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BUILDING. INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenUl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat 2-o{- 2r,BEH / '>
<br />lt/ aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Frnal Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />t,",
<br />FINAL z//d/-%:'4r.)
<br />Certificate of Occupancy / / r'\
<br />Notes, Remarks, Etc
<br />OWNF'R BUILDf, R DEI,('AI'A-I'ION
<br />I h6€br amnn unds Sialr! ot [riurr-' lhal I dn .rcnrfl fo.r rhc Conlracrod' I-i.mse L.w fo! rhc nnb\YinB rcsn (S< 7011 5
<br />Lrusin6s ast Proleslon Code) Aoy Cny or (ounry \hich requt6 a !6nir ro connrucl- alr6. inDro\c dcmolGh !r k rn dl
<br />nrucru,c l)norro its issuecc, also rcqut6 rlE applrcanl lor such p.nnil ro file a sirn d srahhr rh01 hc ot shc b ltmsd pursu.nt
<br />lo lhe pAis re ollne Conlraclois t-i..nscd Ij$ (Chapls !. Conm.ncinr $ith S{lt.7000 olDivision I olrh' B lin'( 'nd
<br />Pioi€siofls ( odc) or lhar hc orshc is.x.mpr lhscLom and lhe hasis nn rh€ alicsed crc$prion A.vviolalionolsc.iion T0ll.5 bv anv
<br />applicanl iu a Nnni $'6j.clslhc applicanl lo aciriltcnaIyolnol morcllEn li!. hundren dollars($500)
<br />I.6 o\ncr olrhe I.or.ny, or my enlploy6 \iln Nars a rh.n sok colnFLnsal$n. $ill do lne !o* a rhcsltudftismt
<br />iatnH or oncrcd tu sl. (Sr.7014. Busins dd PNlsiof,s ( odc-th. Q,nta.d s Lic4s liw dos nor.pplvlo morsnd.l
<br />rhc ptulEly sho tn'il& or nhlmvB lh6t. od \ho.n)E such \.rt hims.ltor h€6drorthrouth his or hr oNT.mptuve6.
<br />pR idcd rh.r soch iDlrovolnb rc nor iddd.d .r ofld.d for tsk I t hor c\ 6. rhe hrilding or inllm\Bnmi is pld s irhr o.. -vw
<br />;rconpldion. rh. ovfler Ruild6 \yill har rrE hrdd of FoYing lhd h€ or sh. dd nor hild or i:nr.ot rh. pstElv lor rhc IEps ol
<br />L s o\.er ollhc lrftrp€ny. e o\.lusivcl, conn ldrts * irh li.e6.Ll ..nL icio6 tu Qn$r.r rhc ll ojcd (S( 7044 86'nN
<br />atrd hltessnnrCrdr:IheConlrocloisl-iccnsct-awd..snor.l)DlvlosnrsncroiD.pcnvvhobuildsormuovcsth6.u.
<br />.nd $ho co mds fo! $'ch lxojc.s $ nn a (-onarto(, licens.d tu's if,l ro rlrc Contacrn s Licse La\v)
<br />I rne\cnr undcrsecln,n
<br />O.le: O*ner'
<br />\toRKEiS; coNlF[Nsa-I toNp[cuaaro!
<br />I hd.6v.ilnn undcr poahy dlFjuryon.olthe follo\vins dtlrarioB:
<br />l lnvc ind \vill nrainlain a Cdincd(. u l (-dsctrr io Scli-lnsure litr \turkd t con[En{lilD, 6 f('!id.d ld hv Sdrn'n :] 700 ot r hc
<br />l)(rlii,nntr.c.llhr \o'l li,r $hi(h rhc frnlir ,s i\n'cd
<br />randsill rii'nain worke6 coll]pensaln,i nrrrnncc.6 r.qtriedhvS((ionlT00oilhelllxr(odc.lorrhcFfoma'"""f
<br />)1",r+e
<br />\I)
<br />Fo L)D y'z
<br />*)l.Ll {o t 7 o -2-<>
<br />l\l
<br />i
<br />s, asro hN.rnc subiNr ro rhe \ortss co,np..sart'n l.ss oicalifornia. lnd rsr.c r[ar ifl shouki lBoln. s biNl io lhc
<br />rorksJc.,P6sari0rrovisiorsorsectonlTo0olrlEt,ib.rCodelsh.ll,lin[sirhcomply*i!hrho*fllvisions
<br />WARNTNC Failrc la sur. \.'kd! con,pssariofl covcra8c ir uihstul .nd shall subj&l an qnplov.r ro si'nin.l ptrlrie ond
<br />.ivil nn.s up lo otrc htrn&.n ihousand doll s ($100.000). in addnnrn lorhc c.s.lcompensaiion. ddn4.s 6 pr'\ideil ror thc
<br />( odc. inro 6r md dl{,me}'s rc.3
<br />\)AJ'
<br />DEcLARATION
<br />I hcrcbt amm trndq penall) oiprjuryrhar I m: licdEn under provisi'noI('n'p169('on'ncncin8 \ith sdion 7(u0) 'r I)i! ilion I
<br />oI rheBusiicsand ftolsionsCodq Md rylicdse is in tuU force ad.ller
<br />rctr\c( A' c 35
<br />,,.," Itl4ii?
<br />0 at0g
<br />^*,,",., .\t4,toa{r- ?t4.
<br />CiJNSARUC TIoN T,ENDIN(; ACENCY
<br />I h@by dlfim undd Fn.lryoap€.juryrhar lhs.ii, coniruclion Lnditrs aloq for lnc pqfomdc. ofrh.\vork tur which rhi! pont b
<br />issued (S<. ll097. ci!. C ).
<br />Lend6's Nsrr.
<br />APPI,ICAIiT DE(:LAII,\1 ION
<br />I hElr aninn u dd penahy of Frju,,- onc olrhc lollo\rins d(latarions:
<br />Uemolirnrn l!.rmir* sbcros Notificarn,n F.dcrrl Rcgtrlarions(liller0. ran6l
<br />R.\tL'ncd l-cns olNorifi cartrn
<br />I colily rllil rhc l.ddal rcsulai ions regudina 6b$us, t tr al arr fol lmlic.hl. b rhis pFlect
<br />irilili rhd I lurc rcad lhis.nt,li.rrn{sl.ierhar rhe!hre Lnlnr rdriL!l
<br />,nxls!dc La(s rlihn! ro l,trilil
<br />abo!. Denrntnd |,nr|,tll) for inspahon pr
<br />1l\pflictrnr or \,rrn( \irtrrlIrr5+Ar<nt> cufr'"'"lsl4
<br />SITE-WORK
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