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BUILDING- INSPECTOR BECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS owN ER ttu li,DliR DELCA L rloN
<br />I h.Eby lffi.m urds p.nllry ot r,.rjury.hd I an.co 6!m rh. (lonrmcrou Lt.os. tj, forrh.IollorinS Eaen (s<.'7011.5
<br />Busincs and Proltsion C.Je), Any Ciry or Couniy which ,cquncs a lEmir 1. connrucl rh( imp.ow, dcml o, Enan Dy
<br />anc..alsorcqurt\rh.rpplicaNtursu.l'p.rni('fileis*cds{.nEnrrhlrIEordEslt..EeJpurul
<br />Conr,crois ,-icnscd ljw lchapr.r t). Commencin8 wnh Sccrion 70(n oI Division I .frh. Busircs\..d
<br />u rhar fuorshe iscknlpt rh.r.liomr l rlE bxi\ lnr rlE dLsed cx.n.Fridi n) vtrlridrofs.diotr7Oll.5 hyany
<br />rNnnil suhl.cbrh. rppLicrDt trr xcxilp.orllvofmr 'nor. n,r llvc hu dtddollM\($5(r{r)
<br />ow.crolrh.Dreplny.ormyc'nDhytcslirhwlgcs.sr&n$bcotr{x.sarion,*ill tlx eftl.rd th. nM@ t mr
<br />or offcr.d fn $le (5(.7044, Burin.s\ mJ fmf.$ions Cod., The Coturdois l-ic.n\. Lo* do.s nor dpply to snowE ol
<br />th. pNl.dy wb builds or in{xoEr dr@r 0nl who Jc $ch Mtt tumsel, or h.rclfo. rtrcugh hn or h.r oM .n'ploye!,
<br />,)r.vidcd rhd $ch nnpow.Enh @ tur idcnd.d or ollerd lq $lc 1,, ho!.[\ rlr &iltng or intprowmni is $U wnhin om ra
<br />oiconrplerior rlE Owrcr Builder willhsvcrh. budon orpmvins rhd he or $. did ndr buiu or inpov. rhc pmFny nr E purposoi
<br />I. $ orn.rofrh. DNp.ny, rmcr.lusiv.ly conkorint wnh li..i$d conreNs ro $nslrucr lhc pojed (Se,7{rr1, Bu\ies\
<br />ard PriLslid Cr.d.: The ConrEcrole Lic.nse ljr 'las mr aDlyb a.owEr ol protEny *ho bnihs or impmr.s ih.r.on.
<br />and wh. mntracN Ior ruch [roBl! wnh a C..rero(il lic.tr{d I'ur\ud h rh. codrachls Li..tuc trw)
<br />I rnr.rem un'l.r Sccr
<br />u,,,,Ll>r1zo:,u
<br />!:i!L4-8:!-1!!l!
<br />I h.iebyafllrmunder rnalryolxiury.m of rh. hllouinB {lcclulrions
<br />_I have rnd will nrinrdn a C.nificar. ofCons.nr ro S.lI:nEo€ lor wort.ts r$nD.nsorion, $ Iovit|d for lry S.crion l?00 olrn
<br />Iiho! Codc, for rhc psfortrru. ol tn ro* lor which rhc permn ir i\\ued
<br />_I hrv. rnd will minri,n *or[.^ cor{xaarion lsufuM., rs roquird by S..t iotr 3700 of thc libo. Cod., tu rh. IE tomm. of
<br />rhc rorl ttr whih rhis Frmir t is$cd M, *orkrs rcn{.Nrrion d ir.c r-$i.y drl plicy.unhq e:
<br />Icetrifyrhd in rh. I,.raornEre ohh. wo* lor which rhis 0.roir is isu.d,l shilnor cmpbyrnyp.tron ii my ndNr
<br />$ ss ro b.co'm $bjccr ro rhr s*cn'@mpcnsariotr law\ of CaLifomii, .nd r8re rhar it I shoild bccom sobjer ro rhc
<br />*orlich conll'.r$(io. pDvi\ionr otS.crion 1700 offie llbor C(nt,I snlll, fonhwnh&tr41y wirhrh.s povGionr.
<br />WARNING: F{iluE ro *cufr worx.6 on{E.sr'$n cDv.rusc is u.law6rl. rnd slEll su r cnrloyn io rinind !.olri6 rnd
<br />.!il nn.s op ro onc hundrcd rh.u$nd dolh$ (sllx).lxrr].rion. drm.8.s as povid.d lor rh.
<br />S.ciion 1076 of rlE L.hr Ctrl.. i' .r.n and ar
<br />pEtt 84.1!!)N
<br />undcr t6riri.nof Chapre.r(c.mm(rngB hScdiotr7(X$) of Dnision lI h.(hyarlnm uidcr l).Mhy.f0.rjuryrhir I a'n
<br />or rl'c Busircli ao! Pofsnns Adc, ul my lic.or iii! tull lnrd lni craocr
<br />Lic. sc Cla: Licen$Numb.r
<br />Dole:-
<br />c!)!rBrJE!lD.!!!D!relcErg
<br />I h.eb, afllmr und.r ,.Mlry ol p.rju.y rhlr rh.G ira @nrndn ! irg a8eNy for rh. r'e.fomMe of(h. work tor whlchrbiJ n m r i!
<br />nlucn {sa. :1097, civ c.).
<br />APPLICANT DECLARAToN
<br />I ltrhv afl'm uM.r |Enalry of D.riu.y on ofrh. follow$A dcclohfiotr!:
<br />D.nrliioD Pcrnrir$Asb.nos Norifiqrion Fei.ral R.3ularions (T(l..lo, Pan6)
<br />f.d.BlrcgubiioN mgJJins ilh.nos r.nlvJl ,c tror rp icJblc io rlns lmFr
<br />thn applicarion mtl iar. rhd rh.'. inlomhrion kcomd.l r8r ro $orply wirhu[ Cny!ft1Counry
<br />riv.s ofrhis C[ya Courryro ctrr.r upon rlE
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />S u bf loor/Ve nVlnsu latio n
<br />Roof Sheathino
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Reporl
<br />Flood Zone Certil.
<br />\r^- , "/),
<br />FINAL D'l.,l"ll)/l)U(UW J(6b/
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc.
<br />Rev.08-07-2015
<br />Contmclor:-
<br />kndcarAddrcs:_
<br />Dn", I f2:-/ 2'ozo
<br />UFER Ground
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