud.., abo r.qun6 fi. applictun for such Fflnir ro nk a sisncd slal66l rhil h. or sh€ G licoscd p6udr <br />ro rh. prcvirions oarhc Cofltacrd 3 Lic.ns.d btr (Chaptq q, Comncncins snh sarion ?000 or Division I oflh. Busin.ss dd <br />ProrcsioB Code) or thar hc or shc is cxcmpl rhr.iiom a.d rh{ baris ror thc allcsed €\dflion Anylioltrtionofsc.lidn 70115 byanv <br />lpplicanrior.!..nitsubjdlsth.aptli.mrtoacnilpenaltyoinollnorcrhdfivchtrfldrcddollas($500) <br />rilL <br />i.rodal or oitcd for salc {56.7044, aBi.B ed Prc adioN Codcr Th€ ConrEdoi s Licffi Ls{ do6 .or aPply lo u otr <br />rlE popdy who hilds or iipo!6 $@tr adqho &6 such \rerL hiEelaor hdrlf or lhtourh his ot hd om chplovc6, <br />provded rhal such i.psv.m8emriod.dorofiF.dlorFlc.I(h.*6s.thcbuildinsoriqmlmlis$ldwithinon.td <br />ofcomplclioo. ttc Osid Builrls sill ha!. $e blrdo oaprolinB rnal he or sh. did nor hlild or iml,Drc lnc p@Fry lor lhc pur,()F ol <br />-1. <br />d oMtr ofrhe pmpaly. d€xclulivclyconlr.crin8 \vnh licoscd coilradoE ro co6trud lh. prejdr (se. 7044. BrEinB <br />.nd Pio,isiI Codc: The co ra.lofs Li..nsc Law do6 nor applylo so*ndofprop€nytrho brildsor imp,ovd $fton <br />and who conrhft aor such proj.ds *nha Conl6clo(s) li..s.d puG@n kr rh. Conlradois Licds liv) <br />I'm.\on trndd sa"on .B &P( alrrhB'@on <br />-ZC- tO s^e€E-To r.vauo S <br />lg-8[.!l3l!ar!tE!ji r.9!uEt!!Bll!9:l <br />I hcrcby afl,m undq p.adly ot psjury oo. of rhe fulbsnig d(leotioN <br />('inid <br />- <br />.-ExPir6 <br />ccniryrhal in lhe pdromncc ol th. \vork lor shrch this Prmn is i$ucd.l shall nor @ploy.trv pqsn in uv nmn.r <br />s a! b b.corhc sobjd lo nrc $or(sJ c.nFnsdrion l.ivs oa( .lilomia. ud arrE rhd ial shtrld b.co,n. subjd htlE <br />Nork6' .onpsarion prcvGioE oasalion l?00 of Ih. Libot Codo t shall, lonh$nh comply Nilh rho* provisions. <br />WARNINC: Failurc t sur. work6' cohposrnrn .o\dBc is lnlarvtul- md shtrl subiel M mplo}lr ro diftinil peEhie ud <br />civil fines up ro on. hundi.d lhousdrl dolld ($l0o,0oo), in addirion lo rh. cod olcomp€Nalnrn, ddn.gcs 6 provid.d for $c <br />Sarion 1076 orlhebborcodc, int66l ud tnoiney's L6 <br />Aue col <br />llrcLASarlQN <br />I h6eby arrn und6 Fmlty ol pqjury lhal I on li.as€d und6 Provisioi ol( hapl6I (conrmdcinS wnh Sdion ?000) otDivisioo l <br />ol lh. A6ind &d PoldioN Codc. ud my lrcse s in lull lorcc d€fi*l <br />CO.NIIAICIIANTE!!$!.ACEXS <br />I hd.by amnn und6 p€oahy oa pdlory rhar th@ t a consrudion L.di,8 .socy for rhc Flonnec. oflh€ wort lor lbich this pdmn n <br />issucrl (S(.:1097, Civ. C.) <br />atfLlca[LDDcldSal]aN <br />I hdttr aflim und( ,erally ol pajcy od€ oalh€ follo\ i.s detl-tr io.sl <br />oamlition Pmntu-Asb6lor Nodication F.ddnl R.Sulalions (Till.,l0. Pd6) <br />RcquirL{ LLlier ot Norifi calion <br />-, <br />c61ify lhal rh€ t d6al rceulalioB rcstrdins sbelos re,nolal d e .ol applicablc to rhb poid <br />and dar. thot rn. ibov. iniomaidn t or..1. I asre lo confly sil[ .ll Cily d Coum, <br />ion. d lErcbyadho.izcrcpr66laliv6 oflhis cnyed Countylo old upon lh. <br />above 'ndrtuncd <br />ptupdy lor <br />x_",.,a <br />Avacoa <br />l-26" / <br />SITE-WORK COMMENTS <br />r" <br />-l <br />har. dd will rainl.in a Cdilical. of Consdl Id s.la lsu. for workda onD€nstion, s provid€d for b, serio. 1700 of thc <br />Labor Cod€. lor th. FaomMc€ of th. trolt fo. which rh. p@n ie issu€d. <br />-l <br />ha!. rnd will nlainlain wdd(.i! .onp.Narion iGuraf,cc. 6 r€qun d b, Sal ion l70O oflh. bbdr Code for lh. p6aommc. of <br />rh. *o* for wtich rhjs p€nnir is iisu.<t. My workdr onpsdion insure.e tmid stl policy .!mbd dc: <br />L.nd., ! Nam. <br />- <br />I e ,lo r aJ.lid <br />- <br />md 9d. L,ns Elatina ro <br />tt <br />I