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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.OWNER BUII,DF,R DI]I,('ARATIoN
<br />I hdcby amrm lndd p.tr.lry of parury lhit I m .r.mfl nom rh. conn ado6 Licas lju lor rh. tollo\ in8 rcNn l ss 7Ol I 5
<br />8ush6s and Prolssio. Cod.) Anr ( ily or Cou ! shich r.qtrte a F6nil lo constucl. alls, impftivq d@olish "r'r.rFtr an)
<br />srructurc prior ro ns isu cc. al$ rc'tunB lhc alplicdn aor such p.rn ro filca sisn.d slalfl.nr rhar h.orshc k li.d\.d l)trrsuMr
<br />to 'h. t ovirio.s ofrh. Conta.ro.s l-i..ff.d lr* ((]laprr 9, (\nn.ncin! *nh S.crion 1000 oaDnision I ollhc Busin6s .nd
<br />Prcf6sio.s Cod.) orlh.l h.or sh. is.r.m lh6.fromMdlh.bsisforlhcrll.s€d€xaplion.AnlviolalionorScnionT0:rl5byaiy
<br />apphcanr foraplmil subjdsrhc applican( lo acivilp.naltrofnor nnneih filc hundrcrl dollds ($500)
<br />l. 6 o\Tr ol the prolEny. or my cmplorG rvil h v.g6 6 rhctr $lc .onp.nsaxotr, *rll do lhc \ o* and rh. itudu. is ml
<br />i.rsd.d or.fi.'.d fMel.{sa 7044, aGindr md Aoi6si{,ns Cod. Ihc conradoas Li.ds. hs do6 nol apply lo an o\rn6 ol
<br />Ihc rmpqly \fio buil& or improv6 th(on- sd qho doe such \n* himsclfor hssclfor lhruush fiis or hs orr cmpl.y6.
<br />provid.d rhar str.h inpmvdnr! @ mr idnddl or oftd.l tu sl. If. ho$.6. rhe trildin{ o! inp.ovffir is $ld \ ilh'n onc rw
<br />.rco,q,l.r6q rh. (rn6 AuiU6 *ill Mvc ttE brdd ofFovin! rhd h. or shc did.or h'ld or if,pmv. rh. popdiy lor Ih. puqrse ol
<br />l. 6 ownd ofih. Iropdt. m .rclusir.ly codraclin* N irh li.ds.d contacloG lo conslrucl lh€ proj.d (S( 70,1t. B6ms
<br />and Pi!,lissan Cod€:'lhc Conrra.lois l-icens.l.av do6 nol apply to o orvnr ofrroFny\ho huilds.r inpro\.s rhdon.
<br />and $ho.oihdsltusu.harotars$nhr(.dh.rons)li.dsrdptrBuamrorhccontacusLicflscti$).
<br />I dn crcmfl trndd Ser .R &P( i.r rhis rason
<br />osner
<br />\!oRxplls. ( oN,PENsa-tl()N
<br />DI'CIAAAI!g!
<br />I h6cby amrn u.dd pmallyolD6jur! orc ofrh. Lllo\rir8 d(larari.ns
<br />I ha\. ard will nainrain a ( difi.atc oi( ons( kJ S.ll ,.sur. li! $.&ds' .ompaEarion. a Fovidcd for by 56l ion I7(x I o f nr
<br />Lab.r ( .de. 16r ih. piliJmdcc o i rh. stt lor whrh rhc pEmil is asuqj
<br />I havc .nd *,ill nminlain worl6 compc.sdion insuran... a:::::l;rud:i"[;Z reqtrned b! Sdion l7tr0 ofthc l,abor Codc. rulhc Fromance or
<br />ion insurancc cm6 and rdicy numhr ec:
<br />,.,,",""^*,'qO9/7// - 2P 14 ../y',9
<br />I cdilyrhar inrh.p.rfonnanc.olrhcwort tor \rhi.hrhh pdnir is issu.d.l shallnot dnplo, anr p6on inanr hanns
<br />s 6 lo hccomc subjEl lo lh. solt6 conpasllion le\s of C.lifomia. md 4r that if I should b$omc suhjrl ro rht
<br />srrk6i' conp.nsl ion provisioE oa Sdion 3 700 of ihc Lob.r Codq I shall. ronh*,(h comply rvirh iho* provisions
<br />WARNINC F,ilur. ro ks. rorkm .ompmeiion ..\*au. ir unl,wiul. Md shall subja.t an dnploys ro oimnalrdFltis.nd
<br />civil fin.s up lo otr. hundrcd thous.d dollas ($100,00Y)). in addhioi to rh€ cost olcomp.Balion. danqcs as pro\id.d ror lhc
<br />Sdion 10?6 ofrh.Lrbor(-od., inldd md otuq-" s a.6
<br />DIC!6AIUA!
<br />I h.Eby.fnm undd p6ah, ofprjury rhar I m lico$.d unds Frvision olchatro 9 (..mmmcii! Nirh Sdlion 7L'00)olDnision 1
<br />or lhc Busn6s md Prof6sioE Cod€. ud my licsc is in tull forc. od cltct.
<br />2a)a/
<br />z
<br />6,.-* ","..
<br />, C
<br />"rrr,r{l/t
<br />COIIIA.ICTAN!EBIIIGJGtrICI
<br />I hd.by amiin und6 pcnnhy olpsjury that th6. is a.oNtudion ladins as6cr lorlh€ psfommc. ollhcNrk t, \'hichrhis ldfrii is
<br />isu.n(sd :1097, civ c )
<br />a.tlucaNllEctAsallo!
<br />I hod, arm undo poally of I,6Jury onc oflh. follosing d(lUalionsl
<br />l)cmol ion P6mits-Asb.stosNolifi.alion rcdsal R*ulalions(1i11..10. Pan6)
<br />Rqtuned l.cllcr orNotifi calFn
<br />I cdiay thal lh. Lddrl EgnlalioN E!fudins 6b6los rdoval d. nor a,pli..bl. to rhis prcjdl
<br />hk"a,rv rta t**,^atis .pplicarion dd nd.rhd fi. abov. inronndion is c.rd.I arc ro.omp, wnfi all(iryand counry
<br />y dd Counryb dr6 trB)nrlEo,J'nrnc6 and Srar.l s\,,.Lrinu ro ttrl,ld,nr coNn,cr,on,-d hrib$drho,',r,degrrrN6.f rhtr t
<br />ibo\. mmr.neJ n,op.nr r., 'N;.*" p,4-* -// Z
<br />a pprh,nr or A*enr sisn.,u re X % a' D.re
<br />p.rhi,en.ne,prin,r * /4W,/ G lrlt/lrqu
<br />',/r/.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUl nsulation
<br />Roof Sheathing irn,;/t+-5.D Arr-a+q t\
<br />Shear Wall 1-T
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />FINAL a//,K 5'ilt aiEtur*l
<br />Certificate of Occupancy '
<br />Notes, Remarks, Etc.
<br />-+
<br />COMMENTS
<br />- r/,/.l , -o""' :__!L1_bZ-1=L
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