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BUILDING- INSPECTOH RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />4zatAUFER Ground I b/tr /n-
<br />SLAB Floor I
<br />Sublloor/Vent/l nsulation
<br />Rool Sheathing
<br />Shear Wall
<br />Framinq
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\/ason ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certil.
<br />I
<br />FINAL I u4*|ttr A t62,
<br />Certilicate of Occupancy 't I
<br />Notes, Remarks, Etc
<br />OWNTJR BUILDI:R DIiLCARA-Tll)N
<br />I hcrcby rriirn uMcr lcnalry ol l).lury rhar I am crenrpt lmnr lhc (bnrrlctn Li(isc bw loi thc lnll.wirs rcrv,n (Scc70-ll5
<br />Aunrcs\ , P(ftssion Codc) Any Cily or Counly *[ich requtcs r Fmir b .otr{rucr. tcr. nnProvc. dcnx,lish ft rcp{r r.y
<br />rd.ntrc. pritrto irs hsuarcc. nko rcquircs rhc lrplicmt ror\uch ltmir b fih. ri8tr&l slllcnrnl rhrr htor shc i liccnscd Pursnnr
<br />ro rhc povi\iis of rh. A)nkr.r.fs t-i.cmd Lrw (Chrprcr 9, Conrmrcing wirh S..ri.tr 7fiD ot Divhiotr :l f,frhc Bu\inc$ rnd
<br />Pnn'csriois c()d.) orrhr hcorshc hcxcmDl rhcrclrorrnd rhc hr!is f{tr rh. rllcScd cxcnlllion. Anyvi'lariotrolSc.ri.nT0ll 5 hy rtry
<br />{,pli.!flrlnrr!.nnilsubjcchrhcaplli.rnrhd.ivilpcnrlryoin.rtrnrclh!!livchu.drcdilollrs($500)
<br />L rs ow.cr ofrhc,nrneny. or toyrmpLye.\ wirh wasc{ rh.ir $lc conlp-nelion. *ill do rht *ork drd rtE stulrc i! mr
<br />inrcndcd or oficrcd &tr elc (Sd.7tl14, Busir*ss 0trd Prulcssio$ Codc 'l hc Codt0clofr LEcnsc tiw docs nor aPPly i, d o*trd of
<br />rhc pmpcny *ho hilds or in{R,!cs rhcE,n. dd who des such sn* himscll or hc^clf or (hn,u8h his or hcr own cnPl(Jyd.s.
<br />lrovid.d ihrr \u.h i'npmvlmnh src nor inlcnlcd or oltcrcd lor elc li hNaw. rhc hoildir8 or impmlc'tnr h $ld wirhin onc )enr
<br />oiconplcrion. rhc Owrcr Blildcr lillhnlc rhc burdcn of,iovin! lhd hc.r shc did ml hoikl or in{,r.t rhc pmFny ior thc PurPs ol
<br />l.rso*ncroirhcpmp.ny.uncrclu\ivrlt.onkr.hn!wirhli.ctr{'d.urrnr\t,(m(tudr}fl)rj..r(S.c701,1.Atr\incs
<br />r"d fi.fc\\im Codr: Thc Conk.cktr-r Liccns. Las docs nolrt,dy t, xi owncr.ffropcrly qho builds.r i't!tuvc{ rhcrcon.
<br />! d (ho contrNI\I{n suc| 0r'j.ch $irh a C('ntxckdn lt scd Nr {nnr ro rhc Contackr's t-i..n\.1-,v).
<br />l orcxcn{ utrdcrSccl
<br />]YABKI&::lQlltl:NSi UION
<br />DLCLAMIION
<br />I hcrchr.l'ltn uDlcr !.nollyolp.rjrryonc of Ihc f{nk,sing dc.l*rri.ns:
<br />I hrv. md willtruirrt.ina Ccnificlltol Con\cnrbS.lf ln\!rc fin sorkcs conrPcnrarion- rs Pn,vidcdfotbySccri,,nlTlX)olrhc
<br />Lltb Gd.. ror rh. r.fonmncc olthc $od tu which lhc pcrn,ir n h\ncd
<br />-l
<br />havc lod *ill D"!nrdi. w.AcB .o rpcnsariotr insurrncc. rs rcquiEd hy Sccr i(,. 1700 of lh. Labor Cnlc, tor rhc FdnnuNc.l
<br />thc work tu$hichthis pcnnir is L*ucd Myworkcri (,nP-trslion nNuruktc,ni.r Md t.li.ynumbcrnrc:
<br />Policy Nutr$cr:-ErP
<br />-l
<br />r.nifyrhd rn rhc Nrfo nrnc.oflhe*orklbrshichrhi\pcrdir(i\\u.d.IsldltrolcmPl.,yrnyPc.s,ni an!r!trtrcr
<br />\o ns ro h..onE {h]cd to rhc w..\c6 compcnsdin laws of Crlifonrin, rhl .gEc lhrr if I \hould hc&nnc ub.,cfl to rhc
<br />*orkcrs.onr!.ns0ri.ntr.vhionsoisccrtnr.lTtDolrhcLih,Cdic.l.hrlln)nhwilh.onrPly*irhrlxr$fmvhions
<br />WARNINC: Iailurc b sccurc s.rkc^ ompcncilnr.ovcrrgc is utrlustul. ,trd \hrll luhj..r ai crnPloyc, lo mminrl Frlr.\ r d
<br />ci\il i.es up ro onc hundrcd rhot lrr(l.(xror. tr r dilkin n) rhc .r\r of() t).n\rrof. dxnr8.\ r\ Fnnlcd nn rh(
<br />l 'larz8II
<br />Ltlrltlllll\Blt]!)tsDrtt .Erllalt
<br />I hcrcb!lfllrnu .r Nnallyoi rhar IrD,lnrtraluM.r ovi\i(),,1'ClqrrcrI(.onnlrn.i'r!srlhSccri,r?(x{r).fl)nnit{I
<br />of rhr Btrlnc\\xn(LPxnc!\iol\C.dc. rtul nr) li..n\. i\ i'r l',llturr nd cfir.r
<br />c./pasad)-
<br />I tE ( , tt*_ *l-r ))c a 2
<br />I hcrubyrmnnu d$ Jrtr yotFrju,yl
<br />issu.d rs.c :l(J9? Civ (-)
<br />rhcrc hacon(dcrion hiJi Sd8ctr.ylorrhctcnornDnccofrhc{orklnrwhi.hrhhFrrniri\
<br />AIILIIA.NLDIEI.ASAIIIIN
<br />I hcrchy ri-rnn un&r Fnalrt orFrjuty o.c of thc lollouine dcclurilions,
<br />Dcn$lilion P.rmik A\bcstos Noriric,rn,n Fcddtul Rcgnhri.n\ (Tille 10. PM6)
<br />-Rcqutcd
<br />lxlcr of Noriliaridr
<br />I.cn,rr rhJhr rcdurrl rcoulo
<br />x;k;,/*,","".,.;"
<br />Ld,n.kc'i srrc Ij." rcld,npi'
<br />"r^"" ,*ry'*i;r,p.n1 t,' *.p-r
<br />lions rcsfllins astE\los rcnx'lal drc mrnppli.ahlclo lhG lmrcr
<br />iclrion ud xrare rhrr rtc ubor. i.romdi0 i\ cotrd I asre ro n,nDlt wirh all Cily and Counry
<br />]\ppliunt or Ag.nt Sign.lur(::: . :':3fr1;-
<br />l.cr'cr'. \,l.hc.
<br />I
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