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BUILDING- INSPECTOR RECORD COMMENTSSITE.WORK DATE ID/SIG. Set Backs Forms/Steel/Holdowns Erection Pads SLAB Floor Subfloor/VenUl nsulation Roof Sheathing Shear Wall Framinq lnsulation/Energy Drywall Ext./lnt. Lath Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif FINAL a )I va) Certificate of Occu anc Notes, Remarks, Etc. OWNER BUILI}ER DEI.CAR TION I nn by l,'m on& Fuly ot Fju.y rhn I d odrpr 8!6 rh. Co t.l6' LiGG L.$ fot llE rolbwins ron 1sd.70l t.5 Bcind sn P.ofsion Co&): Aly Cny or Com, {tah rcquE . Fn lo @'ti,uci. tn6, iDFove &Dlit or i.Fir dy irutue Firlo ir! isulc,.lD G+t6 th. +plirl for rud Fnn to 6].t 3ei.d fiald $r lEordE a lilErd Flla ro rlE FliibN of E Cotrrrsto.i Li..n .n h* (Ougr6 9. CoI1lffis! $nh Seibo 7000 of Diti.bn I of tl* BolilB .t( PmtBbN C.d.) d rh, lE d rlr r 6dqr rhd.6oo .!d tlr b..ir for lh. dLs.d d@Fbtr Ary violrri.,n of S.dnn 701 I 5 b, d, rpglicet for a Fni .ubj6r' tlt rlplicei ro . civil F hyofml mclna 6v. hu.&.d dollt! (1J00). l. s olle ofrhc prop.nt, or my oplot6 *iih w.sd d lh.n sk codFsaio.. will d. tlE m* d tlE 3lrur@ b mt inExtct or ofra.d aor sl. (SE.7044. It@iB Md Profaios (irt : Th. (onlrrclois Lic@ lrw d.6 not +9ly lo M oMd of th. p,lFry wkr h 6 .r !rgn6 ttEEtr dd who d.6 sch mtl hitu.lr or h*lao.lhmuSfi tit or td oq dployâ‚¬, FoviLd rn{r uch mFDrqF$ e er id.d.d d orsd nJr rL lf. ho$E. 0E hlittitt d i'qlrldld L $U vithh oE ,r olconpkia ilE OrE B{itb hll lIE U! hmtn ofFori,E thr lE o. $. .lil ml hrild o, i,rFoE lh. FoFl, 6r tlE Prpoe of l. s o"c of dE Eorary. 6 Grclu!'rly .otu&li.3 r nh l(d!.d coftl.R ro @rdlu<1 llE F.j.!t {sd ,olt, lrBlB drd Fok6 Co& ThG ( onl,.!roi! l.ic.e L.w do6 ml $gl! to d o*c of F.pdry wh. h{ild! or iEptor6lho6( ed $ho o lefo..EhFDF wnh. ColEer6(.) li..6.d Fol'ld b lh.codhdn ! tf,de Lr). latr.rmpr udd sdl !.aBtrlt{l;olttElrAu9r DECLARA ION I hd.$y .mm u!d6 Fuhy or pqJry on. oatb. aollowin8 del&d ioN I h.!c !d will drllliin. Carift.r. of coiMl to S.ll-lM fo. *qt6r 6.lP.n!xi@ s FrvlLd fot by S6lio! 17m of th. bb Cod4 fr th. Ffotu. ol $. *ul fd strtt rlE Fnn a iB!.d. -l har. r.d *ill tui.r.i. hit6r ..nFEaiotr iBuuc. s r.qrilqt bt scdion l70O otllE |ito. Co{t.fo. th. Ffollm. ol rh. *vt tor *nih thir Fmir it io.d My wkd' onFEibn 'Nu@. .eid ed Poliq mnbs t. Policy Numb6 -ErdrBl -l ..niry ln,l in rh. pdaornrlnc. of lh. work lor whi.h rhn p.rEn i ntq.{. I shall rcl oploy oy pdsn in e, nmd $ s ro b.(oBc lubj{r ro rh. *ort6' .omFdion liw! of Cdifomia ud .sc $d if I 3hould bEoru rbrl to lh. sort6 cooFurioh pnivi.ioN of Sdlior 1700 oathc bt r ( o&, I lhrll, fodh*nh smPly wm ftE F$vabd waRNrNG: fnlu. ro w. wI@ @stEgi6n sr6+. i3 unLqfirl dd dull subjd e .,ntloF lo aiBir.l p@Xi. dd civil fu6 up to o& huldrd thou$r, doll, (tl0o.0o0), '..ddilion lo ltE con oa.omFdion. d&rus6 a Fotid.d aor i,E Sdm 1076 or dE llb.r ( o&. d@n ai .nsrEy ! f6 IICENSED.(;AIIIACIAA D&CtlSdfloa I h6.tr Erm u'r& ps'du o f Fjury rhd I m liccnq! ondd For6ion of (1upl6 9 (com.i.! Mh SdtDn 7000) ol DNnio. l ol rh. asind ed Prclsiod Cod.. ed ny ltcM ii in ful n ...nd.llci. I ic.N. Nlmtt colsralJcroutldulc-acEBcx I h6rty !firi u'dc Fuly of Fiury lhd rlE. b .odMion ladus .sdy ir tlE FfM. oa tL uqt 6r rl hrli!Fni i! isu.d (SE 1097.Civ. C ) AIIIIIAULIESJSAIIII! I hddr 6rEn und( poilly ot pdJurt 6n. of th. fouowing dcls.riotr!: Domliri.n Pmir-AsbdrG Notific.rhn Frd6.l R.suhro.r ( Ttl. 40, P.n6) -R.q!n d L.u6 of Nor'ftrtr I .diry rhd rh. laldrl ..8!hioN Esrdins 6b6los rflx d {. nn qlpla.t'L 'o rhis Imrel I .dit rhi I IEE rd rti ltdtlion .d lrdc lht $. ib.v. i.formrion t .om.l. t ,srt & ompl! *ht .ll Chy dd Cooly odile6 ed Sta. r.s Elr!| ro bildiis .oNriucrD!. Ed lE hy .dhoriz. r.F&ndir6 of lhi! Cny dd Couly lo o d l4on $. !bov. Mrion d pmpqty fo. iNperio. F[D(E \l,l,liutrt or,\!ur si[trnr 'r IgEfr III irt'- UFER Ground Brown Coat