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BUILDING. INSPECTOR HECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS 0\vNIiIi nt ll,l)llR DIal-('l\R,\ I ()N
<br />I hcrchy sltnn undcr pcnllry (,f |irjlry lha! I 0n cxcmPr {mm rh. Cont!.ron Li.chc tjs lor rhc f.lli,wiflE tcrbn (S'c 70ll5
<br />llusincs lnd ltot sion Codt) Ary Ci'y or Cou.ry whth rcqunc{ r p.nnir b onsrtucr, ahcr. nnl)n!c- dcfrolisl 'r ENn mv
<br />srtucrure, prior ro ns nsuotrcc- llro rcquircs rhc rytlicanr lor slch Frnrir b fiLr signcd {a'. rd rhd hcorsh. n liensd p!^unl
<br />ro rh. provhion\ olrh. C.nra.M\ Li.enrd lie (Ch+rcr g Connncmin! wih Scction ?000 oi Divilion I olrhc susincs rnd
<br />Prclision\ Codc) or rhnr hc or she n cxenfr rh.tcrtufl,nd rhc blsis iitr rhc trlhgcd cxcnurion Anv violariotrol SdrbnT0:ll5 hv mv
<br />arpli.d n, a ll.rnir subj(ls lhc rtpli.n.r ro a.ivilFnonyornor ntrclhrtr li{c hlnd ldollds(S5,
<br />-l-
<br />a! osncr otrhc pbFny. or my cnil'loles wirh wigcs os rhcn 3nc con{xNition. rill do rhc so.t and ltr srdm is n'r
<br />inr.'vl .rnrT.rcd nr $h lsdc.Tltll. Busincs und ltofc*i{'nt Codc TlE Coturcrols t-iccnsc h* does nor.nDlv lo an oqi$of
<br />rhc pmpcny wh. buikls or iqroks rtrm.. { wh. rlms such *.* hnnscll or heMlf or rhr.ugh hk or her o{n cmi'Lvcc\.
<br />1rn,t"a rta *.t inPnrvcEtrls N tror i' .filcJ.r oficNl f( qb lt htwcwr.llE huildi'tg oi iIr{rFrcnrnr is $ld wthinorc vtu
<br />;r.onpLriol $c O*re, BuiHd will h.rc rhc ho,&n ot F,vins rhd h. or sh€ dil tror huikl or inlpmlc tlE lmFnv lot lhc puqD$ oi
<br />l.isowtrcrolrhcnrutdry,r rcxclusivclyconta.ri'r!!irh)i..trsdconlrrdo^roconsrrucrrlEpftrjc.r(SN 7044. Bn\i"c(
<br />und l\.li$b.Codc ThcCont6ctn s Li.unsc tjw docs nolaFPlykr atrowncr olnroPcnyNho huilds.r n prcvcsrhcrcon.
<br />,M qho c. riclr for st.h pm}rls wilh a Contld{tr(s) li.ctrs.d t'lruor b rh. Conk0cl.r\ Li.{nsc tjw)
<br />I nncxcmor uidcr se.rn,n-. B & P.c. forlht rc*o
<br />Dsler OE.er,
<br />woRxrRs colii'FNsarl(lN
<br />I2ECLA.BdIIA!
<br />I hcrchynlfifl,tndcrrtDrkyofrriryoncoirhcn LwinS Jcclirrlions:
<br />-lhavcandwilluinrainaCcnificare.rCons..rk,sclf'nsurclirwork.^compcnsarione\F,vidcdforbvSd(ionl?IDo{rh'uh.r Codc. lor rh. rcrromncc ofthc wo,k lor shkh rhe Fmit k ksucd
<br />I havc !.d will monrlain worr.rs co,nPctrsarion in\urak., ds rcquncd by Sccrirn]TO0 ofrhc Lrbdr Cod..lorlhc prrfirmNn"'f
<br />rh.wor*lorwhicnlhispcnnnisisscd.Myworlcts.ump.nsalioninsuEncc ricr and polic, nlnbcr ft:
<br />Chro I'na o SL{ c( /}y
<br />.AtJu u.,o lll HaR4
<br />-l.edilr
<br />rhrr h lhc pcriorronc. orrh. vork for *hich lhis peilnir i\ issucd- I shull ior cmPlov rnv F-t$n i.,nv rldnrcr
<br />$ s Io trrom subr.rr b rh. $orisi conrncnsar io. ltrss of clliforni!- lad a8N rh,l il I should hecom suhFl ro th'
<br />rukcs' ompcnsart,i pneisions ol Sccrion ITOO of rhc trtatr Codc. I shrll. fo.lhwiih con9ly wirh rlss frovni{']ns
<br />WARNING: F,ilurc ro sure sork *'.onwnsolion coveraEc ir u.hwtul. n \hill subFcl atr cmPlov.i ro di iml Pcn'ki.s Md
<br />cnrl lincs up ro oft hutrdrcd rhou. J dulle! (Slto,u-y) in addiriotr Io rhe cos or.onlFn$lion du'hlcs 0s lnrirha rr rh'
<br />sc(ri.r nroi,r rhc btq codc. mh'^r ,rdrqmy.lls __--- ---=<"')
<br />*", Ql1L111x noo,$/ < -'&-"=:'
<br />_.. u(E$I};DllrNr3aglr8
<br />DECI,Af,AIAN
<br />I hcrcby .lltm u ndcr t.lalrr .l t rjury lhal I ur li(o*d undn lrovisi.n ol chrnl$ 9 (comntrci'rs wirh Sccl iu 7000) or Division ll
<br />oi rhc susincss d Plofcsio.sCodc. md my liccnsc t i'r rlllldN md cficcr
<br />4 I
<br />*r" ,CLl 14Le
<br />CONSTRIJCI'IIIN I FNDIN(; ACFN(]Y
<br />I h.ruhyrfln undcr pcnlhyofPrjxrylhd rhcEnu con{rucrion lcndin8 rscnc, fttr lhc rcrl'ornumc ofrhcwork for shih thi\ Nrmil Ls
<br />nsucd (Scc 1097, Civ. c.).
<br />I. J"r . NIT
<br />-
<br />Lrr.'(,',. \,rt,.., __
<br />APPI ICANT DNCLAIIATI{ IN
<br />I hcrby aflid und.r pcnlh y ol p.riury orc of lhc rbllowins d*kntions
<br />Dcnmlilnrn Pcnllnr Asb.slos Notificarion F.dcnl Rcgulations ('Iirlc40 PmlO
<br />_Rcquir.d brtcr olNolifi calion
<br />-lccnilyrhlr
<br />lhclcderdnSll ions Eso'ding astrnosrcmvalarc nor +Ili.lblc l{' lhhlhFr'
<br />-l
<br />ccnilyrhd I h.vc rcld lhn ftli.arion md narc rh rhc !}x,v. inrornd ion h.onc.r' l 4N lo conplv *irh all Cirv and Couniv
<br />odnDtuBsndslarc t ws Elarin! ro bxilding conslructio.. md h.dby nutho,i4 Eprc*nrariv.s ofthh Cnv dnd Counlr lo cnrcr trt" rhc
<br />,*-:,-:..,-:;"u*'"81
<br />p"trr** ".,;n , W D#|11 Sheclr o,"
<br />*,., q//4/ii
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsulalion
<br />Roof Sheathinq
<br />Shear Wall
<br />Framinq
<br />lnsulatron/Enerqy
<br />Drywall
<br />Ext.[nt. LaiD tdelt$T,,
<br />^N\-utY-g
<br />,)
<br />Brown Coat U t\v
<br />[/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL r2l24ltfr :I\-r.7t--yt r"l,dz> )urCertif icate of Occupancy
<br />Notes, Flemarks, Etc.
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