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BUILDING. INSPECTOR RECORD
<br />SITE-WORK ID/SIG.COMMENTS OWNIiR BT]II,Df, R DEI,CARATION
<br />I hreby amrm unds p€nally orp€.jury lhar I d .$rpl 6on rho Conlmclos Liccnse Latr for lhc rolbw,ns rce)n (St 70ll 5
<br />BGiocss &d Prctision Codc)i An, Ciry or Coonl, Nhich r.qut6 a p6.it lo construd, 6lld. i6prov.. doBlish or EFiI my
<br />strudue. pno. kr ns isuece. al$ requtB rhe applicdr ior sucl p€nnir lo tlleo sign.n eardnml rhor h.or she t licd*d puiudr,
<br />r. lhe prorisions oflh. Conlrrcrois Lic.nsd Law (Challd 9, Comm€ncin-! Nith SElioo 7000 ol Dirision I ofth. A6ins and
<br />PrclNiom codc) or rhar hcorshcLs d.mrt lhqefrom and lhc basn lor rh€ all.s..i cranflion Any\ioldionols6lion70115 by y
<br />applica.t fo. a pmn subj&c lhc agplica.i o a civil pdall, of nor sorc nm nv. hundr€d dolles (tt00)
<br />l. s o\Hs ofrhc prcpe1y. or m, cnrplo)€6 rilh Nas6 6 their elc coDrpc6alion. lldo lhc Nark ud thc slndE n mr
<br />inrdded or ofid.d lor sle (56 7Mt, BBin* ed Prci6sions Cod. Th. (irnimctoi s l,ics* l,aw dos lol apply to tn o(td oa
<br />rhcpspoiy Nlm hrilds or nnp.ov6 th6en. d { ho d.6 such sork himselt o' hNl l or rhroush his or hcr o*n .mPll}e6.
<br />povid&l th.r su.h nnFovmmls e mt intodcd or ofiald for elc la ho$6 r. rhc hildinS or nnprolmE is $ld wilhin "n€ )a
<br />ol co,nplcrion. Ihc Os,nq Buld6 \dl ha!. $c bud6 oa pioin! rh, h. or she did ool hlild or inproE rhc lr.pqi, for rhe pur?oE oa
<br />l. 6 o{nE ol the DroFsly, d .\.lusi vc l} .6nta.t nrg Nnh li.cBcd contacro6ro.onslruct rk projd (se 704,1. BcinN
<br />rnil Proleim ( od.: I hc Conrracloi s l -iccnse l.a$ do6 nor apply to m o*..r o f rrop.ny {hD builds or i'.P.ov6 rhd$ .
<br />and who coih.ls nr $ch pmj{ls with a Contmdo(, liccns.d pumuarl ro thc ( ontmdofs Li.croc LoN)
<br />_l m .rempr rdr Sdtio
<br />"ffi*
<br />I hdeby aftn undd poaly of pdjlr, on. ollhc lollo{inr dBlaarionsl
<br />I hav. md will mainlain a CalificatcolConscnl lo S€ll'lNurc fo, rvoikeu'co.rp.nelion.6 pmvided aor byS*xon 1700 orrh.
<br />tiho. Cod.. lor ih. pdlollrmc. ol the volk for shich lhc psnil 6 issu€d
<br />I hav€andNill mainrain wori.rs'.o,np.6arion isrd.c, s r.qut.d br" Setion 1700 otlh€ ljbor Cod..lor thc pc{onnancc oa
<br />'ll. so,tlorahrh ,LlEm sBEI Mr *orke! .o,n6qon,6urMc. mo dhhft numbF &e{,,, llJc O,^iu*h"n lm h,,.^oL ,
<br />X,*,***.. tobt6St{'t"\ X,,,,, (J!,fi_
<br />-l.dr'ry$ar
<br />in ih. pdrotrmccoarh. work lbr which rhs p.m, ', o,l Lr,"lr nn, *prny
<br />"n) P65on in any mens
<br />$ sro b..om.subjat to thc{ork6 conp.nsalion Iavs ofcdifomia. dd tlB thot ifl should b{om. bj(lroth.
<br />vod<m compasrion provisions of Setion 1700ofrhc Llbor Cod..I sh.ll. aonhwilh comply wilhlhos p(rbions
<br />WARNING F.ilurc to su. MdcB conposalion covmgc Ls unlarvful. ud shall sobld m snploya to oninal p.nahi6 md
<br />civil nn6 up lo onc hun&ed lhoBdd doll6 (5100.000). i. .ddnion to tlE cosl ol comp€Mlioi, ddages a pruvid.d for lhc
<br />Cod., i' ctuartuda(onrv s li.\
<br />zo\n q o!(F
<br />I hqeby aJlirm undo D€nahy ofpojury lhal I an lice.s.d undd prorision oachaplo 9(cornmcin! NnhS&lio.7000)oll)ivisionl
<br />oi thc Busind md Prol6sio6 Code, aid h} li6* Lr fi,ll hrc. ald €i|cl
<br />)*
<br />I*,'c
<br />loo5\7 f
<br />I '31 2D\1 ""1-;J'r'-F4^o A,*LLC
<br />O I
<br />{:a.UllalJcrloNrElDlxclc.Elc.l
<br />I h(eby aitdn md6 p.nslty o t p.dury thal lhqe G a coNrucl ion lddins a86cy for $c pslollrucc of thc wo fot which rhis pdnil b
<br />tsu.d (sd 1097, civ c.)
<br />AXTLIIANLDICLAAAIIQ!
<br />I lErsy arm und6 Fhany of pdjury of,€ of lh. fouowins dtrldat ions
<br />Dc'nol'tion Pmits Asb6tos Norific{ io. r_.d6al R.Sulat iom ( l illc 40, Pan6)
<br />Requtct lxlrooaNoriarorion
<br />I cditytlh rho feddal regulitions r.-ladins sbetos rcnov.l a.e nor arplicabl. rd this prq{t
<br />-!c€nirylnal
<br />I hav. red lh6 appli.alion ed $arelh $c above inlonnarion iscotr€c1.I asre ro coorply s irh a! CntmdCornry-tldiancB d Srarc L3ws Ehlins ro blilding .o6tucrio'L dd hd.b, ao$ornc rcpr6fllariv6 of rhis C7//
<br />".7r./.(
<br />^'ilL:-
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subfloor/VenVl nsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />Handicap Req Z/t7lt1 W{rt)
<br />Deputy Final Report {
<br />Engineer Final Report
<br />FINAL 4t1/r1 ,LQ{r'
<br />Certificate of Occupancy
<br />Notes, Remarks, Etc
<br />DATE
<br />T-Bar
<br />Flood Zone Certif.
<br />lei lor r
<br />^,i,is..
<br />tt
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