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BUILDING- INSPECTOR RECORD
<br />I h.rby afrmr und.r p.naliy of p.rjury rha( I m ex.mpt from rtu Co mroR LtrM liw for rh. folldring E,sn {Sd.7011.5
<br />Bdsi.css .nl P..Icshn Codc): A.y Cny.r C.unrv which rcqlircs . IE.mir ro c.nnDcl alrs. ifrprdve. .kmlirh or Npat my
<br />in'.rur, ,rior ro ih isru! ... aLs Equr.s tlE anplicmr for $ch D.mi ro fih 3 rtEd srarcBni rhd tE or sh. i3 li!!r*d plrsdr
<br />ro rhc povxinni ofrh. Conk&ror's l-tcnsd Ij* (Ch8Fer 9. CoBrutuing *irh S(rion TUXI of Divnion I ol rh€ Bsims lnd
<br />Pml'.sioN CuL) or lhsr tE or llr h .renpr rhuronon and rhr b.ris for rhr all.B.d .r.mtrDn Anyviolrionofse.rionroll5 by any
<br />lptlicrm for, p.mir subjeh rh. itplicrnr io. civilpcMhyofnor mr. rhan nv. hud.cd doll& {rJlX)).
<br />_I. rs owtur ol'rhu lroFny, or 'ny.mtloy.cr wirh eig.s ar rhck s.lc co'no-nsirion, willdo ih. m* a'rl rh. (M@ is mr
<br />inrc sl or ofi.rd ror $lc (Sa 7or,r, Busin.s and Pmf.ssions CoJe Th. conkcrois Li..n* Ii* docs nor rprlr ro.oowEr or
<br />rhc pnp&, *FIl b.ild! or inpruks ihctu , xl who do6 snchMd( hinselfor hcNllorrhrculh ht or herow!empl{,yeds,
<br />provid.'r fiar sucfi impowtutrK &. n.( inledcd d. nltBl lor sali ll hd*.vcr, rt* lnildin8 or nnprovcmnr i s.ld {irhin onc ra
<br />ofconubrbn, E Owrcr Blil&r vill IuE rlE bud.n oI poving rhd lt or sh. did nor buill] .r inpNB rh. pmpd, nr lh. purDo$ of
<br />L asowErofrh. pmp.ny, anr.iclurirclycoor.di,,g wiri li.lnEd.dntft.tnb.otr(rucr rL poFr ls{.7olil. Busin.s
<br />![] Prnlla\ir Code Ttu C'odBcx, r Li..nrc b$ dc\ not rpply ro an own.r of pn,p€ny sho 6oilds o. ,n mves rh.rcotr.
<br />atul wh. c.ntr{( for ntrhFoJc.N *irh a Con'6c'o(s) licoNd pu^utur h rh. o)ntNr.r'r Licctr\c t w).
<br />-l
<br />mcr.mpr utlder S{rbi-, B &PC for thi{ r.rvn,
<br />EAB{E8S:CA!4&NIAIII}N
<br />DECIABAIIQX
<br />I hr.by rltnn und.. l.ndryof p.rury.n olrh. following d.cLr.rioN:
<br />Ihov€atolwillmdrrainaCenni.0..ofcon* to Sclil.ruc,or wor(er'!-mp.E ion,a\ pdvid.d for byS.crion lU00 ofrh.
<br />Lahor Cod..lor rh. p.rtormec olrhc wo lbr *hi.h rh. pddn is i*!cd
<br />and willnrinra work.rs'uonl!.Nlrioninsu.lee.ar.eqtrir.dhyS.cinrl7mofrh.hhorCod.,forrh.l.rf.rnuNeof
<br />rNulrnc.6n'.r nlFn'cy nunrhir rc:
<br />e
<br />N*"6-,. q L2 <--'t AC-t L-7-Z I
<br />I.cnify rhar ,n rh. p.rfornrncc.frlF *ork for whichrha lErmir is $ucd,I shlu nm.mploy oy pc*on in ay lfuRr
<br />s .s ro bcmnE slbjlrr ro rh4 s.Ic 'comr.nsion laws of Cllifomia, and agtod rhar if I rhould b.corE subl.cr ro tlr
<br />tuders.orrp.hgrilnptuvieonsolS.crionlTmolrh.I-lh]rCod.,lshaltunhwnhconllrwir[rh.ep61irio .
<br />WARNINC: Ftrildr. b $c!rr qo .B !$.,p.d on.ovcBAc a unla*tu|, and slrll subjcd an .nrlloyer ro oi0iml FMI'i6 ud
<br />mtr. d.ms.s !s rovidcd r{j: rhcciv,L iD.\ up to on. hundr.d rhousrnd Jolhrs (Sl{xr,(xx)), in di(
<br />Secrid 1076 of rlE hhr Code, inr.r.s and a omy\ f..\
<br />,'?--Zo - z-t t
<br />DE!!A!AI!O!
<br />I hdfthy dlftr trnd.r ptnahyolpcrlurr rhar I rfr lionr.d und.r pmvirion otChmrs 9lcomEn.i.g wirh S.cti,n 7fil))ofDivirion 3
<br />o, rhc Busincs nnd Piolcsioni Code, a. my licenre is in tirll nrE anJ.liicr
<br />I lrEby iflim undd IEMlry of F.rjury rhar rh.r. t o conn@ion Lorins 'g.my lo! d. F.folre. of tlE rsk fo. *hi.h rhis pdnir is
<br />iisucd (Sc 1(})?, Cir C.)
<br />dEE!IE$qDE!LA!{I!1A
<br />I rtr$y itrm und.r ,.n!hy oi p..jury om oarhe followirs r!.cld,arioh:
<br />Demlnion Pernirs-Asbe(os Norification F.d..d R.Eulatiotrs (Tn1..10, Pd6)
<br />R.qun.d lr(er ol Norilf,ario.
<br />I fy thd th. f.d.rul Eglbriorls Eguding asbcnos rcmtal Tc ndr +plicrhlc b rhi! poj.3
<br />arion rnJ $nr.ihdrh..6r\. i'rfombriotr ii coa..r I nBlero.-mply*ilhrll Cirland Coumt
<br />oili'!tr[.s ]nd Srdc Lrs rcltritrE ro 6uildnu ofrhnCiryr Cou yro.nr., uponrlE
<br />ntrnr R.nrion dIn)F..nv ntr m\E(hn
<br />/\Dpli.lnl or ,lg.nl Skru
<br />SITE-WORK DATE ID/SIG.CONi MENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Roof Sheathino 7/z</=a Zlztt
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />ftilaso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />FINAL .lzv,/z;)/2it5 uzaas A)
<br />Certilicate of Occupancy / t
<br />Notes, Remarks, Etc.
<br />->
<br />Rev.0B'07-2015
<br />n*,'Z.n- 2a- 2-,o
<br />UFER Ground
<br />Sublloor/VenVlnsulation
<br />?zG < /L
<br />IrnJ.''\ N.{c'
<br />kn,lcr's Ad(hrs
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