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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCAR,TTION
<br />, hcrchy rlltm undcr p.nalry,)l rcrjtry thd I !n crc.r fmnr rhc C.ntacron Li..ns. Ldw for rhc idlo*inA rcav,n (Sc.70ll 5
<br />Busin.l\ ! Pn'fcs\i(,n Codc) Atry City or Counry wnich r.quircs I pci,nir t, co.slflct. rlrcr, in!rr,!d. dctrrlish nr rcluir y
<br />{o.rurd, Drinio ns hsuan.c.nlso reqln6rhc lpplkanr tur \ochFnnir ro lllc 0 sisncd {arcnEnr rhar hcor shc n llccn$d plrulnr
<br />ro rhc polhions ol rhc Cotrtn.tr\ Liccnscd hw (ChaDrcr 9. Comnrking sirh Sc ion Ttloo of Divnio. I .f rhc Businc$ nnd
<br />Profe\\ions Codc) or rhlr hc.rshc is crcmpt lhcrctro utrd rhc h is nrrh.illc8cdc(cmplion Any!n n[o, Sccrio70:]l 5 byrny
<br />rpIli.itrr fo rFnnn subjccrsrh. anplicinr t, r.iv'l pcnrhyofmr nrrcrhln fiv€ hrndi.d dolltus ( $5m )
<br />L as owncr of rh. lmrrny. or my cmplorccs *irh wdAc\ as $cn soh con{t nsll ion. will d. il* tolk ord rh. srrerE i\ nor
<br />intcodcd orolitrcdaorrhlsd.Tu4.Busincs.ndProicssionsCo{cTh.coitrcttrst-i.eneLrwdoernor0prlvrornowncroa
<br />rhc pn,Fcny qho huilds or i'q,rnws rh.mn..rxl who des such worl himsclfor hcsclfor rhrcugh ht or h.r own cmplovccs.
<br />rrovid.d rh,r \uch inpiUvcmnis orc nor inlcndrd or ottu lor eL ta hoscvcr, rtE triHins or inrproR'Enr is sld wilhin otu Fd
<br />ol.onplction. ltr Owrr Buildq *itl h!rc rlE tnrd.n oa pbving rhxr h. or shc dn lx)t build ot inpmv. rh. ImFny for rhc pulPo* or
<br />-1.
<br />a\o$ncrotrhe popcdr. nmcr.lusivclyc.nl8ctias uilh lienscd conka.ro^ b consrucr l,r lojccr (sd. 7014, ausrcss
<br />and l\of6sb. Codcr Thc Conlrrktr\ Liccnsc tlw dms n.r rprly ro sn owncr ofpropcny *ho build\ or itnprorcs rh.r.or.
<br />trnd uho conrBcls for such pbj.d. *nh ! C.ntrnclo( r liccnsed purud h rhc Co ra.lols Ltcn* Lnw)
<br />lrmcrcnr.rundcr Sccri(r .ll &PC larrhnrcr{nr
<br />lvaBtrE8,$1.(:9-AllrNl raN
<br />DEclAntrIll!
<br />I hclcby !ll_rrn undcr lcnalr, or Frtury orE oi lhe IhllowinE d..larllnn'\
<br />-l
<br />hak snr willtuinlain a Ccniflc.rc otCofl$nr ro Scltlnsud for *orkcB comrensalio..rs tmvidcd lor byScclbn 1700 orrh.
<br />Labor Code. ihr rhc rEfollr@c ol dE work fm rhtn ln pcmi n i$ucd
<br />,21*,",,0 *r,.,,n,u,n *n,*cc .onr.nrarion insuram..,r rcquircd bySccri,n l7morrhc bbo, code.lor rh. tcrrotnuncc oi
<br />rhc work r'orwhichlhn pcnDir is issul{ Myworkcrs conurn r,n trNrun.! rric( 0nd lslry nunftcr {c
<br />lns.lrncc 4"r ".,\.$<te- Grhftnso+*'n
<br />qaollblo ErnR\ O utq
<br />1""dilirh!! i'irhcpcrfo nrrccollhcsorkn,whichrhnpcrnil is n\u.d,l slrlll nol cmIl.ry ary FB.tr irrnytr rnct
<br />s, trsro bccom suhicct to rhc {orksr conpcnrdnri hw3.rCalitomio. and .srcc rhrr ill dn,uln bcc.m subjd lo rrF
<br />wo*cr .omDcnsatiotr tmvhioos of Sc.rion l70o dr rhc Ltb(, Codc. I nmll. lonhwirh .armfly wirh ltb! I,mvtionr
<br />WARNINC: Failurc ro s.m wo cs compcnsdion oveBs. ir ulD*ful, Md sh.ll sul,ilrl an chploy( b dnrin0l lcMhics and
<br />.nil fine\ up ro utu hun{rcd rh.usrnd dollan,ls l(xlll(x)1. ii addiri.n ro th. co{ ol compcnsarion, damscs as provid.d lor rhc
<br />q(ron 1076urrrk lrt-rcod. inr.r{ands "' r( rcc\
<br />-*.:loLE nd.,L I u(ENruJ-lt NrragllB
<br />IIECI.AAAIIQ!
<br />I hcrcby ofinm undc. pcnallyofp.rjurt Ih0r I afl liccn*d undcr pmvnion ofCh,pr$ 9 (co'nnErcins wilh Sccli.n Totx)] ofDivnion -l
<br />or rhr Busirc$ and Pmlcssions Codc, aid my li..ds is in rull lbt gqt.fr€r
<br />-1 lqLd 1
<br />ta
<br />coxun]lcuaNrlilllM;-LcliNrI
<br />I hcrhtrinnru drr Ft.lryulFrlurr lhli rh.r. is r..nntdioi Ltdirg ilcncv it rh. FrtrnLn(.frhc w.rk li,r wl,ich rhi\ Iinnir 1\
<br />nsuc'l (Scc 109?. Civ C )
<br />AfILICANLDECIA&IUA!
<br />I lr.:hy Jfinn undcr Fnnlry ol pcrjlr, orc ol rhc ftnbeins dc.hrri.n\l
<br />DcnDlirion Pcrmlk A\hc{o\ N.rifi..tion I;cdcrul Rcguhrion\ (tillc.l0. Pn'6)
<br />Rcqut.d t-xcr of Nolifi cari,n
<br />-l.cnilithsr
<br />rhc rc cr|ltugulIiols rc8{dinB astEsros rcm,vrl are D.r amli.rbh ro rhn tojNr
<br />I ccnilyrtur I lrrc rrld rhi\
<br />ordi,rf(\ rtrd Srdc tru( rcldi
<br />xh.r nrcnr .nr(lt',,|r.,rr lnr
<br />Appln$l or ,\,tml Si,rn lu
<br />n corat. I asr ro codply wnh . City and Counl,
<br />rclrccnrarivcs nfihtr C yrndtiiunqhcnE unnn rhc
<br />",",!141fr
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenVl nsulalion
<br />Roof Sheathinq I T,ffi/fi 6ttM?/fi--
<br />Shear Wall
<br />Framinq
<br />lnsu latio n/E ne rqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coal
<br />It4asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Beport
<br />Enqineer Final Report
<br />Flood Zone Certif
<br />FINAL I 'oD'///(V??)Lfu /6-)
<br />Certificate of Occupancv
<br />Notes, Remarks, Etc
<br />I
<br />L(nd(''r Addrc$
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