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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILIJER DOLCARA'I'ION
<br />I h.rcby rfitn uidu pcnrlry {,f Frjrry rhrr I 3rn crenU liln rhc Co act,6' I.trtr\c hq litr rhc folldsi'rg rcdsn (S( 7011.5
<br />Ilusinc$ ind Prolc$inn C-rllc) try C[, ur Coutrry shi.h rcqunc\ d frtrir k).on{r!.r. rlrcr. rnprovc. dcnDlhh nr rcIur rn}
<br />ntucrrrc, Iri.r b ir\ hsurN.. aLso rcqutcs rhe apdicad nn slchFrftirro nb! ris'Ed (arc'Enr r hil hc or sh. s l,.cn\cd ru6urnr
<br />r,) rhc provhiotrs ol rlE Conh.lors Li.cnscd lju (Chucr 9. connncNnrg qi'n sc.rion rom oi Division I oi rhe Btr\incs and
<br />PbLsn,N Codc) or Ihar hc orshc i\ crcnu thcrcli. aDd rhc hast lbrrhcrllcgcdcrcnDrion Aiyln,hrnnrofS..riotr70.ll.5hyant
<br />irpli.! fo.nNnnn subjc.rsrhc apphrtrrro r.iviltcnilryormr nxtrcrhdn fiv. hundr.d doll.h($500)
<br />l. owis ofrhc pmlrn!. or n1,cmpk)\r\ sirh *rgcs !s rhcir n't .onl,)en\rri,)n. *illdo rh. \oA md rhc {turm i. dur
<br />i c,xlcd orDff.rd lnr srlc (5(.704.1. Btrsi,rcss dnd Prolasi{).\ Codc Th.CoftrcttrsLi.cn{cl-dwdncsnorlPflyhnnown.r.i
<br />rhcpn)Fny *ho huilds or nnpn,vcs IlrG,,. iurJ who d,r!\u.h wolknnn\cllorhcrr.llo' rh(,u![ h \ or hcr own c Dlorccs.
<br />prolidcd rh.t such in{mtqrtrh!rcml idcklcd or.ltaftl hr$k ll hnvcr.r rhc huikline o, inlioEnrnr is e $ilhinorc}rr
<br />of.o {kridr rh. (hmr auiUd w l hnvc rhc hurdcn of l)(,vin8 rhar hc or nr did mr hrild or improv| rh. frn,F y for rh. purF)r of
<br />-1.
<br />!s oBns ofrhc pmpcd, 0nrcxclusivclr.o.tra.tinS wirh liccn*d .ontrlos Io onsrrucr llr !i{,jd (Scc 7044, Bu\ims\
<br />and Pn,fcsci.nC{dc: Thc Conirrcrois Liccnsc L.* does mr lprrly k' atr.*ncr ofFropc y{ho huildlor imtft,vcs rhcrcon,
<br />and Eho .odtuts lor su.h tojcds wnh, Co.rdo(r liccn*d llnu rorhcConrodorsLicenEt w).
<br />Inn,cx.n'm unilfi S.rr
<br />ul)Bx[Bt].el)ulliNsallaNuEct Mlroll
<br />I hc'rhy rllirD !oncr prndryoipcrjury onc oill[ hll(i*irr dc.hrrli,nr\
<br />I hr!.mlsill minr3ir rCcniicarcofConscor t. Scl,rl.surclor sorkcr'compcn$rion.3s pmlidcd ftn by Sccnon 37m ol $c
<br />l,atx)rCodc- r'orlhc pcraonnrtrccof lhcwork for whi.hrhcFnnit k ksurd.
<br />Ilkr *il1'nrnrn,sorkrrrcomFnsxrioninsurrn...rsr.quncdhvSccrii)n:17ft).frhrl-ihorCodc.furrlrNrLnnNcol
<br />rlt s.'k ntr s[i.I r[n I['nrr (!cd Nly\or[.^ (onlrotr\xri, iNur ro.]n'c' rllIx)]'.\ trtrnhlr dc:
<br />H
<br />4. zz -/1
<br />-l
<br />enilyrllr nr dc lcrfurnurce oflhc lort for which xris p.irni n tsucd. I \hrll..r c'n rby flny pcnon in rny nunncr
<br />$ I n, bcerf, shjcd lo lh. workcrr B,mpcnsrnrn kw\ ot Culii(mia. !' a8rccrhd irI should lx.o k suhAr hihc
<br />solkc^.o'nncn{JionpDvi\n,i\.lS.cri.n:l?(DoIrhclnk,Codc.l\hrll.fonhwirh.o'nplywirhrhos.prcvisiotrs
<br />WARNINC r&ilurc ro su.. workcn'.on,r.nsari.n c.vcmec n unhrru rnd \ball suhjer ,n.nrlo}tr r. cnninrl !.nrlra\ and
<br />cilil linc\ ut n) on. hutulrcd Ihorsnd dollsr l5llr0.0{x)). ir addirn,n n, rhc cn{ ol rompctrurnnr. darmgcs.s Drovidcd t)r rhc
<br />{|::|j" : iL: : &' - *xil';
<br />^!.".,*4vu*w,\ I .
<br />I hcreby.iltn und€r n nolly oi pcrju.r rhor I um liccnsl udcr Drovhio. ofChlprcr 9(contutuin8 wirh sdri,n 7fi)0) orDivisiotr -l
<br />,l lhc BusiJrcss Md Pmfcssiors Codc. and myliccnsc is ir,irll hra mdcitlcl.
<br />9 k**",r.,*,' tA gc
<br />xi,",", 7 -/ a-1 t x..,""",..
<br />l-!).I5-lltl.t-11!1!!l:}!:!Llj:!!.!,!!l
<br />I hcrcby afliin undcr penrlr, ol pcrj.rr rhll rhcrc h, drndrucrion hndi'rg !8cmy nn rhc FdonMtuc.rrhc *dtk l(r $hich rii\ permir i\
<br />hnL{ (Scc.3097. Civ. C.)
<br />ArIIIclNfDEClrLBIIll)!
<br />I hddry dnnnt und.r Fnrk, of trrjury oft.frhc followi'r8 d..lrdn,ns
<br />Dcnknirbi Fdnlir\ Arbest^ Norifi.arbn F.ilcrnl R.8xldn,n\ (Tirlr40. Prn6)
<br />Rcqutr d lxfidol Mrifi.rl0n
<br />-lccnifylhrllhcLderllrc8ul.lionsrcBrdingasbcsorrcnmvrlm
<br />olitplic$lcn,lhhprojc.r
<br />-lccnifyrtuIhivcrcldlhnlprllclli
<br />dnl (alcrhllrhclh)vc inntrDrrion i\corccr I srccr{,coigltwirhnllcirya cotrmy
<br />odiMtr..s andSr cLa*srcUrinarobuildinsconnrucrnnr.onherch,aurhoriturcprcscnrriivcs.rrhhciry. dcounlylocnrcruNnlh.
<br />abovc mtrlioncd potcdy for nrslarion purlns.s.
<br />(pprcmr orAgenr $rgnrrum, I J t/-Ur*
<br />, P.mr.. @n. {pdnr): -l$-t uZ-l.Or<=4.eW >'f*tLoWetr+D/,",,"7- /b4I
<br />Set Backs
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Rool Sheathinq
<br />Shear Wall
<br />Framing
<br />lnsulationi Energy
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Masonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL < /, /td .=-b.4 ,h
<br />Certif icate of Occu I (-/pancy
<br />Forms/Steel/Holdowns
<br />Sublloor/VenVl nsulation
<br />Notes, Remarks, Etc.
<br />L.ndcis AddrEs:
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