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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OWNER BUILDER DEI,CARATX)N
<br />I hcBby ,filrm uDdcr p.n.lly ol pcrury lhrr I d crctntr Ioni rh. Cohrdd.rs Lictnr hw for rh. ftnl.wira rc.sor (Sa 7oll 5-
<br />BusnEss 0ft1 Prolc$ion Codc) Any Cny or Counry *hi.h rcqunc\ o pcinn k, conrr .r. ah.r. inllorc, dcrtulish or mr.L any
<br />srrucru.e, pri{,ro ns tcui'N, als rcquncs thc splli.ant lnr sucl pcrn b fitua ri8tr.\l sl cnE lnalncorlhc i\ Iiccnen ,unumr
<br />lo lhe provhions olllE Conrracrr\ Liccn$d tiw (ChrFrcr 9, ConnncncinE wirh S.crnr TqXl of Divhion :l olrhc Bu\inrs rnd
<br />Pmlcsi.nr Codc)orrhar h(orshc scrcDrpl rhceiron.nd lhchasis ntr rhc allcfcd cxcnwion. Anyviollrt,norsccrh.70ll5 byany
<br />rptli.n.r rdr rucnnn suhjcct lhc 0pplicanl i{, !civilpcnrlrrornor nkmrhtn livc hundrcd dollqs ( St{n)
<br />-1.
<br />as ownq oilhc nmp.ny, or
<br />'nycnrtloyccs
<br />wilh wo-lcs os rhct qrc co rp.trldn r. will do lhc wor[ lnd rtf, nturm n ml
<br />n{c'iLd or.ffcrcd for $lc (SN 7014. Br\inc* lod Pm{c\sioN Cldc Thc Conrrctr's l.ircn\c tiw dB nor nmly ro ,n o$ ncr of
<br />rh. Inpcny *ln, tuild\ or i'n ohs rhcrcn. uri sho de( \uch v)rl hnn\clf or h.^c lt or rhmuBh hh .r ho own cntlloyccs.
<br />lr,viiicdrlur \uch nnpmvcnf,nhdrFr irncrlcd n otld c,l lnrsolc ll ho*elci rhc Stildi'rg or inDtuwrrc h $ld wirhi" "N Jtrr
<br />ofcon[lcri.n,lhc Osrcr luildc. willhavu rhc hurdn urlmvine tMl lE or shc dil nor hih or i"Provc rhc nmIEly tr rh. PurF,*.f
<br />l. rs oqrcr ol r hc |no|rrry. aD crclnsivtly roftacrirl8 w hli.cfscdco rrcir h condtu.r rhc In$].cr (Scc 7(]11.3u\i,t..r
<br />ad l\.ls\i cldr: lhc Contrctn s Liccnrc I i* do.\ nor applyb rnosrcroiProrcnysho huildsor nnplorc\ lhcrcoD.
<br />md who mrrmch lor \uch F!.ris wirh r Cunrm.to( si li.cntd Pursurnr t, rhc A,nh.tt's Li.cn\c ljw )
<br />I umc\cnrnl und.r s.crion-
<br />,,,". ?/ifl! / ","",,/-
<br />DECLANAIIQN
<br />I h.rcby.flirr undcr pcnalt, olFrjury oN or rhc rolbsirS dcclnrntiuF
<br />I havc rd willturinr rnCc liicrlcoicotr\crrbSclaltr\urcritrqo'kc6'c. D.nsrion.r pn,vidcd for hySccli." r'dr"i'h'
<br />lihr Codr. nn ihc Fnnrnrn.c ofrlF $ork nx ehich rhc F.nnir i\ i\stcJ
<br />lhdlcaftl qilt mrinllir lorlcrr co rFnsrri,,n insunn.c, is rcquncd hyScrrn,n 1700 ol rhc kborCodc. f{n rh.pshtnurnccoi
<br />rhc sork r'orwhichlhispermir is ist d. My*orkc6 .oDtrnsario. insuratr.{ .,ricr dnl Flicy nunrbcr m:
<br />-lccnilyrhar
<br />inrhc p.rforroncc olrhc*or[ lor which rhi\ prnnir i\ isu.d. t \holl nor.n{t'yany Fs.n in anyn,rnncr
<br />v) N ro hcdnm srbjd h lhe worlidh .ompctrsdion l,ws ol Calilornit und +tc rhd il I \hould heconrc snl,irr kr rlt
<br />qorkcB conDctrsrlion DDvisionrors(rnr lTmof rhc tntu Codc.lshrll, rdrhwnh conrrly sili rho* Provi\nn$
<br />WARNIN(:: Frilurc t) r.urc sorkc'\ .onlPctrs n .okrr!.r( trrlntrhrl. Ntl shrll.uhJccr d.q)lrlcr lo rin,iml F rlril and
<br />.trrl fi .\ trt ni m htr r.tl rl tr.xnJ Jolfuh l\](x).lix)r, tr nlr .os ot.onlFnsri.n. d!rusc\ rs lrovidcd Lt rhc
<br />sccrin 1076 oirhc Llh, Cod.. idcrc( and anoary s ltcs
<br />,,,", *E// 1// 3
<br />l2[tt 3rr]0N
<br />I lrrrhy rlli'n trndcr Nr lryol |trjry rhx! I rnr licctr{d unJ.r p'ovi\i( tl C
<br />ol rhc Bu\incssand Pfl,f.\sions Codc. atu my liccnE ir ir tull la'cc il cilt.r
<br />Li.cns Clas:-Li.ctrsc Nunrt cr
<br />D.r€r Corldclori
<br />qaNErSIlcn()[UillrlNc-acENl]
<br />IhcrcbyollirnrundcrpcNli,orFrjuryrhdrh.rcisacon(rcriontndinEa!.ncylotlhcF'onM.ceoflhcworkrorshichrhi{I)c,nilh
<br />ii\x.d (scc.1097. Civ C.).
<br />AffllrlNfluig.,AaAlloN
<br />I rEEby mim undc, pcnalry of p..jury.nc ol rhc followir8 dcchrurions:
<br />Dcnbliln Pcirnik-Asbc(osNorificrrion Fcd.r0l R.!ulIn,NIritt40,Pan6)
<br />Rcqu,Ed t rrcr oi NoliaErri,)n
<br />1..'rilvrhnrrhc hJcrrlr.EUhri.f\ rcgrrdiDE rsh.(o\ rrnmral irt for rJrtlcxhlc n)1hi\ I[ic.r
<br />I ccdilyrhil lhavc reld rhnappnc.riondxl nrrc rhnr rhc ahovc int' uiion is .orccr I rBrs to $nely uirh rll City lnd Counl,
<br />rcprcsctrl.tivcs orrhis Cirynnd Coutrryto cnlcr upon rhc.rdtrrrtrcs nt sllrc I r*a 'chtt{t)btr'ltlrcrHrr nrnrtrtd ti'.|crry r,, irrl).rr,
<br />"",Ztr./<t\prlirinl or nqr l Siutr.l0rt x
<br />,',.-u*.,-," ,r.'r,, (tl AlCa{Ea)
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Vent/l nsulation
<br />Roof Sheathino f:Otl<tt/E.,{>9)
<br />Shear Wall L/J
<br />Framinq
<br />ln su latio n/E ne rgy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />I
<br />FINAL I et8 t lffi , J{\ ,to,^l r*z)
<br />I UCertilicate ol Occupancy
<br />Notes, Remarks, Etc.
<br />-)
<br />Formsi Steel/Holdowns
<br />L r.h,'\ N,n.,c _
<br />I .r 1.1'. \.i,1'r'.
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