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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER DUILDER DIiLCARA ION
<br />I hcrchy iflnD utrdcr pcnrlty of pc4ury rhar Lncrctrfl forn rhc Conlm.lo^ Licctrs.l-08 lor Ihc ltllo*in8 rclsotr (Scc.'roll5
<br />thsincss rnn Profession Codc): Any Cily or County whi.h rcqunes a pcmi' r. on(rucr- llrcr. i'nprove. dcmoli\h .r Eprn Ml
<br />nfl.rurc. pri.r rr irs hludr... lko rcquircs thc NtIli.Mr n,r\u.I trrnir r, filcr si8trdl shr.ftnr rh ln o! she n liccnscd ,)unuri
<br />ro rhc ,orhionr .l ilt C.ntrcror's Li.cnsd tlw (Chaprcr 9. Conrmctuiit wirh S.crnn 7(XD ot Division :l ol lhc Businc$ !trd
<br />Proicssiotrs Codc)or rhat lIorrhc isexcmpi rhcrclmfl,nd rhc h,sis lorft 0llcScd excnrflion AnyriollrionofSdi:,n71)lll5byun,
<br />lppliunl r'or B lrnnil subjccl s rhc 4,llicunr ro a civil pc.olry of nor nr rhm iivc htndreJ dollr\ (S50o)
<br />-1.
<br />{r osncr ollhc poncny. (tr mrcmploycc\ silh wr8cs rs lhct eL otrlllcnsali()n. willdo lhc work dl
<br />'h.
<br />{trrm L\ 'rrinrc'dcd o.ollcrcdfinelc(Sd7044,Bo\iicsrrtulProfcssn,nsG'dc:ThcCo rador'sLlccnst,0*do$nolrotlylo0nowncrol
<br />rhc tmpcny sk' toilds or ilqmB ficNn, ud uho des sEh wor* himrllor hcr*lfor rhorgfi hn or h.r.wn cq,kDtc\.
<br />F)vid.d rhtrr skh nnlrovctunk m nor inr.ndL{ or orn { li)r slc li ho{d.r. rlE buihnE or i tmEmnt h sold wnnin onc ,trr
<br />of conutlion. lfu O*rcr Buiklcr eill hatt lhc burdcn ol povifl8 rhdr rE or \hc dil ft,I huiH or inDmlt lhc rmpcny ror rhc j'uqns ol
<br />-1.
<br />asowrcrollhc prolcny. lnrcx.lusnclyconlrucii'rsI'irh liccn\dc. ricror r. condDci r1r pmjccr (S.. ?(xtl. Bxsinc$
<br />rftlltlt$i)nCodc:IhdCdnhr.r'sLiccnscLrwdo.sorrt)plyro.emrof[oFrlywhohuildsorirptr,vcsrherd,n,
<br />rnd who co mcrsfor such pmjccls uirh a ConrGro(s I liccnscd l)ununr rorhe ConrEctn s Licc.\c tjw).
<br />I nmcrrmnr dffl.r S.crio
<br />uoatrE&r:raulrNs/l]ta!
<br />DECLAtsAIION
<br />I hcr.h! rltunrrnd$ Fnrlr, .l |xrjury otrc ofthc ldlosin! d.ilslrion\:
<br />-lhlvcadwirlfluirrrinaCcnili.lrcolCon{cnrroSclilnsurciorworkc,\dnnpcnerio,s\
<br />pR,vid.d ltr hr s.dion lT(xr oirhc
<br />tiklr Codc. l'or th€ ri.rfonMncc olrhc sork inr *hich rh. pcmrir i\ issucd
<br />lhrvcrnd willr.nr.i. rorkcrs compcnsation insurlncc. trs rcquncdhyScdion.lT(lraflhclrhorCodc.lorrhclrrrnlnan(or
<br />lhc work r(" which this pcnnil is Gsu& My Borkc6 conri..\alion insumncc car licr ud Fli.y n!'nhcr trc
<br />-l
<br />cen ify lhd in rhc pcrformncc of rhc so* aor *hth thn pcr i is issu.d- I +rlin r cnFbynnyp.k,n in rny mann.r
<br />n, N t' h.R,tu srbFcr b rhc workc* .onFnsarion laws ofcalif{mi& ind.!Ec rhd ilI sln,uld hc.onE {hjccr Io llE
<br />workc^'.onp.nsrrionpmvirn,isofS..rtunlT0Oofrhctf,trtrCdlc.lshrll.lodhqirhonrplywirhllo$prcvnions
<br />WAllNlNc: I'rilurc to s...urc worke6' .onrrcrsrrion corcfta. is unltrw .nl $rll uhj..r rn cnI,lo),.r ro di'n .lltMlrnr nrl
<br />civil fincs np tu onc hnndrcd lhousrnd dollffi (S100.()(lo). nr dilbn hc con olcomFnsarn'n, d. rg.s,s nrovdcd lnr rhc
<br />S..riotr lt,76.f rh. lrhor CoJ.
<br />'^,",8L///i
<br />inrcrc( 0d arknEy s lccs
<br />DICI.A.BAIIQN
<br />Ihctuhy lf'nuiJcr Nnrlrtoftxrjuryrhrr I r li.rMd utdcrptvhi{,n f(hrtrcr9(.oDnrEMirrgwihScdn.'70(X))ofDivi\i{nr.1
<br />of rhe Bu\iEs\ rnd Pnfc*ior^ Codc. a ny li.cn\. is in tulln,rcc anJ cffc.r
<br />ts
<br />,"," a!g!> (.n,r...r
<br />tax$f,u.ula -LE!DING-a{iENCI
<br />I hctuh! llfirrn rtulcr prnrhyoi p.rjurrrh rhcrc i!a.on{ru.iinr Lndir-!n8cmy f ihc pcrhfln.ncc oirhcwolk for ehichihi\ pcmrir is
<br />i\\ucd lscc .1097. Civ C I
<br />dtfurirNtD[ElrlSrlIIrlN
<br />I trrch) dlnn rndcr p.!!lry olpcrjxry o.c dlrh. tolbwirg dcclrarnnrs
<br />Dcnxrilbn Pcnnits Asbcstos Noli,ic!liotr Fcdcrrl Rcs!l(lior\ ('l illc.ltr. Pm6)
<br />-Rc!utc
<br />lrrrcr of Norificali{]n
<br />I.cdirt rhar rh. rcd.rul r8ularions rcB.rJirSnstf,nos rcnmvrlur. nrapplicnhlc ro lhn troF-^r
<br />l.cnily rhi I lBvc rcrdrhis rfpli.xrnnrril {n,n h .or.c' LBra k) c.mply qnh rll Cny and Counry
<br />onllnrD..\rtrd Srnic L'ssrc!ri'rE k, huildn!rir rcprusc rlivc\ ol ihi\ City ind Counlyro cnrcr upoD rhc
<br />atxlvc nEnriuEd nron ny r'or insp(cli{in
<br />lDDIi.r orAIcnrsitn.ture
<br />Y,'r l.\crC "","t!v/tY
<br />Set Backs
<br />Formsi Steel/Holdowns 1l)/lu O ('24)
<br />Erection Pads , t ( I')t
<br />UFER Ground
<br />SLAB Floor il"ltq1t/Av.rt+r,/,2r)
<br />Subf loor/VenVl nsulation Lt t \
<br />Boof Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lViasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif.
<br />dhbln il.rnt ".t a'zo)
<br />Certificate of Occu anc
<br />Notes, Remarks, Etc
<br />FINAL
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