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BUILDING. INSPECTOH RECORD
<br />SITE-WORK DATE IDiSIG,COMMENTS OiTNER BUILDER D'LEARATION
<br />I hereb, nnlrm undcr pcndry (,4 Friury rnd I cxcmPr trcn rh. conuicton Liccns Itrw iot lhc lollowing rcrstr lscc 70-l l 5
<br />susincs .nd Proltssion C.d.): ny Cny or Counry which tquircs i lrrmil ro ..niru.i. ahcr. imPr'!e. dcnmlnh or rcnun rnv
<br />srfl.rurc. priorro irs hsu,n.c. rlso rcauncs rhc upPlta.r for\u.h Frnil ro fiha sign.d snEmnr rhrr rEor shc n liccn$d pu,su,trr
<br />h rh. trolisions ol rhc Conrr!.ror's Li.cnscd Law (Chaprcr 9, Co'n rncin8 sirh S..rion 70OO o, Divi\ion 3 of lh' Bnsinc$ ond
<br />Pmfc$ions Codc ) or rh lEor shc is excmpl rhcre{mnr Md rhc blsh lor rh.alhecdcx.mflion. A,vvi.l(rionofSccrirnT0]15bv,nv
<br />lpnlica0r r.rap.im subjccrs lhc applica.r b rcivil!.naliyo{nor turcrhdl nvc hundrcddollds (!5$).
<br />I.rsownsoflhcpn,pcny,ormycmployccs*ilhelrcsn\ihcirsolccompcnsrri.h.silldothc'orklnJrhcslftturcisnor
<br />irlddcd or olicrcd tu sl. I Scc ?04-1. Busincs dd Pror.sions cod. 't hc C.ntrr.ls Liccns l-aw d.ct trot 0pplv h m owncr or
<br />rhc rmp:ny who hoilds o, inl)rur$ rhtu)n. ard wh. ie\ Mh *ork hi'nsclf.r herkltor rhnruSh hn or hcr own cmplov.cs.
<br />pn,viden rhrr skh iftproEnEnls !ru mr inrc lcd or .ffo cd for slc lf. ho*.rd. rtE huiklin3 or i'npnrqEnr ir sld wirhnr onc ]tnr
<br />of.onr0lrnr rla Osftr Buildcr willhlw tlt bur&n or pn,vi,r-q har h. or shc dil mt hdih or irqiolt rhc Pn'lmv ror dt ro4is or
<br />-1.!so*icrorrhcpopcny.onrciclu\ivclrcont0.rinswilhliccnsd.onrMlo.stoonnrucrrhcfl.i..t(Sc.7l|44.Bn\i'r'sa l Eslission Codcr'lhe Contack, s LiccDsc l-awnocs Rn llplrtr, rno*ncrorliopc ywho builds.r i'nrovcs rh.tcon.
<br />Md $ho .ont s for such l,oirh wirh.\) lEcn*d pu*unirrolhc(bnrrrktr \ Liccn{ l.r\')
<br />I rD.r. rU utrrl.. Sc.ri,,
<br />-S0'--r&
<br />DICLTBAIIAN
<br />I hcrcby atfirnrundcr pculry of p.rjury oN ollhc follo,in8 d*ldarions
<br />-l
<br />havc arxl sillminlain a Ccniararc orconsn' to Self'lnsu.e tn work.ts coryEnsarbh. $ tmvidcd lorbvScdrion]?(xrorrhc
<br />L.bor Code. to, rhc lfrdnu.cc oi thc sort ror whi.n rhc Frmil is isslcd
<br />-l hdlc,nd willmainlain worlc^ .omF$artrn insuraice, as rcquiEd by Secr ion l?fi) of rhc Llbor Cod.. lor thc I).rlontutuc or
<br />rhc *ork for which lhh p€mir i\ issu.n My *orkc6 NnrFnqriotr iNurana cuhr end Brlicv nun$cr dc
<br />-l
<br />ccnify rhal in rhd p.rr.trromc oarhc qotk ror *hi.h rhis rcrnrir k nsucd.I rhnll nol cdplov,iv p.r$n ia anv m'nncr
<br />s rs ro t .onf, slhFr ro rhc $olkdC .onpcnsd ion la$s ot Calhtnid- ond aSR rhd il I stsuld hecotu iubj.d !o rh€
<br />qorkcB $mn€nBlion povi\6ns ofSclion 3?m ofrhc tjhor Codc- I sh:ll- fonhsirhonplv viih rb{ pmvkions
<br />WARNING Failurc ro surc krkc.J.o.Dcns ion otn8c i\ onlawtul. aod shall subj.u ,n cmplorr ro diminrl pcrullics 8nd
<br />civil fin.s uf r, onc hundrcd rhou\rtul dollr( (
<br />/?
<br />damg.s os prolid€d for th.
<br />S..ri{ 1076olrlr l-ihn(ixl.. inic'o{atrd r IJ 30-iF<-
<br />DECIAIAIIAN
<br />I hcrcby!!firnutrds p.halryorpcriuryrh l am licen{rr undc. Pmvht}n of Ch,Prcr 9 (.ommm ina wirh seth. 7000) 'r D'vnion :1
<br />ol rhc Busircs md Pmfesbns Codc. atrd myliccnsc is in fullforcc otrd clTccr
<br />Li.cn\c Ndmbcr:
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<br />CONS'I'EUCTIoN I tsNDING (]FNCY
<br />lhcEby.fiflnundcrPcn.lryolrErJUrlrharrhsc(r.on{rudionbndioSrecn.vlorlhcpcrformn.collhc*orktdwhichlhhtcmiti\
<br />il\u.d iscc 1o')7. Civ C )
<br />lrnd.is N!m.
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<br />Set Backs
<br />Forms/Steel/Holdowns
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Venl/lnsulation
<br />Roof Sheathinq
<br />Shear Wall
<br />Framino
<br />lnsulation/Eneroy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Itrlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />A
<br />FINAL g/24/tv,a:94 U
<br />Certilicate ol Occdpancy
<br />Notes, Remarks, Etc.
<br />Erection Pads
<br />Pool Fence
<br />Flood Zone Certif .
<br />AETLLEANIDSCIABAUO!
<br />I hfr1,y allm undcr penalryofp.ljuryorc oarhe a.llowins d.claErion\:
<br />Dcdolnion Pcrmirs'Ashcdos Norincarion Fcdcal Rcrularions (l irlc'10. Pan6)
<br />Rcquimd titcrolNoliljcuriotr
<br />a
<br />-l
<br />ccnify rhlr rfic rcdcral rcguhlioos Esnrding nstE{os Emvulm nor,pPticahlc x, '!ir
<br />ptu,.cr'
<br />I.criifyrhd, iovc rcad rhis 4r,lkurion and srrlc lrtr rhc ah)lc inlonn(ion i\ codccr I .8iN ro conPly *th ,!l Cilv od Counry
<br />ordrtrnccr Jrd Srrrc Ln{r EltrrinS)obu'Urns c.nnrudnn. and h.rc$y aurhori& r.pescnrolives olrhh cirv,nd Countvro cm'r u,$n ltE'*^1*".Iilvwz!%'
<br />_ **l<,r'+
<br />".-u*-*,,n,,,'' FhnlrrE Gl <Zrtittltz-
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