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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.
<br />-1.
<br />6 osn6 ot$c I,Np.ny. or my flplorG rvnh var6 a lhcn sE coftposarioo. {ill do tc ss! ed lh. id.lG ie ml
<br />intatcl o. olId.d aor !rl. (Sc.?ol4. Buire ed Pr.fcstions Codc Th. Conlruclols Lic.M Liw &6 nal rpply lo u oqs of
<br />rh. popcly rho bilde or inpmr6llEon. 6d wlF do€ sucn vod( hiesclao, hcrlr or llwush his or hd oM .mployG.
<br />prolidcd lhat such inprovmrs @ nol hr6(k or olIq.d aor ek. Ii tula6, th. hlidi't8 or itrllrcvoEr ie eU vi{hin ok }d
<br />of.ompldio,L th. omo &ild6 will hnvc 0. htrd6 ofprovi.s tha h. or sh. did mr biL4 or imFov. th. FlFry tor lhc puFe of
<br />l. 6 own6 of th. Ptopqly. dn.rclusiv€lyconrrocrin3 wilh lices.d conlEdo6 ro consrrucl lh. projrl (sd 70.14, Bcr6
<br />rnd R!ft$bn Cod.: Th. Conk.cloi s LiceN. Law do6.ol +pl, to m own6 oapop.ny sho builds o. ihprovcs thqen.
<br />and who contmcls lorsuch proj.€rs virh a CoflrEclo(s) ltccd pu^unt lorhc Cohrh.rofs Lica€ LNI
<br />_l m cr.'npt ud6 S.dio.- B &PC forlfiis l@n
<br />D q Ontr.r:
<br />vaBKEA!_CAlISEllAr!9rqucla-8Arot
<br />I hotby .mnn unJs pcnaliy o I polury one ol the lollos in8 dddatioB
<br />l have ud qill nriarain a Cenificatc of Co64t ro S€la-lnsure for workeB conrp.nsar io,r, .s pro!ided lM br sNrion lT00 ollh.
<br />L.bor Cod€. lo, lh€ pgaof,rwcc ofltc No lor shich the pmn is issu.d
<br />lb halc and s'll nrainrain tror[cs compcmalion insurance. as requned by sdron ]70{ or rhc Lah.r (odc. rorlhelsfomanccof
<br />rli.\o'lln,\hL.hrh\to,rnr'sisnnl Nl!\o'lds r.n,Fnsrri,inin\urn...rtr,o,trrllx,l,(\ rni.'r.
<br />( xnLn . fhfc 0^. D"n rAtl; a Tn,u.an c. Ead-i77rcZ,d/7 - //-//- >0/tr
<br />l.dify rhrt in rh. pdfo.nmc. of th.qo for shich rhir Fmir i! issucd. I sh.ll nor o.ploy any pcMt i, ony ndnd
<br />e s to bc.on. lubjdr ro rl'. No*6' codpdsdion krvs olcalifomia. dd as,e $al if I should bdonc subj(' to lhe
<br />rvort6' .onp@rio. povtioN ol Sdion l?00 of th. Labor Cod€. I sldl fonnGlh .onply wirh lnor pmvilioB
<br />WARNING: Falue ro s@ $0116 compasrion @vcE€. i. mlarful, ed sh,ll sobjdl m onployd to qimin.l peuhii md
<br />ciyil fme up to on. nu.&.d thoMd dollm ($100.000). in addnio.lo rh..oi oacomFNrion. dm46 6 provid.d lor lfi.
<br />S(riof, 1076oalhc kbor coiq imdd 6d al(omy's f.s/tr-/s 4-L-
<br />DDCIAEAIION
<br />I hs€by a,lim uad6 p€nahy ol psjury lhal I m licenscd unds provision olchapld 9 (..nmdcin! *nh S<iio. 7000) of Division l
<br />ol thc Busins and PmtdsioBCod., ad mylic.N is i. lull force md €rT6l
<br />El t-l cr)7 7 7)//
<br />",,",' l/-r'/9 co,,,,,c,,w--+ .?---
<br />c0lllaucuaN.LEdDlrcic!!.Cr
<br />I hdeby amnn undd pd.hy ol psjory rh.r rh6€ is 0 consrtuction lqrdins asdcy for rhc pdfomancc ol rhc Nork aor trhicn this psnn b
<br />i$u.d (s(. :1097. civ c )
<br />AISIICANLIECI.A8AIION
<br />I lErby 0fmn ondd p6rhy of Fjury one of thc followinS drldaiions:
<br />D.nolilio. PmiteA3b6r6 Nolifi.alion F.d@l R.*ulariorc (Tnb40, Pd6)
<br />R.qut.d Ldrs olNodncdio.
<br />-l
<br />colily rhar th. tcdsal r.sularions rcsadins sbGlos rmorsl se er applicabl. io rhir pojd
<br />J( cfiit rhar I hlve r@d rhs rppli.arion rnd stal. rhar lhc .bo$ inaomrio. is coE..l t .srr ro co'nply \rilh all Cny ud Cou.ry
<br />odi.anc6 .nd Sr.te tiws r.hins ro hildins coBttuction. od h€eby authorirc r€prMlariv6 or rlis Cny dd Comry to drd ,p.n th.
<br />rb.ve mdniobed pmpdy lor imp&1ion puFs6
<br />^pplicMr
<br />or^*enr sisn.rur€ *
<br />remirenrmeoano, )(.a,,r aa * ro,t
<br />,",", . //-r/f,
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing h ltltX t 'fMofYk F\,
<br />lnsulation/Energy t'0
<br />Drywall ////r,//t '?7//t-va-/d> -Ext./lnt. Lath
<br />Brown Coat
<br />Ivlason ry
<br />Pool Fence
<br />T-Bar x l/,2/-/B-,t/.$*?r,
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />FINAL //1r-/u.JJ.J>dd
<br />Certificate of Occu pancy
<br />Notes, Remarks, Etc r'r
<br />-+
<br />COMMENTS OWNER BUILDER DEI,C RATION
<br />! hqcby amfln und6 pdahy ofFrjurr lhat I m.r.npl ftom tn. Conlracto6' Li.en* Ii$ lo! thc followinr t.en (5@7011 t
<br />Busin6s ad Prolsion Codc): Any Cily or Counly $hich r.qui,6 a rE ril lo .oEltud. ,lro. nnprore ddrolish or rcp3t my
<br />nod@, prior ro tu issuec.. aLo ,cquiB lnc applicdl tor such !.rnn ro an a signcn staldnot rhar hc or dr n lcos.n p6uel
<br />to the Fovisio6 oltn CoDlrlcloi! Liceiscd ljw (Chaptd 9. Com€nciflB unh Sdion 7Cr00 olDivision .l ofth. Busi.6s md
<br />Prulcsioas Cod.)orthar hcorshc is crcnrpr rhq€liom d lhe besis lorrheaU.sed.xorrion Anyliolario.ofsdionT0ll.Sbrany
<br />arpli.afl ao.ap@ir subj<rsrhe applicafl lo acivilrcnahyolnor dorerhm fiv.hundr.d dolltrs($500)
<br />L..,i(iAdd*'_
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