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BUILDING. INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER AUILDER DELCAR-ATION , J
<br />I hdebv rmm undd pcnally .r polui, rh.I I m .xcmpi 6orn thc Co,lrrcton l-ictu. hs for th. follo*ing lwn (Sc70115
<br />Rusin* &d Prolsion cod.) Any Cily or Counly which r.qun6 . tffni ro co.nrucl, sllq. improvt. dcnolish or r(?tn ay
<br />$rudue Fior t. ns isuecc, atso E{ut6 rhc applicdl ior such Fnnil io fiL 0 sBn.d sl3lmol that hc or ehc it li.m.d pu$an
<br />ro rhc pmlisio6 oarh. Contactols Lic.nrcd l,* (Chapts I, Conndcin[ wnh Sdrio. 70OO of Division ] oflh. BusiB ud
<br />Proa.sions Codc) or Ih.l h. or shc is .rmpr lhqcftom d rh. basii for rh. all+.d .rmption. Any vrclalion oisdFn 701 I 5 by my
<br />ippli.anllor.F.flnirsubjErsrhcapphcdlloacivilFnalryofnotmor.lhml-rr.hun&.ddouds($500)
<br />l. r .\rd oirh.FmFnt, ur ni mploy.6 siih q0s6 6lhcn Fk cod!.6ation. will do ttE vork ad lhc sln[lw t mt
<br />imddal or .fld.d aor slc (S{ 7044, Busin6s dd Pol6ions Co3. Th. Contactols Lt..& ljw do6 nor ipply to s ow.6 ol
<br />rh. propdy \ho builds o! iqrcv6lhqan. ,.d $'ho do< 3uch torl hims.laor h.elf or rhrougfi his or hd oM cmploy.6.
<br />rovd.i rhar sn h mpmlmrs m noi inrdv.Ld or o,Is.C aor $lc Ii ho$66. $. hilduB or imrrcwl is sld vithin on )@
<br />oi.onplriorl ihr L)sr€r Duild6 will hrvc th. trd.n ofrrovi.! tha h. or $. did nol build or imFolc Ut prlFly for ih. purpoE of
<br />-
<br />l. 6 os nd ofrhc pmrdy. m .rclusivcly conk.clins wilh liccnEd conuiclo6 ro coMcl rh. pmjdl (Sa. 7044. BsEs
<br />ed PJoesbnCod€: Th. Conirs.lo.s l-icdsc t-aw do6 nor applyio owf,s ofp.oFly who bnil& or imp.ovB rh6on.
<br />and who coflra.1s for .h lojds wilh r Conl€clo(s) licmed pu^@t ro rh. Conir&lols LG.ffi L!w)
<br />Itu ei.n,p( undcrSc.ru Il &P( f$rhisrcason
<br />lloBf,,i8s:l:OMt[rsirloN
<br />DEOAAAIIO!
<br />I had\ amrm undr penallyofpsiurynne oflh€ lollo*iry dtlrariotu
<br />I ha!. od Niil mainrain o Cdincar€ ofconmt lo Sclf'lrsur. aor sort6 comp<sahon, d pmvid.d lo. bySdltn 1700 otlhc
<br />Iib., Codc, for rhc pdfome.. ol lh. sork aor whi.h lhc pdmit ir suol.
<br />#r t* *a *irt .uinru. *o ot comFBario. i ura.cc. s r.qut.d by salion 17oo or rhc bbor cDd.. ror ih. ps,bmmc. or
<br />rl-. wc,l l(i sh(h lhs prfr 6 Nudl MJ uorrFr'romptur"r n'u'ilcc.FH aid!ol() numbd m:
<br />,",,"e7*TE: hstt-d , /-zs
<br />,",.*"",,:;E4V$l - zn,t ,.,,,,.2?z l'
<br />I..difylhii inthcpslonmnccofth.uolk lor utrh this pcmn is issucd.l shallnol dnployanypsso. i.erndna
<br />F N to b.come subjtrr ro thc *o 6'comp.tuatu.liws ofcaliaomio, md asrr lhal ilI should t tom. subldt to lh.
<br />so!k6' .onpo&tio6 po /iliom of s..tion r70o of lh. hbor Cod€ I dull rodhrilh comPly wilh rhoE provisio6
<br />WARNIN(; l;arlur€ to Kur. workc6'compcnsal,o. L\\dN. s l. and sn ll subj.rl d dploF ro dininar Ftl,i! Md.
<br />civil fir$ up ro onc hundr.d ihousand dolld {ll Io th. cosr ol comDccalion. .ldas.s a ovid.d lor lhc
<br />Serion 1076 olthc li! CoJe inltrcsr ed
<br />3l-26
<br />I hftb) a'llm ondd p6.lr, o I pdjury rnd I m licas.d !nd6 provision oichaplq s (comndcin8 wilh Sdion ?OOO) of Division 3
<br />of rh. BEm6s d Prol6sio6 Codc. dd my lrcftc s in tull lor.. ard .iINr
<br />b
<br />-L
<br />20
<br />cax aucuoNtllDlNc-acllct
<br />I hcby alttrm Lndd FElty of p.rjury thd th6. is a $Nlruclio. ldding agm, for lh. pdlomecc of lh. w.!k tur *rich $n Fnn !
<br />isu.{(se 3097, civ. c ).
<br />AIEII(AILDI:O]I8AIIQN
<br />I lEtb? rffm trndn p.aalty ofp.'jury on. olrhc rorn^linr dclrarions
<br />D.nblrin P.rmils-AstEtos Nolinc, io. Ij.d6.l R.aulat ions (TnE 40- Pdi)
<br />R&uir.d l-.(d.lNori6c.ri.n
<br />I rdia! rhil rh€ feddal r.sulatioN r.sadina dbGlos rqnoral ac nor apdubl. tu lhG pmjd
<br />I ccilify rt5l I l_ov. lcad rhis ap!li.atio. anC srar. rhar rh. abo!.,nlomaiLotr rsrond. la-qrElo conrply*irh all Ciryand Counry
<br />.i,nir6andSrirc Irqs'.bt ! h build n. &rd hdebyauthrnc G?rMtaliv6 olths Cirydd Coorrro dro upon lh.
<br />at{r. mqrioncd p.op.ny lor insp.rlron
<br />,\ltli$nlor ttml Si[mxr ",,,''/^7l.zd
<br />Set Backs ,/',u{69Forms/Steel/Holdowns Y !r?o"b DVaatkll,
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUl nsulation
<br />Roof Sheathing II
<br />Shear Wall v 3il!lr@ twY r
<br />Framing 2IILilP'A qilun<ty^
<br /><f-nsLffi@r/Enerqy 4t,tlun Abdbt aU
<br />D-rywa ll I
<br />Ext./lnt. Lath
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL €/&1tu $brra t{t#
<br />Certificate of Occupancy I
<br />('tJ|-b Awat f
<br />SITE.WORK
<br />Brown Coat
<br />Notes. Remarks, Etc.,,.4
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