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BUILDING- INSPECIOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS oWNER BtIII,OER DF:I,CA RATIoN
<br />I lrcrchy rrfinn undcr Nnllly of pcrjury ihd I u c(ctr,pr rronr rhc Contadon' Li.cnsc l-nw rbt rtu blk,snrS rci$n (S$.?l)ll5
<br />Btr\inc\! a llofcsri,,n Cod.) Any ciry or coutrr, whi.h rcquircs tr ,E nir io .on(dcr, rlr$, in[mvc. d.nn'li\h ,tr rcn]n riy
<br />nrucrurr. nri(rt, ns isuotrcc- rho requn$lhc qplicanl for such pctr r t, filc r silrcd {drcrntrl rhai hc or shc n li.cn*d PuisuaN
<br />tu rh. Fovi\n'ns ofrh( Conr&iols Licctrscd L.* (Cnrprcr 9. CoNrcNn,S wirh Sccrio ?Ux) ol Oiviion.l of rhc Busin.\s nd
<br />Pbltsions Codc)orthrr hcorshc hcxcorplrhcr.lroDand rh. hrsn f.r rh.trllcEcdcxcmPtior. Anyviohri,)nofS..rion70ll5tyutry
<br />lpnlicantlorapcrnrihuhjcckrhctrppli.anrL)nc,vilpcnklnrm'nntrcrhnnl-rKhuidrcddollr\1S5m).
<br />l. {r oNtrcr of rhc pmtEny, or my cnployas {iln slscs a\ rhcn vnc .o.D(nsdnnr. will d. thc work uxl rht stulE n mr
<br />i cd*l or olt'c.cd lor salc (Sr 7(l:1.1. Brsi.c* rnil Aorcsti6.\ Codcr Th. Cont .toi\ Lie.se Lsw do.s nol 0Pply x' !n owmt or
<br />rh.Ihtrty who huildr or nwn)vcs rluon.0lxl who des such wd( hnnsclfor her{lfor rhn,ugh his or,rcr o*n eq)loyccs.
<br />p.ovacd lhursuch inDercrEtrh @ mr inrcdc.l orottlrcd for $lc lf. hoscvur. rlL hrldirB or inPmrcmnr is $Ll wirhinoic rtt
<br />ofcomd.rFn. ltr Owncr Buiklcr *illharc rhc nldcn oftrolinS rhll hcor\hcdid nor l ild or inqJmr. Lhc pmt$y lor rhc puqns of
<br />-1.
<br />u\owncrofth{ pnncny. {mcrclt\ir.lycoftrcrins qirh licr s.d.otrn&kn{locon{ cr rh. Ptu.d (Scc.704r, Busi".s
<br />rRl t\Dfc\\in (idc Thc Conra.tn \ Li.cnsc Las doc\ nor rpt'ly(i ro*trcrofpior^- ywh. huildsor inrProvc\ rhcrcoi,
<br />rtrd $ho.onricrsl'ors,chpn,F:(wirhrConrmckn(s)liccnsc Nr$r n) rhc Gnrrrcroi ! l.icc.\c t 'w)
<br />-l
<br />amcrcmnr undcr Sccrn,n ,B &PC lorihivca\otr
<br />Dale: OtD$:
<br />IVOR(ERS' C0mPr'\L{iATI{ lN
<br />IIDCI,AIAIION
<br />I h.ichy rfllnhx.d.r Fmlly ol p.rJury onc oflhc aollowins d(lanrt,.c:
<br />-thlvcrndwillnrnn.inrCcnific.tofConscntroSclf-lnsurclorworl.rr'conp.ns.trn.as[ovidcdlbrl,ySNrid]70OollhcLatorCode. lorlhc pcdornEnccdrrfic wor* ror*hi.hthcp.mir is issucd.
<br />Ihdvcdndwill r air workcri .omrcnsrl ion in$ran.e.6 r.quircd hySeln lTmollhctjbotCodc.nnrlcp.rfonndnccol
<br />rhc worl lur whi.h rhis r.rnrir Ls nsu.rl. My wo c6 comncnulion in\urutrc.Micr rld Flicy numbc, !rc:
<br />lccnilyrhrr inIhc pcrlirnun.c,)trhc work l, Nhi(h rlnc N nir i. i\\ucJ. I drll ior crlnby rrry l].ron in !n) 'nrtrrurs nsrohcorf, \ubjc.l n,lhc sorkcr(con,ItD\rri,n lrw\olC lif{rnia. tr(lJ8rc,lu il I should i.conr\ubj..rt)rh.
<br />tr.rtd\..nrpcn{tio|nori\ion\ofS.crnnr.l7(X)ofrl[lrhrCodc.l\hrll.l'odhwirhc.mPly*irhrho*rR)v^ions
<br />IVARNINC: lr]ilurc tr {cur. s.rkcr\ .otrrp.trs idr covcrdrc i\ urhstul. rtr{l \hrll ruhj(t ,rr cndoycr Io qiDi'ur Ftrnlrf,s Md
<br />civil tj'r\ uI t, otr. hr dr.d rhousrnd dollim (S|(|O.0(D).onr|ti\rri( r. drnl.lrc\ rs nr{)r(lc(l ntr r[.
<br />::l-'4irrifi
<br />'.dc. ir cEe N axoa.y\ ltcs
<br />XB\*
<br />DECIA&I.UAN
<br />I hcrchyaafirm undcr pcnalry Dt lcrjuty rhd I Jm li..Mn uMct ptuvhion ol Chrptr 9(.onnkn.nr8 wiih Sccri'n ?000) otDivi\bn l
<br />ol rh. Bu\i',cs tr.d Pnfcsio.\Codc nnd nvli.ctr\c h in lull frtrccrildcllccr.
<br />-)13tr/0
<br />N
<br />AIIIICAII.DECIAAAUO
<br />I trltbyumanu cr Dcnally olpcrjury ooc orrhc rol[,sins d..lar,rn,'s
<br />D.frnirnrn P.flnils-Ashcstos Nolificalion FcdcEl RqrLrinns (Tnh 40. Pd6)
<br />Rcquncd bllcr oi Nolifical ion
<br />l.cdiiyrhnrrh. tcJcrrlr.ruhri(,n\ rtBddn,g r\trif\ rcrnlhl c trflrpIli.rhl. n, rhn pr.jc.r
<br />-,
<br />ccnily rhur I hrvc rcad rhis,rplicntion md shre rhlll rhc $o!e inronnrrnnr i\.uftccl.I agre toconDly *irh rllciry rtrd counry
<br />.(liun..\ ind Srdd I r*\ r.lftrt ro huidi'l .tr h.'t. rcfr.\cirrrn.\ol Ih \ ( iryrnd C.unr! k, rirrr trti rl[
<br />ntx,vc Nnrioncd |rrNnrtu iNpccr
<br />,\ppliutrl or ,\xrnt Sittrrlurr
<br />qltrfrf
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Ven1/l nsu lation
<br />Roof Sheathing 1o[s2 \te l^aq(,r)At\ *,,' sLe,"-fi,r"^ s,,*.?
<br />Shear Wall *t{\o kAo- duL -A,t
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lrlasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />I
<br />FINAL /o/4/n -zb{t lU
<br />(Certif icate ol Occupancy
<br />Notgs, Bemarks, Etc
<br />'lnutl Ir-t/4da,t*/ tumzta-b.-c'
<br />.-"""*,X
<br />CONSTI'I]CTION I,FNNIN(: A(:ENCY
<br />I hcmby afltn undn lcnalry of ricrjury rhar rhcrc k a ..n{ru.rion kndinS nglh.'y for lhc Frfotun.c or rhc Rort for which rhh ledir i\
<br />is{ucd (S&.:1097.Civ. C ).
<br />I cxdc''. \tn:.
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<br />I Jr'. AdJrs _
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