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BUILOING- INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.OWNF:R BUII,DER DELCAR{'[TON
<br />I hcrchy rflnn undcr Fnalr, {)r Fruiy rhar I am cxcm from rhc Conrrrkm t-icc \c uw rd lhc folbwin8 rcarr (s..?0.115
<br />BusnNs iid Prrcssin Citc): Atry Cily or Counly qhich rcquircs r lcnnir t, .oi{rucr, rltcr, irn0mvc. dcnxri\h ,tr rcFn Jtry
<br />nrudurc. trrior ro irs issuam. iho rcqun$ rhc atpliclnr 16. ruch pc.rn b l,lc 0 si8md ndcnEnr lh0i hc.r shc t li.cnscd Pursu l
<br />b rhc pmvi\ionr ot rtE Contador'\ Lrcnscd uw lchrpl$ 9. ConrmcncinE sirh sc.rion ?fix) oa Division 3 of lhc Busincss and
<br />Prurc\ri{in\Cod.)orrhdh.orshckcrcnrlth.r.lroarandlhcMrisnrlhcall.lcdcxcn'Prnrn.AtryviolaiionufS.crionT0rl5by,ny
<br />rlpli.rd ftr n Dcirnn suhjds lhc rpplicdn .r.ivilpcnrlrt.tn.r rrcrnrn fvc hundreddours(S5LD)
<br />I. ,r ownf or rhc Fmtf,nr. or my enulorrcs *irh wascs a\ rhcn vn. .ofrp.n\nliotr. will do lh. tnrl( rnl rhc dmtun is inr
<br />inrcaLd or ofic.cd l'or elc (sr 701.1. Brsim* and Pr.fcssions codc Thc Conkcrois l-icc sc Liw docs !.r lpoly t' !n o*ftr of
<br />rhc F)pcny who hoilds o. in{mrs rhc6n, tul] who dds such slk himtlfor hcr{llor rhrox3h hh ot h.r own cnrlloyccs.
<br />pn,vidc.t rltu such nnl,o!.mnts c d inrcfthd oroftrcd lo.sk ll howcv.i ih. hiildinS or inprcvcNnl t $ld wirhii om tsr
<br />of.ory)hion. rhc Owner Buiklcr *ill halc rhc burddn of ptuvin! rhd he or shc did trol tn,ill or irlitr,e rh. poNny lor ih. pur IDs ol
<br />traf,trEEsttnu[ENsAllQN
<br />DECI.AAAIIAN
<br />I herchy atfilnondcr pcmlryorp.rJurronc ofthc nnbwirE dcclmlion{:
<br />-l
<br />h!\c lod,ill tunnai'r dc.dific,rcorconsc rosclf-lnsurc,o!Bo,kss.onFn\{ion,Ds povidcd lir iysc.rn,n:l7ll)ofrhc
<br />Llbor Codc,lbr rhc pclaorntu.. orrhc wo* ro.which rhcr.tnrir is hsucd.
<br />I havcnM qillnminrnir w.rk.( confdn\rrn,n nN
<br />rhc uork(n shich rhirr^-nnir ir isud Mysork.n'
<br />.G rcqrncil h, Slrri,in.l7(xrolrhc lil!, Codc, lor Ihc ncrfonuncc of
<br />Nnriotr rNtrr.rcc$tricr md B,licy numbcr dc
<br />l..nir!rhr i', rhc |xrlnn,L,n.t ofrhc qrrk l({hichihh ncnnir i\ i$ucd. lsh lltr.r cDdoyunypc^on innny rrnNr
<br />$ ds lo b..onr subj.\l to lhc sorken flnnpcnsdion lr{r nf Crlifomia. a.d l3B rhar ia I \hould hcom subFrl b lic
<br />workcn'..mrcns ion F)vnionr olsc.rion:u0ool iht lihtr codc,I \hall, fonh*nh.otrrrly wirh rh,* pn)tisions
<br />WARNINC: I'lilurc tr rccurc workcn conrpctrstiotr..vcru-rc i\ unh*tuL rnd \hdll subi.l 0rr cnrlorrr u dnninar Fnrllics !.d
<br />.ivil ,itrcs rp h otrc hr drcd rh.us.nd dolhrs ($l l. in addirion k' rhc.on ofcomrcnslrion- dr'mgcs r, lrovidcd ntr rnc
<br />Srcri, .10?6otrlr t;ft.rCodc. iNcrc(iM
<br />4/tt ltt
<br />B /,,""^,.^","*,-?o\q\1
<br />,r,," ?'J I \lr a ,..,JX\Dzct"r" ?tfcrtr(J
<br />rO! f,U.q&NI!NDAG.ATiEN!.I
<br />I hcrh, aftlrtuondcr rMxyofp.rjurylh{t lhcrc aconslrudn,ibidi'rs,gcn.yforlhcnc.i.lmneolrhcwurklorwhichrhi{trn'iri\
<br />nsucd(Scc 3097. Cir C )
<br />AItLlcANLl,2ElL/BAIloN
<br />I lEhyrlllnntrndrrl,c,lryort)crjuryoncof llrcf.llowirEncch'trri('n\
<br />D.molirio Pcrn,ih A\bc{os Norificrrion Fcdcfll RcEuhlions (lilc 4)- I!nn6)
<br />Rcquncd L.(cr ofNoiii. t
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />Subf loor/Vent/lnsulation
<br />Roof Sheathing
<br />Shear Wall /.4
<br />Framino x.vLt)
<br />lnsu lation/Enerqy \/
<br />Drywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />IVlasonry
<br />T-Bar
<br />Handicap Req.
<br />Deputy Final Report
<br />Enqineer Final Report
<br />,,^\
<br />FINAL K-\9"u wwlu
<br />Certificate ol Occupancy w -\-
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />7-Pl-1
<br />Pool Fence
<br />Flood Zone Certif .
<br />-1.
<br />aro$nerofrhe llorrny, dncr.lusivcly conlroclirrB {ith licetrrd co.ta.roF r. .on{dcr rtB rrcjst (Sa. ?Ol.t, Bu\ims
<br />and Arlt$htr Codc: Th. Contru.rois Li.cns.l-aw dft\ n.r dpply to an owncr of[opcny sho build3 or imtmvcs thcrcon.
<br />and who onrEcrs for such pmj.rls wilh a Conrmclorl, licctrsd nursurnt to rhe Conrricroas Li..trsc bw).
<br />_l am .x.mtr undfi Sc.rhtr-. B & P.C. for rhn rca$n
<br />I hcEbynftirmn.dcr Fnolryotp.r/ry rhar I rn lidn*d xnd$ tiovisntn ol Clqtrcr 9 (enmming *ilh Ssrion 7m0) orDilisio.l
<br />.r rhc alsiruss md Polisions Codc, ald myli.c.\c is i. fullfoiN lrdclfccr.
<br />tln,lcr. \r'nc
<br />-
<br />L.ndci' Addrc$
<br />-
<br />-l
<br />ccnifythnr dc ltdcral.crulario.\m8tudingash.slos rcrmvrlffc n.l q,plicnhl. b rhh pmj.lt
<br />-l
<br />ccnify rhxr I hrvc re $nappliuarionMd (.lclh{ lhc ah)ve inli,rturn,n k.otrcd.I (arebconrlywnhrllcilva Counrv
<br />r'l'nrNc\ trn,lsrtrrc Lxtr. Rhhns rgrfiurUrn-e con$rucri,,n. sld hdcby aurhurizc rcrEsrnlurirc! (,lihh Ciryand Counrylo cnld ulsb rt"
<br />Ti2)^"rL'k,TZW, , ',",",/'ilJfr
<br />*^,,rw,,c,pa.r,,O - tii=-' \-- (a
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