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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE tD/stG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />Su bf loor/VenVl ns u lation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Enerqy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />l\4aso n ry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />4a.\€,;47-)h i/r Iu,-4
<br />F\N^L K-Z)-/6 1 .< o\I
<br />n
<br />Not EtcCSHemarks
<br />rtificate of Occu
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<br />OWNERAUILDER DELCARATION
<br />I h.r.hy .flnN uidcr p.Mlty ot Fiury rh$ ! 0nr cxcmnr I'onr rhc Co rrcntr\. l-iccns lrs r(r thc iollowir8 rcrvD (Sc.7011.5
<br />surirE$ r Pmlc$ion Co.le) Any Ciry o. Counry shich rc!!iE\ d pcnnir b on{rucr. aXct, nnPn)vc. dcnnrll\h .r fttln r'y
<br />ndcrtrrc. prtrro irs isrdce. als. rcquies rh. +rli.nnr for sx.h Fnnir ro lilcr rigtrL\t {rrcnrcnr rhrr h.ordr k liccnscd luBumt
<br />lo lhc ,'rorisions ol llr Co rocloisLiccn{dLaw(Cnrprcr9.Conncnci'rgwirhs..(i.n7ux)oiDivtionIof(hcBusincsrnd
<br />Pdtlsion\Cndc)orrhaih.orshck.xcmp hcrcfroiltrilrhcbsislorrhcrllcgcdcicn{lion.Any\ioldionofSccriunT0ll5hyrny
<br />npplrrnrfor.r.rmirsubFchrlrc lpplicrnr ro ! civil pcorlryot nor nxft thD llvc hu.drcd dollds l$50o)
<br />L nsowtrdr.rrhc p6pcdy. r.rcrcrusirclyconlmdirs wir[ Tn{nscd contncl{mt'.oo{ru.r rh. J)mjccl (Scc. 704,1- Bu$trcs
<br />a PnGssi,nCodc: Thc Conl.erktr's l-iccn\c Il* d&s nor nrrtly b rn owncr.fI'iop.rl, who I'uil& or inpn'vds rhcr.un.
<br />snd sho coita.htoisuchp(,ichsnhaConrack(s) li.ctrrd pururnl ro rh. Conr.a.rols Licn$ ttrs)
<br />-l
<br />!ncic.rpl u.dcrSeri(a & PC lirrhisrcrnnr I]rcf,&8l:ralllIlsarloN
<br />DECT AlINTIoN
<br />I hcrchy !fiirr un,lcr 0cnrrlyolpcrjuryonc olrhc lolL'wirs dcclxrrriotr.
<br />lhrvcntul wrllnui rirrCcnificarcolCon*nrtoSclllnlu.clnr$o'kc^..n!rn\drt,n,sf()videlli,rhyS(ri(mr?(nofrhc
<br />Gd.,ntrrhctdr.ntun colrhcworkrdshichrhcFnni isn\u.d
<br />!i. $orkcr' comFnsrrion insurnN.- us requtcd btS..ri, r:r7()(lollhc Llbor O)de. turrh. pcriormNc.l
<br />Fr trr i. i.\LcJ M\ q,ilc'r.,'trm' utr'n'r\u',.1,", Jtr'c, nid F ln y nutr,hcr,'c
<br />ch ftvn-Pst ut',
<br />*r,,,*,, t Af \Vr.tll+-lc a0l y
<br />-l
<br />ccnifrlhnr nrrhc pcrtorronccorrhc w.rk ror shichrhis l.nni is nsucd.l shrll nol cmploy any ,.rvn' n' rtrym0trrct
<br />s N r{, bc$@ sxhJ.d b rh. wo*Lrs comFnsdion hws ol Cnliiornii. lnd dsrcc lh irt dx,uld hcconE sul,jccr rorhc
<br />sorkc conD.nsari()n ptuvinotrs ofScclion lTmoflhc tjhn Codc.l sh3ll. lanhs irh .ompl! wirh thoc Provtionr
<br />WARNINC Flilur. lo scurc workcs' conucnslrion c.vrmsc i\ unlr{rul. .nd sholr subjd a" cmploycr b Lnnirdl Pculric\ rnd
<br />.ivil finc! up lo orc hundrcn rhouend dollos ($l{x).ftx)), ii ddiridr ro rhc con oi compcn\(ion, dnnug.s 0s pRvidcd hr llE
<br />f(if{g
<br />u!t..!!!tll(a
<br />I hcEhy 0finnundcr p€nllry of pcrjory lhst I rm lid.*d undcr povhn,n olch!flq 9 (conrmming wirh Sc.rhn 7firc) ofDiv(ion l
<br />ol rhc Bu\i(c\saM Pmicscions Codc, sxl nry liccnsc is in lullnxeurdctla.l.
<br />gv u+
<br />x
<br />(:oNS'TRUCTI0N LIiIiDIN(I AGFNCY
<br />I hcrhy,rfirnun .r Fnihyofpcrjury lhar thcrc n r con{ru.tion lcndins nsctuy rrtr
<br />'hL Pcrrormrcc ofth. wo.k ftn $hich rhs Frnir is
<br />issucd (S€c..1097, (:iv C )
<br />Lcnd.r's Nrm:
<br />-
<br />AITLICANTDEI;IJ.BAI]AN
<br />I hdrby,n,mxndr pctrrhy of pcrjury onc oi lhc lollowins dccl0rarn,n5:
<br />Dcmolirior PcrnrirsAsb.$os Norili.arnnr fcdcrul RcBularions (-lirlc 40, PM6)
<br />R.quicd t rrsolNorificdion
<br />ilyrhrr rhc fddrrrlr.!rLtoi\ngrdnr! n\lrn.\rc trtrrlde D.rqrt,licrhl. h rhn p.i)rc.r
<br />lil i
<br />i rhrr l hrvc red rhi{ rmli.rrnrn ,.d s.rc rh$ rhc on,vc inrbodion h cord l agtu{ b .on[ly wnh ull Ciry atul Coud'!
<br />and sur. Laws rcbring x' buildin8.on(ruclnnl md hcrchy ru(lniuc rcpruknrarivc\ oflhir Cilylnd Counr, k' cnr.r uF,n rhc
<br />Lbx
<br />,",. 1\\ ttY
<br />SLAB Floor
<br />Flood Zone Certif .-,-
<br />-1.
<br />as owncrofrhcpor.dy, ormycmployccs wnh w08.\ {s rlrt $lcconr!.nsllion. *illdo !h.workdxrlhc nruturc i\ nol
<br />inrendcd orofltrcd tdsL(Sd 70{4. Busincsa Prolirsiotrs Codc 118 G,nrraci{r's Li.cn* ltr* dds not ryrly ro an os ncr o,
<br />lhc Im,Eny *ho hrikls or improrcs ltt@n- lnd who tlttrs su.h {irt hi'nrclfor h.tr.lfor thmugh hn or hc! own cmPk,rccs,
<br />fnJvid.d rhar su.h inFmvc EnG m xn i.lcnLd ff oilarld fitr sh ll. h.wtq. lh. bilding or in{,mwmnr ir v,ld wirhin ',n. }t.u
<br />ol c.nllbrt,n. rnc Osrc! Bnilder will hrlr tlx bxrd.6 of fbvine rhm tE or shc ! il mr huikl or inllroe rhc tmFiy ftr rhc t,urJ!$ of
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