|
BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE IDiSIG.COMMENTS OWNER BUILDf, R DOLC,TRATloN
<br />I hcrcby iffiirn undcr pcnolry of pcrjury th{r I nD cxcmF from rhc Conrruckm t,ic.n$ li* ,or rhc fdlo*ing ,.astr (SG_ 7011.5
<br />Businc$ and Aoicssion Code) Any Ciry or Colnly which rcquircs r pcmrir io connd.r, ,licr. inprov.. &rmlhh or rcp,it dry
<br />dru.'ore. priqlo ik hsuanc.. also rcqondrhc 4plicdr tur such pcnnir b lllc, si8tud {d.mnr rhor rEor shc is licensd puruanr
<br />ro rM !rcvirions ofthc Conr.c'ols Liccnsd L,w (Cnnprcr 9. Coarnrcncins *ith Sedbn 7O(().f rrivhn,n I or rhc ausinc$ and
<br />Polcssn,ns Codc ) or rhrr hc or shc is cxrnrp hcrcrrcm flnd rhe b3sh tu rhc dhscd .r.ntpr i.n An, vior ionofScdion?0.11.5 byony
<br />!|llic,trr ron p.nnir subj.ch'hc omlicanrtu ncivilpcndlitorn.r nrrcrhnn livc hundrcddollm (5500).
<br />I. as owncr ot rhc l)(,Fny. .r ry c.Dloy..s wiih wagc\ N rhct *,1. .o lp.n\ ion. will do lh sor[ ud llr dnf,tm i\ nor
<br />idcxlLil ur otlato{ roi sh 1S€.r014. Busincss nnd Profc$io.s Code: Thc Conhdois Liccnsc La* does h.r apply ro an oqncrof
<br />rhc nn,rdy sho htrilds or i'nlrovcs rhc6n, d who d,Es \r.i $I)rt hinNdlf or hc^clror rhngh hi\ or hcr own cmplolc$.
<br />l' ovidcd rhll such imtmvcmnrs e mt intctrdcd n oficE{ lar srlc ll h.wcvcr. rh. l{ildinB or inDmvcmnl is sold within ,,nc )tr
<br />ofconplcliotr. rhc Owncr Buildn wiu hrlr rtE burdcn.fptuvints rhnr hc dr shc dii mt tnriu or ilnlhvc rtE nn,Fny for ilE Ir{n{ ol
<br />-1.
<br />as owrEr oi rhc pmrEny, aDciclusivclrconrracrins sirh licc tr rd conrrlct,n ro .o.{ flcr rrr roFcl (Scc nlr,1.liu\inc$
<br />rnd l,r.rs\ioncodc: Th.Conr.crtr'sLic.trsc t.awdd3 nor ipplyro otrown$ olfnpc y {ho builds .r imrrolci rhtreo..
<br />flnd who .onrEckror uchrhjcckwnhaConrmdonl licenrd plEunr hrh.cont,.ttr\ Lkcnsc rjw).
<br />-l
<br />m cxcnfl undcr Sdio.-. B &PC lorhis rcson
<br />Drl.: ()*n..
<br />vaatrEEslrouflNtA.lta!
<br />DECIA.EtrIION
<br />I hcrchyriirnDtrdrr plndryof ,r4uryoncol rh. lalhwi',s.lcchrxrnnr
<br />Ihrvc, $ill nuinrdin , C.n ituirc nf Cotr{nr r, scl isuic tu sorkci a conDcn$ ion- n\ nrovirl iorbysccr nl7(nolrhc
<br />trltxtrC(xlc. fttrrhcpslbrruEc ofrh. {ork fd*hich rhc |tnnn ir i$ucd
<br />-l
<br />hrvc itrd sill.ui rin$o cri conrp.nsorion insuru.cc. as rcquir.d hySc.rion.lT(n ofrhc Lrlxn C.ilc. for rhc lsfoilnlncc o,
<br />lhc *ork tuwhich lhh pcrnrir is issd. My*orkcn conDcnsllt,n innmNc.x cru'd F,lirylnn'bdr ml
<br />PulicyNunrbcr-Lxltc\
<br />Iccnifyrhrr inrh. pcrfurn .d,)frhc so f$ shich rht p.nnir is nsucd.I rhill nor cnlpk,y ary ptrstr in rtry nDnnc'
<br />w' r\i'bcconr sul,JLrr r,'rhc $orkcn con,Fn{(ion h*\ ol Culirbrnia, rnJ rgtu rharill sk,uld h..om suhjccr hrlt
<br />worlc .o lPcn\ id pmvi\ions of Skrn r lT(n of rh. tf,lrr C,d.. l \hrll. hn h*ir h coNply w ilh rhoe previsions
<br />WARNING: l'n,lurc ro {curc workcn con{'.ns io. covcrrlc is unhrvful. and \hnll \uhjccr rn cmpk,ycr t, diniml FMlric\ rtrd
<br />civil fincs up t0 otrc hundrcd rhousand dolh6 (S100.0m). in '1'n ro rhc cosr of conrpcn\arnrn. Jrtu!.r,s lrovidcd lor rhc
<br />Sccrtr{r 107ho||4 Ltnr C.{c. inrcrc{Jnd dh ky
<br />u*", 9/as/P o,o,,",,
<br />I hcrby amih u idu Fnahr.f p.rjury rhnr I rm liana{ undmpn)vk n of Chnplcr 9 (c.m,rcncir8 wilh Sccrion ?(x)0) of Divisi, .l
<br />ol lhc Blsirc$lnd Pmtcs\n,ns Codc. ad nryliccn* is in fulliorcc"nl.[.cr
<br />l.'..n.c Cl.\ Lr.n.. Nu
<br />D,c 2/.t:1n - .",,_","*_
<br />rrrrvr r nr r rrrw r rrrnrl(:,lrlrncr
<br />I hcrchy rrlr.muM.r Fnalr, ofpcrjury rh{r thcrc k a onsrrudntr hnditrg rdcnc, fnr thc n€rfo',tumc nfrh. *'trk ror {hi.h rhis lEnnil is
<br />issucd (Scc .1097, Civ. C )
<br />affl.rcdItlDDcl,llf,allgx
<br />I hErt'! afinn undcr pcnihyolpcrjuryonc oflhc iollowirs dccl0rorions:
<br />Dctrblition P.i,nns A$.sos Nolifi.oliotr Fcdchl RCBUl,ions (Tirlc40. PM6)
<br />RcAuircd bncr of Nolifi catu,
<br />-l
<br />ccniiyrhar th. ltd.ral Egul.rions rcsardin8 a
<br />I c.nify rhd I ll3lc rdadrhh {tli.ariotr d s,c
<br />uidi.dr.s rnd Srar. L:ws rlrtiig ro buildinS con{
<br />abvc mnliotrcd rropcny for inspcclio. purrF{s
<br />rhe\r.s rcr!!l rrc 0orrpplic l.b rhi\ |xic(r
<br />nt$!c irr.ilrtrion kconcd I 0sre lo clmpl, wnh all Cir y Md Counry
<br />md hcrhynurlnriTc r{rcscrhiivcs oflhis Cily and Counry i, ctrrcr rllnrhc
<br />/1ppliQDl..,'\AenlSilnrlure
<br />tcmii.c nHD€(prinl)r 4rn
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Venti I nsu lation
<br />Roof Sheathinq
<br />Shear Wall
<br />framing
<br />lnsu lation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />T-8ar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL /o//t/r{-H9 t)
<br />Certiticate of Occupancy
<br />Noles, Remarks Etc.
<br />----+---
<br />----+---
<br />--r------
|