|
BUILDING. INSPECTOH RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUTLT}[R DF]LC RA loN
<br />I hcrc$y litn lndcr pcmhy ()r p.rjury lhrr I "n crc rfl no rhc anrrrrx)u Licctrsc lnw rot thc lnllo*in8 r.aw.lsa?r)ll5
<br />llosinc\s mJ Profcsnr (xlc) iy Ciry or County which rcquirc\ r Fnnit b .otrnrucr. alrcr, inrrcvc. dcn,lhh , r E-nrir itrv
<br />{ru.rurc. }ritr ro irs i\ruan.., fto rcquircs lhc lpllicanr tu su.h ltnnn lo filca sisncn n cmnl lhrr tror sh. i\ li.c.scd Put\ranl
<br />lo rhc F,!Nn,ns .r llE Conractn r l-i.cns.d Lrw (Chtptcr 9. Onnnli.i'r8 wirh Sc.tion 7ux) of Dilision I ol rh. Btr{in.\\ rhrl
<br />Pn,rcssiotrs Codc) or rhur hc or \h. i{ cx.nn thcrcfrom rnd rhc hr\i\ ror rh. rllcScd cx.mflion An, violarionolsc.rionT0ll5 hvanv
<br />rptlicrnrfor rrrmir suhjc.k lhc apllicanr io r.irilP.nrhyafmt more rhan fivc hundrcddollnBl!5([)
<br />I. r( owncr olrlr pmp.n). or nry.'nfl,\ccs wilI w!sc\ r\ rhct \,lt.otrrl.trsrridr. $illdo Ilrc Nort md lhc (nicrurc n nor
<br />irrcNld oro[crcd lnr$lc(SL\ 7l],1-1.llu\iics d Protcssoi\ Codc: Thc Gtrln.lff! l,icctrt Laq docs nnt nltrly h rn o* n.r ol
<br />rh.pn,If,nt wh,Irilds or iq'r*s ihcEt nd *h d.c1 {trh $orl him\.lf or h.r{ll or rhn{rt[ his or hcr .*r ctrDloFc\.
<br />pflN nird rhd su.h NpmrcrEnk ,m nor i' .ML{ ot nfitrcd lir sh ll ho*dcr. rlr burklill8 or i tro\ crmnr h $ld *ilhin otu )td
<br />ol..nnkrhn. rlt Osn.r Buildd will lnt rhc h cnolpn,vi'r! rld,r.rlhcdil ai hoiH or nqrnrt rhc nnltdy lor ihc Purixr{ol
<br />l.NowNrollhcnoplny,rmdx.lusivclyc.nrracrin8snhlice \cd .onr&hn ro con\ln'.l rhc prrlcct (Scc 704r. Bonrcs\
<br />r lhrlcsi'nCoJc ThcConrmcroi\ Liccns. Ijwdo.{ or tmly lo rn os nc. ol,,n)If, } who build\or i'nfiovcs rhcrcon-
<br />rnd qho r. kr.httr rrh prt)1..r\ s[hrC.drrt"l\)ltc's.l n) lhc (l'nrrttr-\ Liccn\. Lrs)
<br />.,". ?/at1 e ,*,*Y-
<br />DECLIAA.IION
<br />I hcrcby amirn und.r ncnlltyo{ncrjury otrc orrhc followins declarornrns
<br />-lhav.ddwillm,inrainiCeniti.ut.orConscnrroSclllnsurcfor(orkd6
<br />c.mFtrs,rion.N Provid.dtubyScclion:r7(x).frhc
<br />Illxtr Codc. lor lfie pcrfortuncc ol lhc !o n, which rhc Fnnir n irsucd
<br />,lhavcandeillnuinriiisorkcrs comrcn\uri(,n in\u0n.c. as rcquncd hrScclion lTfiiorrhc ritirr Cdd.. ror rh. pcrlitntrn.c oa
<br />rhc work ntrwhichrhh pcrmir is issud. M,w. .* .oniFnsarion insrmrcc clricr arxl r,licy nun$d m
<br />lhli.yNu fiLr
<br />-
<br />Iccnilythrl irrhcpcrf. nric.olrheworllhr$hichrhisp.rmiri\1slucd.Ishrllnotcnrlloy.tryPct{Dinrn! trtrh.r
<br />v' N t, h.d,tu nrbj..r ro rh. workcis conFn\miotr lnws ol Crlilornin. and rgr.. rhr ifl dhuld h-conr \uhicd lo rhc
<br />*ork.ri.o'ntnsariotr[ovnbn\ofS(ri( ]Tu)ollhcLuborCoc-l\hrll,lnhtrirhconlllyqrrhrho{lrovisions
<br />.ivil li|cs ut lo onc hundrd th.u\rtrd
<br />s!a'i. .ur7n L,f rh I rh'Jo,Ltr. i' .rrn
<br />,","," efgrlrt
<br />coDtrtr\ id, coloralc r\l. rfld nrll sul,icr an cnrpl.ycr ro
<br />rhc cosl olcomFns ion. dam Ec
<br />IlECLdEAtrA!
<br />I hcEby ,fllfln u cr Fn{lyofncrjuryrhnl Lm licnst undcr polision or Chrprd 9 (.onrmncnrg wirh scdion 7lx)O) nfDili(id I
<br />of rhc Busincs und Prcrcsions Code. ud h, licen{ h in rull ln.N !ft1 cficcl.
<br />l.icrD\c ( lx$
<br />-CANiiIATJIITANIENDING.A.GIN.CI
<br />I hcrch, lilirnr under p.nrlryof Nllurylh( rhcr. nrconnturri,, ktrdi|8r3crcylfflhcPcliomBnccotlhcsorkfitwhichlhi\Irrmiris
<br />n{nlrsm 1(x)7 civ a l
<br />I l(rrilyrlr ihc linrr.'lr.,rul'r
<br />ffin'ry 'ru t u'. -,,r rr^
<br />"11'Ll,rlinincc. rnJ Sr,rc L,q. dlJri"s r,,
<br />nl!,uc rfttrrioncd not.nl l nNl..r
<br /> nrlionr 0r \Eenl si8nsluR X
<br />,n-',"" *-",rnr,, fr I
<br />riofl\ rcgrrtlinB rs$.(o\..tr(rridc ior dIt)licrhlc lo lhi! Dn,lc.r
<br />rhtrrrhrrhivc irlonmriotr i\c.rr(r lrgrek)conlnysilhrtlCn!t lC.unly
<br />ioi, rnd h.rchy r lh.rizc rcDrc{
<br />aJLrGq'4
<br />: -"'Jdi,L
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsu lalion
<br />Rool Sheathino
<br />Framinq
<br />lnsu lation/E nerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4aso n ry
<br />Pool Fence
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />FINAL 4 7/4//tr t 7/rfr-/tu /e-
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc
<br />-'
<br />Shear Wall
<br />T-Bar
<br />//.l/Nrvh 2l'-*h)F h- Qtlz,a Y-2, l/)a@ fuJ I
<br />AITLICANLDEILABAIION
<br />I lErchy ollinn undcr Fnah y of Ntuty onc ol rhc ldlowing d(lf ri,)n(:
<br />Dc x,lirtr P.flnik"Ash.srosN.rifi.dionf.dcrnl Rceuhlions('lill.40. Prn6)
<br />Rcquncd hrrcr.l N.rilicdior
<br />f-----r
|