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BUILDING. INSPECTOR RECOBD
<br />ID/SIG.OWNIIR BUll-Dlll{ lrlll-CAl{AT()N
<br />I hcEby dlrh undd p.ndry ol p.rjury rhar I m .&nrpr lron rh. Ltnk*roR Li..ne L:w for rh. Iollowing Eaen (Sd ?0ll 5
<br />Burincss md Prnresor C.dc): Any Ciry or Counrv whi.h rcqun.s 6 IErmn rn c.n!rucr, alrcr, i'nprov.. d.mlish .r dlrln .^y
<br />nnrtor., prir b irs ksu.u. ah. rcqurcs rh. app!.ahr tar su.h IEmi b 6L a ligtr.d drkrnr thar t or sh. i! lillNal pur$!
<br />r. rtI phvishns.I rh. Coikrctor's l-ic.ns.d b* lchapkr rr. C.hmcncin8 wirh Sccrhn 7Ul0 of Divnion I .rrhc ltusi..$ lnd
<br />Prohsion! Cod.,orrhai h.orthe n.xenfl rhccftom nl rtE b&sl forrlr lll*ed dr.nDrDtr nyvFbri.nolS{ti'n70315b}any
<br />{plicam for.p.nntr rubjcc6rh. +plicantrorcivil!.n.kyoInormr.rhlnfiv.hu l.cd dollor (t5flr)
<br />_1. dr owtur oI rh. IYop.ny. nr ny .6plrlt.s *ilh qa8.s rs rhcn sb .omp.ns.n]n, vill d. ih. *on ard rlE nd@ k mt
<br />inkd.! or oll.ral for sl. (Sd ?(x.4, Busin.s ind Pmfcsion\ C{ri. T1r Codr&rols Li.ne hw d(t\ nor ,prly ro tn ow*r oI
<br />r h. nmn dy wh. hlild1 or irq'roEs rh.N[ ard wlD dr!! luh ro.L hifrs.lt .r lrtelr or rhlough hir o, h.r o*n .nrplote.:,
<br />pr.vidcd rhat such in{oEmnk E rr inrcndcd rorcrd Lr $h Il, ho*.v.r. lhc bu,ldin3 dr in owft ir sld withi.oe }tr
<br />of $npkran\ th. owM Build.. *ill hlw rlE hrnLn ol povins rhd lE or sh. diJ nn boilri or inporc L\. pspdy Ior rh. p!,po! of
<br />ZLA.trkrotrh. pn,I.ny. xm.\.Iu]!.ly !onre1'n3 srh lir.rEJ ronreb^ ro con{tocr rh. lrrd lS<.7044, BusiEs
<br />'rnl Ar'tr5\r,,CuJ. Th. Cunrr.rois Lr. $ Lrr .to.. tur lmly k, !n owkr ol pr.IEny who buil& or inutuv.s r[ersr
<br />.^d who .ont!.rs r.. su.h pmj.{b wnh a c.ddcrorls) la.Nd puBud ro rhc C.nrdor's Ucenr. L,r).
<br />I h*.by.itmundcr prnahyof pcrjuryonc ol
<br />_lhnv.drlwillminr.haC.nifur.ofCo$.dtoS.|fINUEtor*0rl.6comp.nssridn.asrrvidcdrorhys..ronsT00oirh.
<br />tihor Codc, Ior rhc ocrf.rnw. otrh. ro* nr *hi.h rh. nEmn ir i*ucd
<br />*Ihtrv.rndwillruidrinwo.Brcnrp.nerionin\ututr..,r\ftqn.d6yS{i,n37molrhcLlhor(bd.,tarrh.lE.f.mr.of
<br />rh. s.rk lfwhrhrlNplrm n,su.J My*orkcrs o,mp!tr\{in fsurunr cmd alrrl'd nun'h (c:
<br />I andi ftu! in rtf, lxrtnrrore ol rhc work for whrh th6 Frnrir t asued,l !h!U nor cmptry rny pr*un in ry hutur
<br />$ ar r. brsm subj.cr ro (hc wo*.^'o'npcnsr i.n lrws ol C,lifomia, anl 4ro. thrr if I rhou[ b.c.rE suhj.cr ro rh.
<br />wo.tc.' .oop€.satbn pruvi\iunr ol S.crio! l?00 of th. lrEtr ( d., I shrll, nihwirh rcmply wirh rvpmvLio.s
<br />TyARNINC Fi ur. h ec* workcr onrcns{rt'n c.w wlul. rnd ihJll \uhlc.r rn rmpl,'yr k, (nnmrl rcn rs ud
<br />.,vLl fin.s up to on. hundrcd rhourind dollnrs ($l(r)h. .on of comp.trqnon. 'lrrugrs rr p.ovidcd ,or lh.
<br />[,--n
<br />I hcrby.llkm undcr p.nahyotrrrjur! rh.r I.m lic..*d undcr tmv$i.n olCh!0rcr 9lc.'nmncing snh S..thn ?(XXD.Itriftion l
<br />ol thc Busincir md Pn'f.sioB Cod., anl n,y ltcnsc n id tuU tod rnl .[.cr
<br />CONEIBICIIOII,IIDIGISXICI
<br />I h.Eby amrm und.r lrBhy of lErjury thnl r6a. n r coniu-rion Lndins !B.my ior rh. pcdoM. ol rh. ro.k lor whrh rh6 Fmir 6
<br />hsued (S.c. 3rx)7. Crv C.)
<br />rhd rlE f.d.ral E8uldiorl( Eg liry ish.(os r.nDhl !rc no( plicahl. k' rhl pruitr
<br />I (.nify (lRr I havc red rhA rpt . rlur rh. rh)r. nfom iotr n conar I .3@ ro !-nlply wilh rll Ciry rnd Counry
<br />,di,rnrrsrtrJ srr(. Lwsr.hr !lhnr mm.n&l poplny n
<br />,\!t)lirJnrrr.\s0r siAtr t'
<br />SITE-WORK
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/VenUlnsulation
<br />Roof Sheathino
<br />Shear Wall In
<br />Framino bt3tklo A@'rbr oz4[
<br />lnsulation/Energy I
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />lt/asonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Repo(
<br />FINAL 7.27'.torl ltbzle ar)
<br />Cerlificate of Occupancy
<br />Notes, Remarks, Etc.
<br />Bev.08'07-2015
<br />L{\
<br />a u
<br />, DATE COMMENTS
<br />Pool Fence
<br />Flood Zone Certif.
<br />APILI(ANIDECLJIAIAN
<br />I h.EUarmun{.r rnalryof Frlu.yon. of rhc foll{,winA d(kdionr:
<br />D.tulirion P.rmirvAsb.ior Noiifi.lrioi F.d.rul R.3ularions Gnl..l0, P.n6)
<br />R.quir.d t (d of Ndilisri,n
<br />h;'-
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