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BUILDING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER SUILDER DELCARATION
<br />I hlrchy ailnm utrdcr Dcnllty oi fcqu.y rhd I :!n crcnpr fo,n rhc (tntdo6 Lrcnk tiw iar rh. fdlowin! rcN)n (Scc.7o.l l 5
<br />Bunncss r d I'nnasion Codc) Any Cily or Coutrty whth rcquncs o lEnnn to c.tr{rucr. !kcr. int'ruvc. d.rolirh or tolat any
<br />yruclurc. prior to n! issuak . also rcquids rhcnnplicr tu srh Fnnir ro filca sisncd (atcnEnr ttut h.or sh€ n lirctr{d puhryr
<br />r) ihc Povnion\ or rh. Contn.i{, \ I-iccnsed liw (Cfilptr 9- Conrmncin8 wirh Sectiotr 7fiio ol Divnion I ofrhc Bdvicn
<br />'iJPrnt\siotrs Codc) orrhrrh. orshc tcxcmfr rhdcfi. rand rhcbrsis n)rrht rll.gcil cx.rynn'n Anyvn,hrionofSe.^ri{70ll.5byatry
<br />r!tli.rnr r(i a pcnnir \objcckrhe applicanrro a.ivilpcnrlryoftrorflDrcrh.n rlvc hundrcd dolla6 ($500)
<br />_1. ss ownq ol rhc pmlxdy. r, my .mpk,rrds wnh *ascs as rhct v,h con\i.n\d t'n- will do rbc wort ard lh. nnr1m h ml
<br />inrcfrhd or oficrcd f(tr slc (56 ?044, Busincs {nd t}ofesions Codc Thc Conrrrdols Lrctrsc bw dols mr rpply b ,n own.r .f
<br />rhc pmp.ny who build! or i'iTFws rhcmn. ord whn des sEh w!* hnNclfor hcr*lfo. ihmuah hn o. h.r owncmpk,rccs.
<br />pravidcd rhut such inr!rcEmnk m mr inrcndcrl u onc'dl rir qlc la b*chr, rh. builins or iq,owm nsliwnninonc)c4
<br />oro'npLrio.. rrE Owtur AuiEa vill harc lhc hord.n oI provin8 tla! he or sh. did tror huild or iipmE itE t,opdly ror rhc tu,FE df
<br />_1. $o*ncrolrhct'opcny. rmcxcluivclr.onrrcring wirh liccnscd conrr.ron b connfld rhc ImJc.r iS( ?O .8uitrcss
<br />u l PDfdsbn Codc: TheCotrrncrol\ l-iccnsc Lawdocs noritplyio anownq otDolcnywho buildsor improvcs rlr$.on.
<br />rnd uho .onrD.ts hr su.h ,rojc.B snh a c.nki(r,(n liccnrcd rxAum k, rhc G)ntrktr s Liccns liw)
<br />I rncre'npl nndcr Sdion
<br />llauiE&):.couu;rtarloN
<br />DECIA.BAIIO!
<br />I hcrrhy riirm und.r ncnullyoipc.luryonc.lrhc followinE d&lddnotrs
<br />_l h!!c mdwill nui .ir!acnirrc,rcorContcnrros.ltlnsurcrds.rkcn compcn\arbn. !\ rrDvi{lcd tor by S(rt'n .l7r)O or rhc
<br />ljbr Cdq lbr Ihc Frlbrnrn.c ofthc wo.* nn whih rhe ,ronir is is\ucd
<br />XI havcnnd will m,iitii workcs .omncnsrtion insurrrcc. rs rcqutcdbySc.rianlTtroolthcLlt'oiCodc,forrhcpcdornun..ol
<br />thc {.rk forwhrhthr |fmm is isskd Myworkcn .rnpcnuri,n in\urancc cuier ar lxntynumtssc:
<br />c*,",,.*&af@_\>
<br />P.ri"yN,^b.,-. Sql/\)F4Af 3Vf \4 E,Pi,*,
<br />-l
<br />ccailyrhrlinrhc p.riormmc of thc *ork lo. whi.hrhnncrn is issu.d,I sh,ll nor c,pk,yinyF6on inonynuncr
<br />s !s lo lx.o'ft subjdt tu rh. wo cs cotrwnsarnrn hws of Clliforni., and r8rcc lhu r if l struld tEcom subjd b ttE
<br />wor*cr' conpcn{iiotr ptuvhio.s of s$rn,n 1700 ot rhc UtDr Cod.. I shlll. lonhwirh omply wilh rhos Dmvhiotrs.
<br />WARNINC: railurc lo scurc workcB .on{ri$tioh ovcn8c is unhsful, and shlll subjcct m cmplorr lo aimintrl lxnlltis lnd
<br />civil fircs up ro onc hundr.d rhousand dolles (Slm,oOO), in ddiri.n b rh. co{ ol compcnsarion, d!mS.\ as povidcd for lhc
<br />Sccrion 3076 of ihc L{tDr (h.. inr.En and anormy s rccs
<br />aVhn *7,
<br />DICI,ABAIIO!
<br />I h(Nby afirnrundcr pcmllyofpcljury rhd I m lcn$d und.r psvnion orChrptr 9 G\,mtunci.C wirh Sdi,n ?(x)Or oI Dirnion l
<br />o, rhc Businc$ and Pmfcsions Codc, md nry licc.s is in tullroreutcll(t
<br />Li.cDscchs: c-L|L"frt?1a23
<br />o,r", to I tAl za:21 A?t O Al4<rr.)
<br />CAIIIBIJQIIAN.LENIINJ-ACINCI
<br />Ihcrcny!fitDUndcr F.nhyol I'crjxrylhar rhcrc nrc.n{tucri{,i bnJi'r8aacncy lorrhcpe {rronccolrhc$or*loruhnhthhIE nn is
<br />isucd (Sc. 11097. Civ C )
<br />AIPIICANLDECIABAUQN
<br />I tmby.fahr undcr Fnaxy.rlcrjtrry onc oa$e nnhqins dccldarions:
<br />Oemlirion Pcrmih-Ashcsros Noriticalion Fcd$al R.guhrions (TirL 40. Pd6r
<br />XRcqxt d lrtr(of Norificuhn
<br />)<l ccnify rhoi rhc lcdcEl rcBuLiions E8{rding astEnos rtuv,r . nor ,tprdbrc b rh( pol.cr.
<br />!llcdiryrhrrlhrvcrcJdrhtrarrrlKarionundndcrh,lhcatnv.inaornulioniscotrccllosraroomplywirhallCirytrndCounry
<br />ordimnc.s aM Srrlc bws ELring r. bDildint conntudk tr lnd hcr.hy aurhorir rcprcscnrarivc! ofrhis Cny ad Counlylo cnrs utDn llE
<br />rlx,vr rnroi.d |h)Nny ntr nNtr(rn'n
<br />.\pplirinl or ,\!rDr Si!nnlurr orr, ,lrq) ,r'
<br />Set Backs
<br />Formsi Steel/Holdowns
<br />UFER Ground
<br />Subf loor/VenVlnsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framinq
<br />lnsulation/Energy
<br />Drywall
<br />Iti'lasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />.t l
<br />FINAL x /,. I wr,7
<br />Certificate of Occu pancy ll 7
<br />Notes, Remarks, Etc.
<br />Lndcr'r Ail&.sr:
<br />@\
<br />Erection Pads
<br />SLAB Floor
<br />Ext./lnt. Lath
<br />Brown Coat
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