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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION
<br />I hrrcby aflirn lndfi Fnrhy nf pcrjury rhar I !m cxcn,rr tiom rhr ContrdoN l-iccnsc tiw for rh. followirg rcabn (Scc.701l5
<br />Busincss and Prolcssion Codc) Any aily or C.unry whi.h rcquircs i lcrnril lo conslfld. altcr. inrrmvc- dcmlhh nr rcrun lny
<br />dtucrure. F itr ro ir\ hsuona. al$ rcqlncs rhc lpplicanr aor such ,snir ro lilc r sigred daicmnr rhar he or \h. il li.cMd lxKrdnr
<br />b lhc E vkions olltE Contricrols Liccnscd taB (Ch3rrcr 9, Com,rcming *ilh Sccrion 7IX{, ol'Divtion I .r ihc Bu\iic* rnd
<br />Prolc$ions Cdc) or thrt he or sh. is cxctrpl th.rcfronr.nd thc bask for the 0lk8cd cxcmplion An, liolarion oiScdi.n 70ll I 5 hy sny
<br />{rlicr r.r r p.drir subjcc( rhc rmlicant b r civi! pcmh} ol tror rr rh,n lilc hun&.d dolld\ (S5m).
<br />L r\ oNncrolrhc tr.Fny. or n! cmplqtes $irh s!gc\ $ rhcir enc cohncnlrrn,n. trilldo rh. tro* rnd rlF rmrm iI ur
<br />ifi.idd doflarcdf{,sld(S&70.1.,r.Brsind\\mdI'rcf.si{'!sC,.:Th.Conh&r'sLi...s.l2sdocs orlPplyr.dotrnrol
<br />rfu nmlcny w,x' huilds or inryoks rlf,mtr. mn wla) dms flch s1)ll hinxrll or hcnrll or rhn,uCn [i\ or hdr o*n c.rdoyccl.
<br />pnvidcd th.r su.h improrctrEnr\0r mt inrc nd.d or olLE'd for srk ll hosevcr lM itrildir8 or i'nanrcNnr is{'ld wirhinum ,tr
<br />ofro Fhrnn rhcOsncr Buildcrwillhrvc rhc hurdcn ufrrotin8 rhd lf,orshc did or hild or iEnovc thc ptuNny ld llt ptrr1ns oi
<br />-1.
<br />asownerollhc popcrly, aDcxclusirely controcliry vith licen$d conrflon lo onsrrucr rhc rroJ$r (Scc.70r.r, 8us;m'r
<br />rDd Pisfssim Cudcr Thc Contddor's Lic.nsc tjw docs ior qrply h atr o*nr ofrr.pcnyrho builds or nrtrovcs rh.!eon.
<br />.ofrrkts kn {,ch pxlc.r\wirhl a{ni'x.h(n ll.ctrr.(lnurruN tr)11[(i r ktr s l-'c. \c Lrw)
<br />7.DA
<br />-l
<br />hr$ and *ill n$i.!ain r Ccn iarore ol Conr ! ro Scll-lNurc nn workc compcnsllion..( nmviled for b,sNri{m.l7(x) orrhc
<br />Itrrhor Codc, lor rM pcllomrrcc of rhc work for which rh. Fnnn is ksucd.
<br />I luvcrnJ willnuinuin *orkcrs c.mI.n$ri(,n i',\urancc- rr rcqund hySccrnn']Tmofrhc LrUtrC.dc. turrlt !'cnoanrnccoi
<br />rhc $ork lor whi(h rhisr.nnir is N$rLn. Mywurkc^ .onlf,i\rri,m n\un..c.riiicr inl Nlicy nunrhcr nrc:
<br />I ccnifyrld inrh. pcrfomu ncc o i rhc wo.k lor rhichrhis t'. nir tr issucd.l s llnor eflrdo, lny p.,son ihmy mMntr
<br />$ ss nr bccotr- ruhjLrr t, rhc woac6 compcns,r i,rn ln*s ol Calif{rtria. dd agruc rhd if I should h< onr suhJli o rhc
<br />w.rkcn on9cnMii.n pmvisioi\ ofS(rion:17{l)ofrh. klhr Codc.Ishall tunhpirh conrply *irhrhoE lriovnion\
<br />WARNIN(; l.r,l o ni *.u'r so'ko'r coDlron\iri, r.v. !. tr trn ihrll sublr.r ir unrtlDycr ro crNiral pcDfllttcs md
<br />cn'l rnr\ u|r r) oft hutrJi!1| rlhu\ n{! lolLn'\ lllrnr.rxxr). rr
<br />hc ljlnr G\ac- inrcrci a lrxrrcy\ fccs
<br />D b
<br />I hcrcby rlTlrN xnd$ p.tr.ltyorFrjurt rhd I {n li.cnsd undcr Imvision orChJlns 9 (connmncins *i
<br />or rh. Btrsii.\\ and Prcaesion\ Cod., ,rd my li..n\c i\ in tull ftxrc ud .ffdr.
<br />CoNS'I-RUCT!0N I TNDIN(i A(iFNCY
<br />I hcEhy rmrm undcr FnrlryolFljurylh,l rhcrc is 0 con(rucrion lcMin8 a8cncy r(x rhe !.rtuhutr.. orrl[ sork lbr *hich rhis Pcmil h
<br />hsucd (Scc.1097.Ci!. C ).
<br />AITIICANTDIgI,AIAIITN
<br />I IEE'by a$mn u .! Fnally of Frjury onc of lh. nrbving d.clr{iions
<br />Dcnblirion P.rnirs Asbcrd Norific0rirn Fcdcrdl Rrgnhbns (Tirl..{}, Pd6)
<br />Rcquir.d lllifi .f Norifi .!lion
<br />l.d1fy rh{ I )trvcrcadrhn rmli.driotr rhcal!,vc rlonn.rio r cotrccl I rE cc n,.onrply *irh trllciry r dcotrfrr .
<br />ortli'r3 c.\ rnd srrrL Lnqs (hri'r! nl !rlrlrnC lt itr(l (in'nry n,.nrrrnto rhr
<br />lhovc rcnrtDcd pr)F-ny lnr ins
<br />,\U,licnnr n. \x0l Sixn,luc 7 bt,t8,
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Venti lnsulation
<br />Roof Sheathinq TllrlrK -z4qa 's/
<br />Shear Wall \_:/
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />It/asonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />t,
<br />FINAL 6thn Y t l^.tl/-'l /14,,'
<br />Certif icate of Occu pancy
<br />Notes Remarks , Etc.
<br />Set Backs
<br />I h.'ch!rrrirmunl.r I[nrlryol pcrjurvonc.l rhclall{'!irs n.(hrrli,n,\
<br />Licensc Closs:-Liccn$ Nunbcr
<br />-
<br />D cr Co mlor
<br />l.cnitynrr rh.lcdcrxlrcgulrri(,ns rcEJdingr\tf,n.\rcmorrlrrc nor"ppli.rbtu t, rhn pi,ic.r
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