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BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILT'EA DEL(ARATION I na*y .rm undd Frny oaF]{ry rhI I m amPl 6!n rh. C6tuN tiuv L.w lor tlE folloria t@tr (Sa.7011.5 Buin6r ald Prot6lion Cod.)r Any City or CounIy which r.quir6. Fni lo ooEtud, .n6. io9rcvc danolah o, np.i -,rr!(dc Fi.rro iu isilte. rbo Gq{i6 $. @ltan fo, $ct Fmn ro 6L.3Et'.d niaEr lh. lr or tE i li.q!.d F,aud ro llE FsvEioE offt Conrrsroit Lk.ircd L.$ (Ct Fs 9, ColmdirB *nh Sdrirn 7000 ol lrivBion I ol$c lruuB !d Pmfdio Cod.) orlhd h.or!h. i!.rdpl thr.&on ud thc b.!! for r.ll.s.d qdtrion Any viol iooofsdbn?011.5!yoy .pplt ,n ror. Foi $bj6r ln. .rpltrd to..i!il Fn lr, of @r rcE $a 6r. holxtld &lLB (lrm). I. s oMd of th. proFry. or my dplolE with ers6 s lh.n eE comFEnioi. will & tlE wII nd tlE nnd@ i mr iiod.d or ord.d for 5Ic (se 704.!. BdiB od Proa6io6 Cod. TIE coffid t LilE t { rh6 rbl +pt b a o*E of rlt FlFry o hr*ld 6ro\Brhd6a in *tE <tErd @ hi@ll6r lEdror dmuSn hn d lE oM orplor6, povid.d rhd such imF!!6ds e m' inlod.d or ofEEd for da l( hoM. tn hl dry or !trPtowEl is $ld within onc )r ot.o'qLiioc 0E Osc Buil& wiu h.!. tE h!&r olFDvi'E lhr h. d !E dA lDr hlild or dqoE 0E FoFr, h. llE Frro* of I u.ropi un& S<(lih D.r._ _ Ownd_ ._nttrxrrs aoMpE s^noN DECTJAAIIA! I h@by lmm uidd podry of pajury o.. ofth. followins dfthr.rioB: -l hwC od silt ni.l.ia. ccr'fr.dc otco@lr ro sdf]tfu 6. *o.id @iiF!.b.l. a Flvilcd for ttsatior 1?00 of E llbor Cod.. for fi. FfotM.c of lh. wo fm q,lich lh. FEn b isuâ‚¬d _l h.\r lri *ilt m! .in *ort6 .omFldEn !Efu.. a r.qunol ry saran ll7@ of [E ttlor Co&. aor rlE Ffolrjec of rhc srrl for whi(h $n p6nn n is!4 My world @ip<Enron 6tuc 6ir dn polty osba e I .orit rhi in ih. FfolMc of rhc worl a@ $t'ai $6 Fon n Bud I irll mt anpb, iy F$D i, ey nlffi s 6 ro bcom rubJdl lo lh. worl6' cosposrion LB of Crlifomi!, ud isE Ihd it I dDuld b..oo. subjer lo D.*!46' odpisrbn FovnD6 of Sction 1700 ot rlr t lor Cod.. I !!.ll font$'rh @6pt sih ilbr F.riiirN. \'IARIUNC. FnlG io s wt6' otrp.dion ov6.e. l! uLwtuL ad idl $bjal & dlphF lo oaidl Fdi= &d civil lins up to onc hudr.d thol[gd dolls (1100.000). in rddnion to rhc con of conp.Mlion. doa*6 a posd.d to. rlE Sdrioo 1076 ofth. L.!d Coda i' 6d rd ironEy ! fc. appllor!: tr(EltElroNri (raf, DTCIJAAIIA! I i@by rlfm uodd FEny o f FJury rtu! I m lcascd undn F$vition olchl$6 9 (6mcing *nh serb. 7000) of Divilio. I of $. U6i,B ed PrcadioN Cod.. td ny lt* L in tuU foN rn cllal. CqNIBTSIA!..LEB!|!EIG!!q I hody .rm urd6 FrIy of p6ju.y thlr dEr ir . oldruclhn lddiie .stry for lh. pafotrlrld olthc mtt tu. s,l&h lhir Fni ! iis.d l5<. .!09'r, Ci]. C.). alg.lca[lDl;clAS uax I holby rJIm undd FaIy uf p<jur_v oE of 0E tollowi,3 d..l{.t ioa tlsolirr. Pm r-Ath6r6 Ndili.d ion Fcldrl R.guLr k)c (Tn!. .lo, Pd6) R.qut.d tdr6 of NolifMbn I cd rry rh.r rh. Ldml r.8uhtu,E Egsrdin8 ab6lor rmr.l eâ‚¬ nor .r,pltabl. ro 'hi! tmj..t I dit rhd I lB. Ed thi! lpplid ion rn !rr. lhr dE rto\r infoMbn ir ccrEl. I rsE lo @mply snh .ll Ciry r{ Courty mdiMcd ..d Srd. LlB ELrtrlS ro boildi.g .odrudiol\ ad hqc6r .dhriz EFBolnivd of thn Cily &d Co6ry lo dnd upon tli abov. Mrion d FrFly for iNpdl6n plrpGd ^ppli..nr or ^861 shnrl!& P.mlr& nrn. tprlnr ): Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/VenUlnsulation Roof Sheathing Shear Wall Framinq lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report FIood Zone Certif. t FINAL -1 Certificate of Occupancy I Notes, Remarks, Etc. L a ogE of rlE FoFt, m dclGir.lt .o.Miry whh liâ‚¬E d .odr&1oB lo oindd lh. Fljel (Sâ‚¬. ?()lt. BGilr .n PloL6 Co& Th. Contr*ror'. Lic@ U$ do6 @r rp?rt ro e omd of FoFry *h. b{ih! or mroE th66( ed who aiE!.lr fot 3ucfi prcjdr wnh ! Co E r(t) licas.d FEu, lorhcco'ndcroir Lic6e t *). 7,117A Frq.l#9