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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATloN
<br />I hcrcby.mirn uM.r p.nnlry or,'.riury rhd I un.rcnDr arom rh€ Conra.km Liccn€ tiw lor rhc lolhwils rcasotr (Jr.....70]15
<br />Bu\in.s !d Prolc$ion Codc): Dy Cir, or Counry whi.h rcquirer a lrflnit k, consrrucl. altq. improvc- .lcnrlth o, rcFnr lny
<br />nn.Mq rritrlo ilr h\u!ncc. rho rcquncslhc aflrlicrnt for su.hpcnnir t,liL, \igncd ddcGil rhst hcor rh. is liansdl ltrrsllnt
<br />io rhc povkb.s of rhc Contuclor's Li.cnscd t-rw (Chrprq 9. Commcncins wirh Section 7000 ol Divkio. :l of rhc ttusi|c$ .nd
<br />P(nasionsCodc)orrhnrhc orstc iscicnrlrthcrclro'naid rh. hrsh for rheallcBcdcrcnprion AnyviolarbnoiSecrionT0.ll5l,y!ny
<br />rpplicrd lor r pcfln subjc.h rhc 0ppli.anr h,civilpcorlryot not nNrc tlrn tivc hundrcddoltarslS5m).
<br />-1.
<br />$ owndr ofihe tmFdy- (n myenllorec\ wilh w B.s.s rhcn v,b..nllrrnsrrion. will do rh. woa,ild rhc {tutuc s !d
<br />inrcnd<l or ofi.rcd ror sh (se 704.,r. Busik$ and hoic$ions codc: Thc conrri.rois Li.cns Liw docs nor amly ro an owrcr of
<br />rhcpn)Fn, klx) huild\ or inDrovcs rhcE n-,nil who de\ sRh s\)* himlclfo. hdsclfor rhbnEh hil or hcr opn.mrk,rrc!.
<br />pnvidcd rhor such impnlrmnls m mr i cftlcd or .rcftn n qh !l howerrr, rhc huikling or iryroirnEnr i\ {,kl *irhin onc F,r
<br />oiconplcrion, rhe osmr Buildd willhrvc fic hlrdcn ol proling rhd hc or dr dd ml huikl or i$mrc tnc ImFny for thc Nqn$ ol
<br />_l- $owNrorthc pulEny. r cr.lusiv.lycotrrncrins $irh liccnscd connrcrorh con\lruct ihc pmjccl (Scc.7OJ,l. Bunncs
<br />r hohsbn Codc:'l hc Conr(rofs l.iccn\.I-iw docs nor rl)ply r' nnowncr ofpn,r.dy wh. brilds or imntuv.s rhfi.oi.
<br />and *ho c.nrmcrsfor su.h t'mrck wi'h i cln h.kn(,lkcnscd punulnr rorhc Conrracroisl,tensc L!w)
<br />-l
<br />amcxcmol undcr Scdi.n .B &PC lor rhh reason
<br />D.L:
<br />w{)RXFL\' (:Ot\l Pt'NSAl ( )N
<br />DD!:f,A.BtrIION
<br />I hcrchy!llirntr cr Ntrrlryoi|{dnry.ncollhcfoll{^vin!d.clxrrli,n,!
<br />lhr\r dxtsill nrirrrh! (tnil|are olC.n\. rk,S.lflnrur. n*or[.rro rfcisrrir)n. r\ proviJcrlf hySccri{rn]?m.lrhc
<br />IitxrCdlc- lirlhcptrli,nrr.c oJ lhc *uk fo whi.hrhc p.nnir k n\ucd
<br />_l hatc.nd will minrain *orkc^ comp.nsrri{nr iniuraNc. as lc.tuircdlrySc.riu:l7rD.lrhcLahorCod.,Lrrhc0sloriutr.cof
<br />rlE *ork Ior whi.h rhisFrmir i{ ixsudl M,w.rkc conu.nstrriotr hnmmc cmicr.lxl Fricynun$$ m
<br />Cc)
<br />ot-c, l- ltl
<br />I r.difyrhar in rhc lrc.lhrn{rcc ol lnc w.rk L. shrh rhis p.nnir t i\\kd.l shrll nor cnfloyanypc^.n in rtry ranncr
<br />{' !rio b.ronr sub.J..r ro rh. *orrc^ L$nri..\arnr hs\ olcalifornh. rRl r8r rhd ill should tEcoflE subjccr lo rtE
<br />r6rkcs' omp.tr\ rion tlft,visions .r sccrion :1 7(x) or rhc I itn. C.dc. I ri.l!. ionh*ilh omnl, $irh lhas pruvtioDs
<br />WARNINGT ljrilu,c l. {curc qorkcs .onpcns,ri('n .orcr,Ec j.ci rn ca,pl,)\cr i).ri'ninrlFmiis rtr'l
<br />.n'l fir.\ ut ,n , '.. |'u ,Inl rh.u\rt J'illr\ '(l'ri'rr'.Z on. ([n,r3.\ r\ Pntrid.J rnr rhc ,r
<br />::"*\:l:?"1;u"^:
<br />t)t,r( t,1t,\ I l()N
<br />nndcr lcnrhy or tuJury rhar I n li( \id tnnq lBN ision .f (hnprcr I (ommmins wirh Scclion 7001r ) .l Divnnr l
<br />zq A 2 /2/A q)Z'th ".",
<br />I hctoby irfirmrtulcr raMlrrotpcrjurylhal liqc is tr (oniflLtion knding a8cn.y lor rhc p.rrorroncc orlhr w.rk ror whi.h lhis Frnrir i\
<br />is\ucJ (Scc .1097. Civ (-,
<br />AIPIICANIDECLAEIIIAN
<br />I hnhy annn uid.r p.nlry ol p.rjury onc orrhc tull.trins dc.loriti.ns:
<br />Dcnnnirio Pcirnir\ Ash.sro\Norljcxrion lldcml Rcsuhriofls(Tirl.40. P*r6)
<br />-Rcqtrircd
<br />lrtro oI Noritioti.tr
<br />#:\#;Y:.s conccl. I r8reb.nnrllyu hrllCily{nd County
<br />rci'rcsctrldnrs olthis Cily trod Counrylo cnlcr uton thc.nl nrk.\ niJ Srrrr I]ss ruLrri'rI rohtrilJ
<br />!)v. r.frnnrd pn)If,ny ln' in\pccriql
<br />,\[0li..nl or Agcnl Si!nnt Air.. crt '/'r/'g
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Subf loor/VenVl nsulation
<br />Roof Sheathinq Elu),9 j4t,rti,r,t.t^r"v)
<br />Shear Wall
<br />Qywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />[/asonry
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />fl i{liP I 4U\u, ^-t 4J
<br />Certificate of Occupancy I
<br />Notes Remarks Etc
<br />o co w2p.t_ A I
<br />UFER Ground
<br />Framino
<br />ln su lation/E ne rqy
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />FINAL
<br />I
<br />c>G/ o, I t1
<br />ol rhc Bu\ii.\{rnd Pmrc\\ion\Codc. aftl my licctrsc i\ ir fullior.c ild.fii.r
<br />L.nici( .\dd...
<br />I ccnilyrhxr rhc lldcmllc8uldions rc8fldirg isl[(n\ rc bhl arc nor rptlir$1. h r lr'\ trtrFd
<br />I ccn'fy rhrr I hrrc 'crd rl,i\ r|flicrrnn,
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