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BUILDING. INSPECTOR RECOBD
<br />SITE-WORK DATE ,ID/SIG.COMMENTS ()WNllR BUll-DllR DF:t,CARA ttoN
<br />I hc'cby rllt unrrcr lcMlry ol E-rjuy rhir I !n cxcnrlr -rw r(tr rhc k,rro*nrs fu\,n ts:. mll 5
<br />Busitrc\s xftl ltolisn,n Codc) Any Ciry or Counly whi.h r.quncs r Jrnnir kr co nrucr. rlrcr. inrrtuv.. dcnnlish or rcNn my
<br />(nr.luc. trior n, nr hsuD.c. rho rcqunc\ihc rpplicrDr li). u.h Nnnit r,lilc I siAn.d {ar.,nnt th lEor shc is li.ctrrd nunu0nr
<br />k, rh. pn,vi\i{)ns ol rhc Conrracrol\ l,iccn\cd lnw (Chnt'rd 9. ('onnncncnr! sirh Sc.rion 7U)0 .f Drvis( r 3 ol rhc Ansin.s rn
<br />Prolc$qons codc).r rh! h.or\hc i\cxr rpr rh.rclro'nrnd rhchl\n rn' rhc rllc8cd cxc'npr idr AnyvirnriioDofsccri{,.70ll5byrny
<br />rppl'.iN nrrpcnnir\u6jpcr\rh. ltpli.rnr b ncivilpc.rlryolnor Ntr rhrtr [!c hutrdr.d dolh( (S5LU).
<br />-1.
<br />!s ow.cr ol'rh. frclxny, or nu cnp,otds wfh wagcl* rh.n $h .oilpcn{rnnr, willdo rhr*.*d rhcnMuris nor
<br />imcnd.d or ontrcd for qL (Ss.7Or4- Businc$ lnd Prctussi.ns Cdlc Thc Co.rractois l,iccnsc l !w docs nor omlr ro Dn o*ncr or
<br />thc pmldy wk' huilds.r if{'orcs rlEEn. dxi *ho dds smh wo* hins.lfor h.sclfor rhDUBh hh or h.r owncDploycc\.
<br />F.vidcd rhrr srh inpr.wn.bn m nor i c lct or ofierd r'or {lc lt horcE,. lh. buiklin-q or imprcErnl h sld *irhin nnc Jcr
<br />of conDbrion. lhc Osncr Buillcl will harc lM hrdcn of pnrving rhd h. or \h. dil ior buiH or ir{hw rh. t6Fny f.i rh. ruqrM or
<br />I. .s osM of rhr |'orcn!, mr cx.tu\nrly ..nkrr in8 wirh lircnscJ contachF b con{tucr rh. pn*.r (Sc. ?(}!1. Busncss
<br />Md h,lixsion Codc ThcConlrrtofsLiccnscLawdocs.or.pplyrodtrosNrolprol)crlywhobuildsori'nprorcsthcrc.tr.
<br />r,'d who culnds tu \uch pr oFts lirh { C.nkacro($ ri(cnscd f ur\u l lo dc at'ntacror's Licc.lc lrw)
<br />Irn.r.nlt rtrJ.r S..rni
<br />]laBtrIi&5:g)ufiiNt lla!
<br />lECL/$AlllJ!
<br />I hcrcby illirmutulcr p.mlry of pcrjury om ofrh. fdlouire dcchrarions:
<br />_lhivco willnhinrrinrCcnilMrc.fL-o { rt,Scll:ltr\urclnr(orkcricon,Fn\rri(nr.r\ pn,vidcd tur hy SNr i. lT(x)ofrl[
<br />lrhor Gxlc, ftn rh p.nomunr. ofrhc sork lu whi(h rlr ,)cn.it k isucd
<br />_l hrvc lnd will nrn iin wortcnr con[.nsrrion nsuh&.c. d ruquindhySftrn,n:]7U).frh.IjhntrC.dc.forrhcpcraonnrmcof
<br />rhc *ork nn whichlhh pcnnit is tsucd. Myworkcn comp.ngrn,i inrurxkc.Mi.r.d policy Nn$$ c:
<br />!.cdiryrhar ii rhcIcrrormlnccolrhc work forwhich rhis pcrmil t i\sucd.l shrllnor cnrrloyuny p.rotr inrnynunmr
<br />$ allo bccom suhjcd b lhc qorkcrs .onp.n\diun lrws ofcrlifomia, ad dlrcc rhn itl sltr,uld h....8 subjer b rlf,
<br />"orkcri .onlptnsor io pmlntuns of Sc.r ion l?OO of rhc Lrhn Cdld. I shnll. f.dhwnh onDly snh rh)* pft,virnrN.
<br />WARNINC Faihr. b Klrc w.rkc^'co rpcnsrtiflr covcrdec n utrhwlnl. dd shnll subJc.l .n{loycr lo annin0l F,ulths aftl
<br />.ivil fin.s ur lo orc hundrcd lhousmd dollas ($l0o.0m)
<br />sc.rirn 3076 olrhc Llhor Conc. irrcrcn !.d otkrrcyt fes.
<br />sdtion, d.lm8cs !s tlrovidcd lbr lh.
<br />o.,,,(llll I lg noou*,,
<br />DIiIIA8^IIIJ!
<br />I hcrcbyalfirmundc.n nallyolpcrluryrhir IaDliatrqluMc, piovnionofChlfrs9l
<br />ol' thc Ausir{$nnd Pofc*rn\ Codc. dd nyliccn* i\ in li,ll iorcc and.lf.cr
<br />rftn. irA Nirh SNtiotr 7Ul)) ol Dirisiotr l
<br />gaNEralcullNr[NlllNc-&{iENcr
<br />I h.ruhy ailim undcr Fcnllly of pc.jury lhal rh.re k a connddbn htuiin8 ag.ncy rbrthcrcdnnDn.corrhcrork lor which this Frnt i1
<br />hsucd (S( lO9?. Civ. C ).
<br />IITUjjANLDICI.AAAII!)!
<br />Ihcrc$y{ nnund(Fnnlryollrrjury.0cof rh.f.lhri.!dcchnri.n\:
<br />I)cnDlirion Pcrnrir$Ast{nos Norli.at$n F.d.rul R.!ularion\ ('l iri..lo. I,rn6)
<br />-Rcquncd
<br />Lcrt.! oiNorifrotion
<br />I csrity lntrr rhl fedcrul rcsllalbns Esardin3 rstcsros rcmvol a,e nor arpliclblc ro lnis pmhcl
<br />-l
<br />enily rhat I novc rcad lhh r,,,rlicarion ud shlc lhal fi. abov. inlormlion k corc.r. I rE N lo sn ly wirh aI Cny rnd cotrnry
<br />o ,nrN.\ r Srnc Lr$srliing (i htril(lir8 corslrxcr hcr.hy rnrhorirc rcprcsctrhli!c1rn ilis Ciry dnd CDuntyt'.nrcr uli)nrlr
<br />rtrilc nNnrionc'l nrop.ny lbr
<br />Apnli(!nl or ,\,rnl SiInalurc
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Sublloor/Venl/lnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing /0-/z-18 6c'z-'7
<br />lnsulation/Ener gv
<br />Ext./lnt. Lath tolrn)tK 4ntnt>-,>)--
<br />Brown Coat rnlii/Il* :*ttriTI-/4i2--.--'
<br />Ivlasonry (t
<br />Pool Fence
<br />De puty Final Report
<br />Engineer Final Report
<br />Flood Zone Certif
<br />---7.
<br />FINAL //2o'/8 '4"9 ,.zg raa )
<br />Certificate of Occu pancy
<br />Notes Remarks , EtC
<br />-( z'/
<br />8S€Z- 2-
<br />')'7-
<br />-70rs-\---/
<br />L L
<br />b dk1/2
<br />,"," ct111 tlk
<br />L.ndci.^ddrc$
<br />P.mne nrn. (pnni):
<br />"","elllt ll(
<br />Drywall
<br />T-Bar
<br />Handicap Req,
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