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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII,DT]I{ DIJI-CARATloN
<br />I hcrch, iliifln undcr ncnalry i'rFjury rhir I r,n.rcnflln, rhc (i,nlrl(1,trr l-i(nsc l.rw r(tr rhc n)lhairs rca$n (S.c70.115
<br />Bu\ircs ud Protcstun C lc)r Any ciry or CouNy qhi.h rcquirc\ r $nnil t, ..rIru.r, ,ltcr. iml'rorc. dc.nni\h ,tr r$rn rri
<br />{fl.rur., Drnr b irs islurn.c. rlso rcquire\ thc rptlifl lil \u.i t4-'rnir r) lilt i Sncd sl.rcnrnr thar hcor sh.is li.ctr{d Pusurtri
<br />r,, rhc Frvision\ of ihc Cotrkacr.is Licc.*d l-nw (Ch.nrcr 9. Cornnr.cin8 wirh Sc.ridr 7000 of Division :r ofrh. Aunrcss.nd
<br />Pn,fc\siotrs (.odc)or rh.r hcor shc iscxcmnr rhc'efronrnd rhcba\n lor rhc rll.Scd cxcnrprio Anyvi,nrri,ri.fSccliotrT0:l,.sbyaiy
<br />rpplicanrforapclnrirsu6j.ckrhr rrpli.ani r. advilpctrdl!yolnor morcllrn llr huiJr.dd.lh l55m).
<br />l, * owrcrolth. f()lEriy. or nry cnrrloyas wilh u!sc\ a\ rhrir *lc.onlrctrs.tiotr. uill do rnc work "fii rh. iMm is nn
<br />i, ctulcd orolitrcd ntr srh tsa.704,r. Bxsift$rnd Prcfcs\ions Co{lq t hc Conta.roi\ t-ir..\c hs docs ror !Ppl} lo an .wkr of
<br />thc pR)r.ny wts tnnk s .r in{novcs rhcron. !d * ho dms flch sort tintsclr or hcrtll or lhrough ht or hcr own c tlk,yccs.
<br />Imvid€d rhnr such impmrtunhmton i.rcndcd oroffcNl nreb lthowcv.Llhchuil i'rg or intnNt r r k eld wirhin onc rr
<br />ol <nphlirn. lhc Owlcr lluildd will l vc rhi burdcn offlovinB rhd hc or shc did n.l ttrik] or imPn*t th. pmFny for rh. purlne of
<br />-1.
<br />!s ownerol rhc pnp.ny,.frcx.lusivclyco ractir8wnhliccnscd.onrr,.r,sr.c.trsflcrlhcProicl(Sc. ?0r4. Busftss
<br />nd Piolksi Codc ThcConrracrn s l-iccosc l,awdocs ror opplyro r owmr of ProlEn y who bu ii& or inrnrov.s rhcrcon.
<br />lnd *ho conrmck for soch I"oFr( snh r Cdnr.rcto(r liccnscd pu6u r t,rhr C{rt&rol s Liccn\c l!$).
<br />lr.*a I' r .4.r
<br />,,"," ,,/./+^ /.- ,** Y,9).,,L' .ulJ-Brr&):1l2]ul\l-1.&I
<br />DEI:LIBAUA!
<br />I hcrcby rltilmn.d., p,nallyoipc!trry oi. ofrhc f.llowire dc.lrmrions:
<br />I hn\r xlwillnmi lir rCcnificarcofConscnr b s.lllnsur.li, wor*cr'conDcn$in,n.n\ pn,vidcdforbySelion.lT00orrhc
<br />tihtr C.dc. for rhc ncriornrncc ol rhc +uk for *hich rhc !.nnn is isu.d.
<br />-lhavcdidwillran
<br />rin workc6 c.nlusrrbn iasuramc. rs rquir.d hy Str iotr ]Tm ol rhc l ihr Code. for rhc Nrfonntncc oi
<br />rhc Norl r.r whichrhnp.rnrn is N{cn. My workcr'c.mtcn\otion in\urrmc criefundrolicy nunrt{t !re:
<br />R)licyNum6cr
<br />-Ertnc\
<br />l.cdiry lh,l in rhc pcrrbirnmc otrhc *ork aq *hich rhn r.n ir is i\ruBl. I rhrll nol cmploy rny p.r$n ir rtry monrcr
<br />s $ b b$onrc sut'jcr ro ihc w.rkd6 .onrFnsario. Irws ofcaliforni., ntu !sr.c rinr irl ft)rld tuoN subjcd b ilt
<br />qortcs' onDcngl ion F)li\ions or serion .17m oa thc tjhor Codc, I shrll. to.l hwirh .omplt * iih lhos Pmvhion\
<br />W RNINGT rrilurc to $curc rorkc6' compcnsrr nD d,vcDE ir unldqtul. i"d shnll \uhj.d m cmplorr rd ainiMl PcullEs aM
<br />.ivil 6trcs up ro otrc hundrcd thousood dollrn (SIO0,(XI)), i'r ddirion ro rhc cosr ot cotpen\nrn,n, dnrmScs as proridcd lor rhr
<br />"28"r
<br />ru\ \ti, /? ) ,7-2
<br />t,,,,,.:lt/-'!*/'4
<br />I t('lN\U) ( rrN I l{ \('loll
<br />DIC|JAAITIN
<br />I hcre$y allirn under pc,ulry oi lcrjurr rhlr I dn li.cns& undcr pmvision oaChrplcr 9 {c.nrmkin8 *irh Scclion 70{]()) orDivision.l
<br />oi rhc Bu\inc$ rd Pmfcsions Codc. ad hrlicenrc i\ ii foll nr.cdJcficcr.
<br />Conlmdorl
<br />CQNEIBIJCIT0UUNOIXIjA{jENS
<br />I heeh, xlfim und.r lttuxy or pcrlury rha hcrc is a consruction lcndins agcnc, ror Ih. pc{otrmrcc oflhc work t r *hi.h rhis lfrnh is
<br />n{Ed ( sN. .1097- civ c )
<br />AELIqANLDECLAf,AITO!
<br />I hoEt'y allm undcr Fnalry ollc jor! one ol'h nnbwine dccl$arnn
<br />D.'frnirnrn PcimirsA\b.stor Nolificlthn l'.dcral RcEubrins ( l'irlc 40, Pnd6)
<br />R.qun.d ktrcr of Notificarion
<br />-l
<br />ccnityrhrr rhc fcilchlrcgrhrhN oAardin8 usbc{os rcrmlnl rrc lor $nlicahl.ro rhG ptujccr
<br />L^
<br />D2,?n,,*.u,t*.- 'ntr
<br />srnl'. n 'n rftl {trrc !h0t rhc ,k'tr inrbrndn,n is cotrd LsrG b.omply vith 0u ciry !trr ('ounry
<br />l6dmanccsandShrli*.rcbrin8roh,ird'ngcnn{turrr{r.ndhcr.bylulhorizcrcl,c{illrn$orthhCiryundCounrrloenrcruF,nrh.
<br />ih,vc n{irn,nctl ln,l*ny tur irspcclion nurlxrcs
<br />*,. - ?^2*- /g
<br />-E - #-fh
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/VenVl nsu lation
<br />Roof Sheathinq
<br />Framino
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lVlasonry
<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
<br />Certificate of Occupancy lr'
<br />Notes, Remarks, Etc
<br />Shear Wall
<br />J\4- <
<br />tin' l.r'. dtlF$:
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