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BUILDING- INSPECTOR RECORO
<br />SITE-WOHK DATE ID/SIG.COMMENTS OWNItR Btill-DllR DI,il-CABATION
<br />I h.Eby alii.nr ! cr,.trrhy of p.ryry thir I m.r.mfl,onthc ComacloR'Lt..E t:w rd ih. followinx rc.$n (Sd.7O:11.5
<br />Bu\iness ad Proltsion Codc): Any City or Counry which rcqunes a pchi( (. ondto.r. ihM. imProvc, dcmlish ot Epan ,ny
<br />srrudu@. piu ro ns islu c., \o rcquiB ir. [I)ILicaN lbr $ch p.mrii t, lih r si8'Ed sd.ft.l rhar tE or shc is 1i..tr5.! pursanr
<br />ro rh. pdvirions of rlE Conrmror's Li4nkd trw (Chaprcr 9, C.mocEi.8 wirh Sedn'n Tlxxr.f Divkion I ofih. B$incs rnd
<br />Pmr'.sions CixL) o l[r tE or sh. is er.mpr rhtrelion ard rlE b&sis lbr rlE ilLged er.oprior ny rioliion ofs*rior 70ll.5 by.iy
<br />rn icrtrr ror!t nnl subjccFrhe rpplico lo!civilp.uhyoinorrmrclh fiv. huidtd dollnts ($500).
<br />)fI. . .**, .r,rr" rcI"ny. .t my cmnk))tcs w h s!g.s 6 rhct $le corpensdion, will d. ilE sork dd rL idm L mr
<br />im.'nlcJ orofieEd for sl. (Sa.1}11, Busin.s lnJ Pmf.sions Cod. TlEContidor'sLic.ns.Lawdoesnoripplyroanowrcrof
<br />ih. pn .ny wtr t{ildr or infnrEr rh!rul id wlD d(6 such !o,t hioyll or rssllor rhlough hn or h.r own emplortA,
<br />provided rhar such impmvcmnh e mr idcnd.d o! olicrd lor sL ll; holevcr
<br />'h.
<br />tlilug or inpo(mnr L( $Ic wnhln om ,!tr
<br />oforyLrior rh.oqftr Buitlr willhsE rh. bunl.n ofpovirs lhd lEorsh.d nol hitl or inpo€ rh. pop.n, ior rh. purT.s oi
<br />I. N o*ncroirhe Impeny, am.xclusiv.ly.onrdirg wirh li..trEd.odracro^ro.onnru.r rtE poj.cr (s4.701-1, Bu\iks
<br />! rtDlAsi CoJe, Th. Contr3ctol ! Licehe L{w rt,rs ftn sI'I,l} ro str o*Nr ol ptup.ny who burlds or impto\ts rh.r4n.
<br />wh. c.nnrd\ lr \uch roi(r\ wih r O)nrr.k)r1\) lic.niJ nu'\,rnlr, rh. c(,nt&nr'J Lr.0se l.rwl
<br />!r!!A-Blll!f
<br />I h.rcby rtiirmundcr ncnahyof tcrju'r/ox of rh. lnlloqing {lcclmtinr
<br />I haw md wrll nEinr.in !C.nitidar. ofcons. ro S.lf-ltr Eformrt. c.n[.osatiotr, a! F,vid.d for l,S..riotr ]?mol$.
<br />Ijh., Codc. for rhc pstorlr@. oa rhc *ort ,i{ rii.h rhc pcrmir is iisu.d
<br />_I hav. rnd will hrinriin wort6 comp.tu.rhn inrlrlac, .s Rquircd by S.crio l?00 of rh. Labo, Cod., tor rh. pdtotu. ot
<br />rhc *ort lbr which rhis l)(rhir is ns!d. My workd: e,nIxjNrion iBlrme cris nl IslEy nunh., uc:
<br />Jxpircsl
<br />ccnilyrl' inrr lc,nrNncc ol rlr wo,k n{ *hi.h rlns r)cntu r i$ued,I shrllnor cnrploy uy E-r$n in a.y manncr
<br />$ !r ro h.com suhjN! ro rhc m.kc6 mrn0crs.rion hws ol C{lifomu. , 33rccrharifIsthuldh.comsubic.irorh.
<br />*o*.r: coftp.nsdrio pDvnioN ol S.d Dn lTlI) of rh. Lbor Cod.. I slull, lonhwirh lxmply with rhos pDrisio'L.
<br />WARNINGT Failurc ro sc.m qortcd comp.ns{ion colcdEc is u.l.whrl. Md slull suhjcct u .mploy.r b aiminll pcMkica Md
<br />.'v'l ft,.! up h fne hun,lrcd rhouirnd 'loll r (Sirn.), in sddition to rh. cos or cDrn0.trerion, dim8cs i\ provil.! for thc
<br />llllfr\8MlQll
<br />I hctubyallirmunddrp.nrhyofp.rjrr,thd Irm lk {d und.r polirion.IChipr.r, (.omEn.ing wnh Sccrhn r0fii).1'l}ivntun 3
<br />.i rhc Busi.s\ ud PrcltsioE code. rd oy lic.nsc t hlrlllbrcc irxl cfficr
<br />Lic.ns.Cla$ Lic.NcNumb.r:
<br />c!)rifltrllcMNlnNllNclcllcr
<br />I tEftby affm rnd.r lEn.lry of p.rjury rhlr rh.E is ! .ori rudiJn LndiB !3cNy lor rh. F{omN. ot rrE work lbr whicfi rhi pdnir t
<br />issued (Scc.3017, Civ C.).
<br />APILTCANIIIECIA84NAT
<br />I h, lrmr und.r p.n.lr y of p.rlury oe of rh. foll,owin8 &.l arions:
<br />Dcnbliri.n P.rnrrlA!b.nos ion F.d.Bl R+ub(nn\ (Tnk.$, Pdn6)
<br />hd rhd r'.'leful re-nlrri,,x rc!&jtr,! r\6.(or r.nx)vrl rr. nor rt)t)lcrblc o nN |norccr
<br />rhi\ uppltnrion a'd sar.thsrrh. rb.'. infornurioo n.ord Irgrroco
<br />ro building cor(DL1nn\ anl h.€hy rborr. r.nr.e ilvcsolrhis
<br />,"21 arx-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenUl nsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif.
<br />I
<br />FINAL (u L:ry4,0 .W
<br />Certilicate o, Occupancy/ I I
<br />tNotes, Remarks, Etc.
<br />Rev 0n'07-2015
<br />l)urr:
<br />lxelL' ' AJJ($
<br />' tl)
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