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SITE.WORK DATE ID/SIG.COMMENTS OIVNER BI]ILDER Df, ITARAIION
<br />I h6cby lmtn uDda pdhy of pgjury ftd I m qdF t!f, dr Coinrrlc l,tGM Llw lor rlE a.llowiis t@i lt6 70! L
<br />tlBin* ird Profd,on Cod.) An, ('ny or Counry $nEh r.9uir6 r Fsi lo N'sNcl. .t6. ifiForq .bmlit or rF.r e}
<br />lrrudurq FFrro ili ls!ffiq rho r.qun6 rh. {9lr& fo'u-hF to 6L. rig..d fldE lir h.or tEi lndn d purs!'n
<br />ro i,r. FDiriiG ol E Conrtrrd r Li6i.d L.* (('tut'16 0. (offibs silh Salion 7o0o of Divirion I ol lh. BBiB ed
<br />ProfBrE Cod.) c $n Ld!h.nqo!fl rtE ton r.d lh. boa hrrlE ll1.8.d q6 ion Anyvi.Ltttnofscoion70.1I5 bytny
<br />rpDltlrn fo! . pcrii rubjd. rh. 4Dli.dr lo . ciril pdhy ol mr mr. thu liv. hun&€d dolld (S500)
<br />l. .i owB of rh. pmrEny. or ny mployB w$h *.!6 s thd $1. conp.Mion. $ill {b rlE uat rd llE rdr@ i br
<br />nldd<t o, olldcd for eL {Sd 7or,l. t}Nils dd ftofdioE Co& Tt Con.rhir l.itB Lrs'dE ml {dt lo s o*E oi
<br />tlE rmFt, "
<br />ho hlil& d inp.!r6llEo'! .n * ho &6 Eh sil hu!,.|loi lrrElf or lhrcueh ht or lE os mployc.
<br />Fo\ id.d rhd kh if,F!\€rEB ft d irad.d or oft,ld fd sl. l( ho$as, llE trilliry or imFnffil i! eld Bi'hn oft ye
<br />oacorpklh.. lh. ( )tr{o Bo]ldd "ill h.tr tlE hrdar ol Fnving thd h. or .h. dd mi tlild or inp..v. rh. FDFty in tlt F,rE of
<br />l. s o$G of rh. F.Fr). s c((lEn.ry {lrreir8 * nh li..N.d co.rrrloR to.onnMr tla rrej..l (Se 7044. BuitrB
<br />Irj ADkir Cod. I h. Contrrroir l,ic.@ Llw 66 ful q,Clv ro m ou.d of prordy sho buildr or improvd lhson,
<br />ad {h. odr.di tu .h Foj.d! with. ( onrtrto(!)licd.n pun!.n' rothc('o drroi! l-rc.@l.$)
<br />t a crnpr undE Sdnrf,
<br />D.r. 1Cl- t 6-, 1
<br />.ll A f( nrrlns,can,n( J€),-r (ca-t P
<br />(rDhxrrt r or,rrr.rs,rr ror.
<br />DECI4f,AIIO!
<br />I h6.try.fiirm u.d.r FMI') ofFjuryoE ofllE follotru3 d.cLr hB
<br />IhA.rn*illmim.brCalir(ar.olcr'grtoS.lf-lB!rcfns\yk6.omFkn'n.6 Fo\ dt! fo. bI Sd i'n I7(b o I lh.
<br />Lthrr C.da lor rh. pdLrlm.. of rh. won aor strkh th. pqmn it isu.d
<br />I fi!!. ind $ill n.ii.in q o*d cotr{Ed,nion ilBlllft.. 6 r.quftd ta sdi'n .lr0o of th. lihor ( od.. for lh. Ffome. ol
<br />lh< wrt fM stkh rht Fnn i! itrEd My IGl6 mmFlnio. iMtuc coir ud policy numb( e.:
<br />I (dii rh,l i.ln. Fforrom. ot lh. *'olt lor Bhth thi! Fn,t Li isru.d, t !h.ll nor dpl.y.ny p.Mn in lry oME
<br />$ srn lEcom. rubicl lo rh. s6.td Nmpdrdion Luorc.lifomia di der rht itI lholld tEc.r 3ut .d ro rlE
<br />\vortd' ontdernJ. rorntB of Sd i.n I700 of rlE llh.r ('nle I tEI. n{htr nh oid} \ nh tlb. fn,vilitN
<br />wAiNINc F.itur. to su. trmt6 co'rFliirn s\@sc i unhn'tuI- tnd !h!ll 3uhj.!l u dploE lo miMl IEUXB ud
<br />.nrl fi.6,t ro oc hntd,cd rlFrsrj dollG (lll)o.(xlo), in lddnion k lh...r dl..mp.trsiion. .1,,M86 a !r'vid.d for lhc
<br />s{&. 1076 6I rh. Iirf, cod.. i,r€.3 ud nrorr.yi tG
<br />/Q,-!G 11 Tesos ?€ ne a
<br />DPCAf,AIIA!
<br />I h6.1,) rallm u.d( r6Dliy oa Ftul fid I @ licaro, ondd Folishn oloBrr( 9(comFc'nr snh sa1$n 7m0) olt)trBio. !
<br />ot rlE lrci]6 and Prutdn'G ( od.. lnl my lica€ i! in lnll l6rc. rd lrdi
<br />l]Jxl.IallsraNt[lDtlc-aqliltr
<br />I hs.ir amrm undn rEnlll! o I pduq rhd lhd. ts t cod{ocl irn lindin8 !8ft} for tlF Frolllrd. ot lh. {.* tu rnkh rhi. Fmi i
<br />lstr.d ls( .1097. ('n (.)
<br />I o'jo { \uc
<br />A.TTUIATfDIII.AMI,&!
<br />I hdda.rm !(ld F.rt, olp6ju4 on. oflhc fdlowins d.clmtions
<br />Doml,rpn Pmil'A3hdror Norifi (dion F.itdrl i.lul ions IInle 10. 1616)
<br />R.quir.{ lllid.t Udifio r
<br />I .dri[ rhd rh. f.n Bl r.luhbB rcs dins sndor r.m\ 0l . nol sottrtrhlc to rhi! rN]d
<br />I (sl iav rh{ I h!!. rad rhB opFticalion od srirc rhar tlr .tn\r
<br />'nlon.a!
<br />nr. is cmd I riie ro omdr \ nh .ll ( iy &d ( oor!
<br />oriln.k6 dd Srir. tlqa EhlE lo hildins conrociior rn iodD,urn'rn rqr.6rn6of lhk('ilyr.dCo{nl,_to rduFnrh.
<br />.tnr. .mrxftd lnrFnr for iNFrion FrFc
<br />^pprront
<br />or
<br />^smr
<br />si*nrrurc /K
<br />/o- 16 - L7
<br />Jgs r-, 5 Pen e a
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulation
<br />Roof Sheathi ng
<br />Shear Wall 411+-Dtt4lc\-*e4l
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />FIood Zone Certif
<br />FINAL 17,-2o-\ol .kl6>
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />a l Aix D
<br />BUILDING. INSPECTOR RECORD
<br />'dz-M L'f 'F Lf,Zt",/
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