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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:. <br />- <br />I Jr'. AdJrs _ <br />--+-