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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Ereclion Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Venti I nsulation
<br />Roof Sheathinq
<br />Shear Wall r^
<br />Framinq t0-3-tK x.\4r0)
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lalh
<br />Brown Coat
<br />lVlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enoineer Final Report
<br />Flood Zone Certil.
<br />/./'\\
<br />FINAL t0-zS'lK x-Vst\l
<br />Certilicate of Occu anc
<br />Notes, Remarks, Etc-
<br />OWNER BUIT,DER DELCARATION
<br />I hcrcby !firnr undcr p.i.lry or p.rjury rhar I an.rcngt fm'n rhc Conrraclo6 Li.cne Law ror rhc rollqrirS rcnvrn lsdc 70-ll5
<br />Buqin.$ nnd PRrrd*ion Cdc): Any Cily or County uhich requnes a p.dir kJ .on{rud. ahs, imP.ovc. dcd.lth or tPdt my
<br />sfl.ruc. frio. to irs issuoncc. ale r.rlutcs rhe applicanr lor such Frmi b nb . siSncd slalcmnt rhd nc or sh. iJlientd lurflMr
<br />lo rnc rmlisions or rlt Cunrir.ror's Li.ensd l:r (Choplcr 9. Con nch-'in8 wirh sccnon 7u)0 ot Divilion .l orrhtr8usidcs ond
<br />Pmressn,ns codc) or rh hcorsh.i\cxcmprrhcrcfronundrheblshr(trrhc,llcS.ncxcmflion.AnyliolnrionolsdbnT0ll5bylny
<br />applic l lbr a pcrmil subjr.'h rhc ttpli.,nr t. acivilDcn,lryorn.r rmrclhon iivc hundEd doU s($5{D)
<br />I. as owrcr or thc lx)|).ny. or nry cnrllores wilh wr-scr 0s r[cir w,lc .o ,P.trqriotr. will do lhc *(fi flnd rhL {Murc n hr
<br />intcndcn orollcrcd lnr srlc (Sc ?0,{. arsitu\said h)r.s\ionscldr: ThcCo rrclq sl-iccnsc Inwdocsn.r lmlyto!no*ncrol
<br />rhc pmpcn, wlF buikls.i infr.vcs rlrtou ard $ho dcssuch*.rk hi'nrclforh.^clforlhrou8hhn.th&ownc lPk,yccs.
<br />,r ovidc rh(l nEi impmvcNih ac ior imc'r].d d olfctu{ tr :rlc ll. howcvcr. rhc huildin! or i'tptuvcmnl is \rtl within N ttr
<br />or.omplcri.n.rh.Osncr auitcrwillhslcll.cbudc.olDmvins rhd hcor\h.did nor buiklor irrpDrc $c P(,lcdy r(,
<br />'hc
<br />nur|)tol
<br />I. ds ow ci of rhc rrcncd y- onr cxclus irc ly corrr*rine wnh liccn*d .ontNhs ro colnru.r rhc pn,lccr (Sc. 7Oa4. 3unncs
<br />lod Pnfcssi,n cidc: ThcConta.ktr s Lic.trsc Lrw docs nal Dlyr,'3no*n(.frropc ywhobuild\orimlrordrrh.rco..
<br />.nd who .onh.rs lor surh proi.rs wnh d cl)nhcd(s) lic.i*d ruFunr ro lhe Conrtecroit Liccnso Liw).
<br />l rmcknrpr undc. Sc(r
<br />tlaBxlas:(oufElrtilQ!
<br />DDlllS/Ill0li
<br />I hcrchy !lr'irm undcr r.oalry orlcrjuryotrc otthc followirg dcclmri{nrs:
<br />Ihnv. dsilltrnirltrinnCcnillcar.ofcoisdirt,Scll:l'srrcl.rB.rkcr\'.o neorxlion.rs pa{iddl nr bySccli l7l[)ofrhc
<br />l-*orCl)dc,ntrrhct rrdnrNc.llhcsorknnwhi.hlhcnclnir l\isurd.
<br />lhc *ork rbr*hichrhn pcrmir i\ is\td My*orkc6 .o rFn\{r n nNddf;stricr md p.li.y nun$crm
<br />-l
<br />ccnily rhrt in rhc pcrlirrnBmc ofrhc w.rk for whi.h i\ pcrnrir F is\ucd. I \hrll nor .nploy rny P.rn'n itr{ny rrnmr
<br />v, a\h hc.onr n ,jc.r rorhc *orkc6 compcnsarie la*s ICrlifomia. rnd,8N thal i, I rk)uld lf,cotu $rhrt.r to rhc
<br />sodd\.onwn\0lotrtrovisionsofSccrionlTlx)of'heLrltrcodc,lshrll.ifirhwirhcondywnhrho*[.vtion(
<br />WARNIN(i }rlhrc k, \ccurc *orkcr conrpcnrdi.n n fh{tu] nid nrull {,l)l.cr rn . rfk)Jrr t, .'i'ni'L'] tri,'lrf,\ rnl
<br />civil A c\ ut t, o c hufrk d lhous&nd dol xr- n, dnion ro rhc.on olconrp.tr\rrion. r rgcr is !rcviilcd iff rhc
<br />S..rnnr:l{)76o1rh. Lrlrr ( txlc. i'rrr'.n rfdrr
<br />",,.,:fl41A uLtitrulraNu}(lanl2!(lzl&uru!
<br />I hcEby ljlm undc! !. lhy ol p.rjury rhar I tun licn$d nndcr F,vision ol Chtprc. 9 (commrcnre u ith Sdi.,n 7(xx)) of D8ision l
<br />of thc Busirc$ nnd Potussion! C.de. ,Jxl nty lic.n\c h in tull fttrN ruxt cl'l'cct
<br />v./
<br />,"," q/ z1/ / k
<br />CONSTRT]CTION I TNDIN(i A(iENCY
<br />I hcrchyrltlrnundd lcnrlryolpcrjoryrhrt rhcrc isr.otrdtudn$ kndD! o8cncy fn rhc Fnnnr h.^.oirhc$orklhrwhichrhnFnir a
<br />issucd rs& 1097.c1u. C ).
<br />APILICANII)&CIABAIIO!
<br />, ffiy afrm x nd.r pc..ll y ol'pc,jlry .ft or rh. rollo*inB dc.ltrmr iotrs
<br />D.,tulirion Pfifr i(rAsb.stos Notih.olion FcdeEl Regllarions (Tirlc 40, Ptn6)
<br />R.qrncd ktr$ ol Norifrcltion
<br />-l
<br />enifyrhr Ihe rcdcrrl nlxlnnons rcSardtrS.shnos rcimlrlarc noi lnrli.lbl. r. rhis pmrccl
<br />-l
<br />ccniiyrh3r I hrvc eM rhisappli.ationmd{atctfi rhc ahorc infnmrr ion is cumct. I agre lo on{'ly *irh lll ciry d.d Counly
<br />ddinlnccs nl Srrrr l. *\ 'cl 1i,rg ninscotrslflclion.. hcrcby lxtri.drdtic{nlarivcsoirhhCir}.ndCoonryk,.mduponlhc
<br />rhorc nrtrrknr.d 0'ot)c'i) l(tr iri
<br />!/7\*7/E2/4
<br />lfl o.r'. \,ld'.\.
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