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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER NUILDER DEI-CARATlo|i
<br />Ihcrcbyillnru.rFnalryort'.rjxryrhaiIa'ncrcnprlunrhcConrnct{iLi.cnsctiwiorlhch1b$insru('nrscc?rrll.5
<br />Bosincss rDd Prolt$ion Gdc): Any Cir, or Coumy shich rrqutc\ I fxnnir kr .rrn{rud. alrcr, i'npflrvc, dcnxnisl' or (nrtr rn) ,
<br />itu.rrrd. priq ro ils isurme. lho lcqun$ rhc applicrtrr tor su.h!.nrirro lilci {g.c nrrc,h r rh.rlf,or\h. rl li.cn{d ,unuur
<br />i) rhc nrcvtions or rtu c-onh.rr\ l-ic.i\cd Ltrw (Chaflcr 9. Comnrncnrs *irh Sccrnrn ?O(D ot Divnhn :l ol rhc Ru\incs and
<br />I'rolcs\i,)n\ Codc) .r lhal tr or shc is .rc.r!t thcrcnon r rh.hrsislnrrhcallcA.dxr.mpri(,n Any!i(,hrn,nofsdcri(n70.115hr y
<br />rltlica lnralf,nnir \uhj\.'h rh. amlicant k) Icivilp.nalryol mr nMcrtun fivc hundrcd dolld^ ( 15Lr )
<br />l.aso$0er.flhcpropc.ly-ormycnulo)eswilhNrgcsdsrh.ne,h.onlttrisrriotr.willd.rhcworkrrdrhc{tulxftr'(tr
<br />i .ndcd or .rIcbd ror $ld ( Sd 704.1. Blsinc$ and Pofcsioos Codcr Thc Conradol s l_iccnsc ljw docs nor mply h !n o* mr .f
<br />rhcpmFd, sho buiils or in{'r,vcs rlENn. ad who docs slch q,& hnnrror h.relfor rhFUAh his or hcr owr cnDn,yccs.
<br />pi(,vidcd rhr such i'ntDrcrmnr trrc rer inrcricd or oilcmd for n'L lf. howcw. rh. bui ir8 or inlrbvomnr is sk sirhh otrc ,tar
<br />oaconDLrion. rhc Owncr au,icr wrllhrvc rh. hunLn.f povin8 lioi h.. snc did nn ltuild or ir{rorc rhc pmrcn, tor rtE purFs of
<br />-l.
<br />r\o*Nroirhc pmpcny- nctulusivclyc.nka.ri'r€ wirh lircn\cdcotrkr.k,Fbcon(tucrrhr rk'jc.r lScc 7014, Btr{n.s
<br />r'xl Pn)fd\inrA c:'lhcC.nlraclois l-iccn\c Lawdocs nor lpflyb rtroqtrcrol ptuJfnywho buil&oi nnprcv$ rhcrcof.
<br />rnd Fho co nrB lor nr.h tsrc.N wilhnc.ikact(\) li.cD\cd pursx'nrr, rhc conrxcrr's l,tcnr Iiq)
<br />l,n cxcmpr undcr Scdion
<br />Dslt: ()En.r
<br />trQBtrIi&r:(Q frNjill-llar
<br />DICLAEAIION
<br />I h.rchy ilrtnrn&l$ |{trrlrv rl |tUuryotrc ofrhc lnlk)q r! dcclrrrrior\
<br />I hrvc nnn willNinlinra Ceniarurc o, Con*m t, Sclf.Insuru fM *orkcs .on9.nsarn,n, N provid.d f(r bt S(hotr lT0Oorrhc
<br />li&, C{le. lor thc ,crfoirM,cc oI thc *ork lor which rh. p.mir ii iis!.'l
<br />1il hrvc ond $rllm.'ntrtrr s.rkc^'c.nrlt.n\dri,,n in\urs.... or rcquncd hySr-rnnr ITOOofrhc ljl,or Codc. [i, rhc pcrrorrorcc ot
<br />rhe work l which thn pcrmil is ksx.n. Myw.rkqa comri\arion in\urance .aricr ard Flic, nlmber m:
<br />.""", 4...i 1€ F," J
<br />z\ 35611 5126/ t3
<br />l..niry rh3' in rh€ perro!roncc orlhc sork tor which rht pcirnil ir hsucd. I sn!ll nol cmploy lny pcmo. in nny nNnner
<br />s, s h) hcdon* ubjccr to rhc sort.h Lrmp.n\dion h$\ otCrlirornia. and !-sB rha' ial slbuld bccoft \rhFr ro rhr
<br />*oftcr.onllcn{l n llovisions ofS.crbn ]Tmofrhc tn]nr C.xle.l \hnll- fonhwiih comrly wirh rhor provi\iois
<br />IVARNINO Failurc lo scurc wotkcr' onrpcnsdnr .o\ri.gd i( urhwlul. rnd $nll subjc.r an cq)n'rr lo ftiniml pctrrllis Md
<br />cilil ,ines up ro o,E hundrcd rhousand dolhr (S100.m0). ii ddiriun b (h, con or.omrcnurion. dnro8cs trr piovidcn io! rhc
<br />SNri.n.r^76.frhc IJh ' C,J.. inrc,cn dnJ sn,{m) \ lcc.
<br />6_t1011,1 noorr-,r, M@J-'LICENS'DTONIBXNT
<br />DECI dR,ATION
<br />I hcrcby rlltin undfi pcndhy or pcrFry lhd I !m liccnd lndcr prclisio! orChaprs 9lconrmncinB wirh S.c'ion 7{)(x)) orDiviri.n:l
<br />.r rhe alsin.s Bnd PNlcsions Codc.and nryliccnr is itr tull forcc ajn cficcl
<br />iot11,<L
<br />c-"""*, '?L.t c.
<br />CANIIB!,]qPIIENDING.AIiENq
<br />I hcEhyalltm! c, FnohyorFrjurylhllthcrcisa consI cti'nlcndinSr8crcyforlhcpcrformrrcotthcwolkforwhicnlhhpcnnilir
<br />hsucd (Sa.1097, Civ. C.)
<br />A.TTUIAILD&CLAEAI]AN
<br />I hcrd,y nitD undcr Fn.llyoftxijury orc oflhc following delnrariong
<br />Denbhnn Pcnnns^xh{.r Ndifi.ario. F.d.sl Rrgx ld ions I Tirlc 40- Pd6)
<br />R. un.d l.ii.rorN,iili.trrh,
<br />_l ccdilyrhat rhc tcdeml rcsulnrlons rcgalin8.strsos rcn$ynldc tror 0pplarblc ro thr pojcd
<br />tLI ccnili rhd I hlvc rcad rhir +rlknr ion dl {arc rtu rhc ahorc infomrr hn i\ .orc.r I rgre ro mmrly *irh rll Cir, dd Co!trry
<br />u,,".5/lo/1"?:;,:.::,:::^"":::;.:.:,:iw,1r,'t
<br />PEmrrR ume rpnnr,: Tali Nt.illlJ
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVlnsu lation
<br />Rool Sheathinq
<br />Shear Wall
<br />Fr amrng ,n 7/h r.>a l^c:nA
<br />lnsulation/Energy
<br />Drywall 4/2 z/r* a jv ftL*71j""<(
<br />Brown Coat
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />En tneer Final Report
<br />Flood Zone Certil.
<br />FINAL 52.'/x \ lV ,_t^E'vlg
<br />Certificale of Occu pancy
<br />Ext./lnt. Lath
<br />Masonry
<br />Notes, Remarks, Etc.
<br />5/to/ tr,
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