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BUILDING. INSPECTOR RECORD
<br />SITE.WORK DATE Om6 B{ildcr D*l(ni6
<br />I h.tB !ffim undd Fn.lty ofp6jur, $.l I r.n 6dnd fm $c Conn.cloR' Licat. Lae ror fi. followins Edon G.c.?03 L5 Burii.s
<br />4d Prcfdiid Cod.) Ait City d C.liry *hich EquiB r p.mir ro cdr!( dr.r, improv., d.mlirh or (p.n uy trr!.t!r., rior to iE
<br />i!!1mc., dro rqulB th. .t lior fd sch p.nn to nl. . .ign.d n.rdat ln.l nc or rh. n lienicd pu6el io r& proviliod of rh.
<br />C@mcl6'r Lic6t d rn (Otern 9, Cdll,Mcins *irh s..rid 7000 of Divitid 3 of rh. Buiin6, 6d P6f6r6r cod.) or rhri h. d
<br />!h. n qcmp( th.r.fioo ed $. blt fd rh. .llcB.d dhtrior .An, viollrio of S.dl6 70, I 5 by sy rpplicur for i p.fin lubj.ca rh.
<br />ipplicur ro . civil pallty of iot t'm $m fiv. hundr.d doll.n (t500)
<br />_1, a oMr ol lhc prcp.ny, d my mployd wid w.Bd ! rh.ir tol. @mr.nr.tion, *ill do $. vork lnd th. ntudur. ii nor inr.ndld
<br />or ofi.ed ar I. ( S.c.?0,14, Boi,6, Md Prof6ti6, Cod.: Th. C6r.dd! Li.dr. Lr* dc! noi .pply ro e ownq of rh. pbp.ny
<br />who blildr or imFov.r $..q, md who d6 lch *d* hitu.ladhd.lf d rhrou8h hi, dnr own 6ploy.o, p.otid.d th.t ruch
<br />imtrovoa|! e nor inrhd.d r o{ftrd fd r!l.. lf, fio*.rrr,rt. building n improv ot ir rold *i$i. o. yc& of compl.lion, rh.
<br />Ownd-Builda willh.v. thr bfidd ofprorir3 tnlt hc or rh. nol buildor ihprov. ror tt. plrpor. ofslr).
<br />_I, a6seof lll.,i.p.n . o q.laiv.ly .onhcrins wnh lie.!.d 6n.d6 ro .6nntu.r th.Foj..r ( S.c. ro.a. Burin.$ Md
<br />Prcf.sioi Cod.r Tlr. Cdt&tor't Lic6t. L.w do.r not 6ptly to 6 @nr of p.or.ny who blild! or ihprov.r th6@n , Md *ho
<br />contra foruch prcj.ct! wirh . Coi'rrcb(, lhd.d puBuur ro ln. cdr*io.i Lic.ir L,w )
<br />_l e .x.mtt und.. S.clio
<br />WORIGRI COi[?ENSATION DECLARATION
<br />t h...by .tnm ona.. p.ndt, or Fju., 6. of thc followi.s d..lmlimr:
<br />_l h.t. sd *ill n.inl.in . Cd ficic olc6r6r ro S.lf-IBurc lor wdkd' cooFnr.tio!, s prcvidcd for by S..tion 37oo oirhc
<br />L.bd Codc, fdrhc p.rfroc. of 6. qot fd whth rh. phn ir i!ru.d.
<br />_ln.vcsdeiu i.dn *dtd' c6Ftuldn l Ume.a Equird by Sftlion 3700 ofd. Libor Cod., fr $. p.rfmonc. ofrhcp{* fd which lhn pmn n tuu.d. My work.f,' .@p.N.tio. iBumcc c6if ed poli.y nuhb.r !r.
<br />Ex
<br />rn'Z;r',oi rccd
<br />-/J c.niry u,.r ,n
<br />nol b. cohrlacd ia lh. pmt ir for on. hun&.d dollq {l100) or l.s)
<br />$. p€fmdcc of 6. wdk fn *hkn $i! pmn i! itr!.d, I th.ll
<br />b.cD. rubjcd ro rhc *o (n 'h*t of C.lifo6i., .nd !src. rhrr il I
<br />L.bor Cod.. I shrll, fonlwirh c
<br />c6p6$rion cov.Eg. i
<br />inl66( dd rnom.yt 4.6.
<br />LICTNSED CONTRACTORS DECLAtt{AION
<br />I h4by rflim undd p.nllry ofp6jury lh.r I 6 lica.d uidd prcvilim ol ChapG 9 (
<br />rn. Budndr bd Profdri@r CodG, sd hy licala it ln fuu fmc.nd.llei
<br />of Fju.ylh rt6. n . .dnrudim
<br />, Civ. C)
<br />APPLTCANT'S DECIAXATION
<br />D.hohion P.mir-A,bsld Notiliqdd F.dc6l R.8!t!tion! (TnI.40, Prn 6)
<br />_R.g{icd t tdofNo{n6d6
<br />dbov. mftrion.d pro!.rty ior in$.cri6
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enVlnsulation
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />T-Bar
<br />Handicap Requirements
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certificate -l^-I
<br />FF l:t rnrr
<br />FINAL
<br />Gertiflcate of Occupancy
<br />Notes, Remarks, Etc.
<br />ID/SIG.COMMENTS
<br />Drtc: OMe
<br />Pool Fence
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