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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OItNf,T BUILDER DELCAR TION
<br />I h.rchy artrn undcr Ftrllry or p.!!ry rh3r I m .r.mt lmm rh. condoE t-kcn* tiw for rh. ,oltdwing E.ai (s*.7o11.5
<br />Busin.\r ad Prufcsirn Cod.) Any Ciry or Counl, whth rcquiB r Fmjl lo conrlMr. !llr. iryrmvc, &mlnh or Elldn dy(Mle. Fi, ro ik isll.N, aL$ Equir6 rh. rfi)lEd lor Mh Fmir r. fik r riSrn.Lr.Enr rhri h. or {E b li.rn<n pwdl
<br />ro rrE F.viriJnr or rtE contutdi Lirn*rl l,$ (Ch.p6 9. c{'t|wrin3 enh Sdrion 7@ of D'virbn I of rlE Burirsr ud
<br />PmLlrhnsCo<L)orrh.!lEdslEir.r.r9t{rmfmmrrnrhb.skforrt.lL8!d.r.qrb. Anyvblrra.olSdb.T0.ll5bymy
<br />$p,k.nr ro, a p.mir rubJc.rs rh. .pFli(afl ro 5 .i!il pctrdlry of mr mE rh3n filc hu Erl dolhrs (t5@)
<br />l, r ower of rh. ,r6Fny. or ny cnl,)lola! *it qasc! .s thcn s! con{EN.rion. will & tlr *frt ltn dr rrEtE k
<br />idcln d d olYcEn fc slc {S6.rOu. Bllsi xd Plof-rb6 C!&r TIE C.llErdt tice liw &Er nn .DDly ro r o*B or
<br />tll FqEly whi t!il& r iqmB llEe( 8i ]l$ drB rn sd hi|Blr or h*l( ot IruBn hir c ts orn..lPbF<,
<br />provit d rhlt rEh inFo\trffir G or irorLd rofcnd forsh.li tr)}ft- tlt hlildug d itrFrcEft'n n oB wahi,oE )q,
<br />ol@npLlbc tlr O*Et Build6 Mll h.€ E hIr,.n of F,urg rh,l lE r ilE dd mr hiu ( inpnE
<br />'rk lh,rdy for tlr,'!rFE of
<br />I. * owffi or E FtErr. d qrch.iklr.ollLlhs *nh lirnsd cofir1m ro otrlrnd rlE F.Fr (S( 7044. BBilK
<br />ui Pt!&sb, Cqic: Th. Codalor't La.tr- trw &Er mr .!pr, ro d owffi or phFny rrE buildr or tr{rmB dF6n,
<br />r.d eho 6tu rs rr fth Fnj<r! wnn r Co r*lono lirffid r'!Eu,r lor,E Conrrr:l( 3 Ltrn* L.r)
<br />1.tr.\rnrt, , rr(, s..rk, L
<br />lrrr. ()$n.r
<br />Irr&i[Es-rauIlsSAuar
<br />DECI.AIAIII}Ii
<br />I hc'.hy affirn drl.r If,Mkyolp.rury o'r olrhc tull,'s n,t ,lsurr !nr1
<br />-l
<br />hiB anl will fli.hin . Ccrirrdc 6f Concnt rn Sclf l.s@ tor knl6 otr{rtri.rion. !\ pmd.n lor by Sdrion lrl[ or rlE
<br />Lhg' clde fd rlF Frfi)|r:re oft& mrt tr wnih rh. IEmr 6 $ucd
<br />l-LYut!d*rllfl !r *"rlcF convEnqrbn 'n$nNc. s FqujEd hysdrbn l7m of E L.bor Cod., fortlE Fnr,ffi ol
<br />'hc hA rq shihihn Fml r! lnf,n M,*ort6 onqtnu.n rnrunR mr.i, FlEy numb.r m
<br />.--, Aco.d,;";.m4!u
<br />-l
<br />enily that itr rlE FrformL! of rh. worl for *hih rhis pcmn B nnxd, I sh,ll nor.fltby rny FR)n i. rnymnrr
<br />e, or
<br />'o
<br />b.em ilhl.cr ro rh. wo.kd: .llljpensllioi laws orcllitomia, r.d rsN rhar ir I rLruk tr{otu $bFr ro rlE
<br />workds on+.nsr i.. pmvirioB ol Sdtk 6 37q) of rh. Irho, Cod.. I rlEU. liflhwnh F,iyily enn tho* ,erilioG.
<br />WARNINC: t.ilurc u sw *.rk.6 cotrp.r ir. owne. ir unLwtul
<br />c8'l nms un ro oE hu,nEn rhousnd dolh6 (llfri.(xx)). in ,rd r)n ro
<br />rhrl, {hFr .rphFr b diniEl FELE rnd
<br />of (rFNUon. d.fr8.i a
<br />:::qAXLi
<br />DSCIJIAtrIT!
<br />I h.r.lry .rfm und., Fn Iy oI p.rrury thd I M lirnr.d un&r Fo\Bil. o, Cll.F6 9 (NnmNinS vnh S.<lnn ,frD) or OilBnn I
<br />or llE Busimri ttn Pmf6sbns Co&..,n hy hm i. tr tuU foE.,rl.lld.
<br />r.r.tr!.chs, C-L O t okLeTtrl4zL
<br />CoNSTIIJCTTON LFNIIIIIG AGENCY
<br />I h.Eby rmrm und.r FEhy of lcrjury UBI tls. n r coNlruclion tndinS r8cmt tor lhc Frfirnw ol tlt *orl for whth lhir itrmn is
<br />ttu.n (S.. 1|rr. Civ. C )
<br />AITIICANI.IECIdBi.DA!
<br />I hdtt'y.Ifmuflr.r F.!x, orFrIry or or E tullo*i.B rt.Lntnnr
<br />lr.B,lirhn Prmnr ArtErtor NolifErion Hd.l R.guLri,rs Onk{{), Pd6)
<br />-Rcquircd
<br />l!(.r of ttotifuri.n
<br />U1*,**,*,t
<br />radcrdrcBulalirnr rc8lrdin8drtErk,rrcmvllft fr .{'plrabL k'rh'\nNi$
<br />rc.d tht .!r .d i'. .rn id. rhd rh. rtDw lnft,mrio. ir .old I rEN ro 6r?1, *nh rll Cny rd Cou.ry
<br />*s rcbri.3 ro l{ild03 connul (rn h.rb, .urhtrE rpEsnllr'Et of lh* C y .,n Co!.ry ro .nr6 urb. dE
<br />ah,vc nrnlio.cd pn,Fny Inr insF{rju |)urlFss
<br />ApDliunl o. Ag.nl SUEtuft -,.8/zlz!
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framing
<br />lnsu lation/Enerq y
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lvlasonry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Fjqpd Zone Cefiif t ,l l/Cttzy,hnre (2 taq t,r,MM.l,l lfh4
<br />U t I ll Ir t20tr-flN UtM,I Tffil6)
<br />Certificate of Occu pancy 7
<br />T-Bar
<br />FINAL
<br />Notes, Remarks, Etc.
<br />Gn,,cf s Addrc$:
<br />tv-*t'
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