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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.OWNER AUII,DFJR DEL(]ARA'T|('N
<br />I hci.hy rfinr uid.r p.n ry.r,'rrjurt rh l,Ncrcnry lo'n rhc Conracron Li.cn{ ljw i,tr ihc li)tki*iig rrtrv (sc..70:ll5
<br />tsNincs a Pmfcs\io Codc) Any Cily or Counly shich rcquir$ a ncnnir t, coi tu.r. ahdr, i'nPtuvc, dcnmrNh or r.nnit atry
<br />idcrrrc. tri{rro ir\ h\oamc, a!n) rdqun.s rhc trpplichr ln \uch Fnrir ro filcr n8trcd s&m rh hcor shc n liccnscd puruanr
<br />kr rhc pmli\ions of dc ConrEckn r l-icdn{d ljs (Chaprcr 9. Con,mctui'i8 wirh S.crn)i 7000 ol Divirnr 3 olihc Au\incss and
<br />Ptufc\si.n( G)dc r or rhrr trd \hc ncxcmpr rlrcrcfro,nandrhc trsis forrl[ rllcgcd cicnrplt,n Anyviohri,,nolS..ri T0:ll 5 ht rny
<br />rmli.rnl lb! rtEnnil suhjah lhc rn!licanlro 0civil penalry.lnolnsrcrhrn fivc hrndrcd dollnr\($5(x))
<br />l. r\ owu or rhr ln)l.ny, or nry cnllrk)r.cs wirh w.!.r ^ rlrir $k ..nrFn\rrion. will do rhc $rt and rtE (tuih t fr,
<br />inrcRlcd oroficrcd nI $b(Sm 7(}14. Businc$.nd ft.fc$iotrs Co<lc IhcConlr!.lofsl,kcn*ll*doc\no!,pplyt,Moqncror
<br />rh. pnFny *hot ild\.rir{i,rcsrhcR)n.aril{h.d€\\uchworthim\clfnrhcsclfo hnn,Bhhi{orhqrwtrcnrployc.\.
<br />pn,vnl(l rtur skh ifl]|nov.nr* c nor inrcrllct] or olr.Rl li)r uL ,t hrcBr. rhc hrildin3 or irpfl,ErEnr t $kl wirh'. on. ru
<br />.lconFkli,n.rtrOwncr,uikcr$illhnwrhctudcnolprevinslharheorrh.did n huikl or in{n\t rh. tsFny fr rhc purlnt oI
<br />-1.
<br />as o*n.rolrhc ptrrpcny. rmcxcllliv.lycoftrcrii8 +irh lccnsqt.otrtmkns k, conntucrth. pn,jt.r lsc.. 7M,l.ltu{Dcss
<br />rl l\r)fc$i,n Codc:1hu Cont.chr'( Li.cnsc Law do.s nor rftlykJ o*trcro, nrop.nyslrr iuilAor nnprc\r( rlucur.
<br />atrd sho qnr'!.r!ti)r\!chpnr.ck *irhrCotrr',.ttr(\) li.cnscd | rsutri k,rhctl rktr's Li.ctr\c Ijw)
<br />I rm.\.n,fl trnLi.r S(ron
<br />I1o.8trtr8$:.laugl$ rloN
<br />]]Iig,^-BAll(D
<br />I hcrhyxllnn,unJrp.nrlry,nt)c'iryo coirlrt)ll((irNd.(h' rnnn:
<br />-l
<br />[orc mdwill DBinhir a Ccnificalc il C{'nscnr r{r scltlNuE lir eorkI \. .onDct\rr i,u. ra Frrttcd rrt hysc.rion ]r(x).r'lhc
<br />t rur codc. rorltu |xrfoanrkcol'll[ sr.k Inr whichrhc lLrtr is nsu.d.
<br />Ht u tr\'{JBc ! tricr:nJ F,ln) "u'tr1f,r ft
<br />1,,rc-0
<br />0t 5 0t-ot-?r€1
<br />-l.cnilyrhiirlh.Flntrnumcotrhcs.r[lnrwhichrhi\pcnnirnt\u.d.I\hrlltrorc]
<br />oyrn,P.roni'runy xnncr
<br />r. .stu ttorc ruhj..r b rhc wor*cn .ompctr\dion hss olCalilornia. and l8rcc rhrr it I \hould tiroft $h)..r hrh-
<br />w. cN .onFns.ri.n f(,vi\iotrs oi Scclion l7rro oI r he Lrtar Codc. I sh.ll. f.nh! irh mn,ply *iih rh,r flovni,rrs
<br />WARNINC: Fiilure lo c.urc \orkcr co'npcnslrion corcragc is unld*rul. rnd \l l.ubJt.r rn cnll)loFi n, ri'niml lrmlr i.s rfd
<br />.ivil fin.s up r) onc hun,lrcd rhou\rtrJ dollrr\ (Sl($(Xx)r. i'r runi.n n, rlt (f.onrrn$rirnr. dim(scs u\ pn,vtlcd fitr rhc
<br />1-2D16
<br />I hcEhyillirm!ndq pcnxlryolFrjLtry rhrr Irnr lnrn{d undcr!n,riri.n ol Ch |nd 9(coinncn irr! strhScdion7(xx)roil)iri\ion.l
<br />ol rhc Busifcs!trIEottssions Codc. rxl n,y liccnr is in flllrorcc mdclli{r
<br />-3\<q6 tzl2
<br />*1r-?a{,-,*n- )(-
<br />IANEIBUqUI.}NIENDINC.AC.EN.CI
<br />I hcnhy !fllr undc' Fnalry of p.ijury rhdr rh.r. i! a oNrudir kndirA !3crcr aor lhc n rfo(rune ofih. w.rk fir shich rhr |f,anit h
<br />isucl(Sc. lrr97- Civ C )
<br />AIILICdNLI}ICIABAIION
<br />I tmhy !fltn undcr pctrally of pcrj.r, onc ofrhc fouowiig d.cl&[nJn\:
<br />Dcmlirion Pcrnrils Ashc(os Nolifi$rion [cdcralRcEnlarioos lTirlc 40. PdO
<br />-Rcquncd
<br />lxllcr of Noriricdim
<br />I ccniftrhnrrln fcdctulr.!uhrii)nrrc8ard$8 r\tEstos rctrhvJl rrc norapplicahlc h rhi\ pnrrr
<br />urdirrfl.csrnn Stirc h*r (l,riry ro huildirAcon(ru.ridr,hcrcbyrurhtrn.r.frc\c rrrivc\,,f ih,\ ( iryn Gnn yrocrrcr uErnrhr
<br />,Lh,\. trn . ul p','t,.,rr 1,tr trAt,.(r
<br />,\pplionl,rA(.nlSign nrc
<br />U*.r"" u,.",r.Ur,. Xt-isr"t
<br />.7.b.?!L
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />S ubf loor/Ve nVln su lation
<br />Rool Sheathinq 7,4t-/rQ
<br />Shear Wall
<br />Framinq
<br />ln sulation/Energy
<br />D rywall
<br />Ext./lnt. Lath
<br />Brown Coat
<br />Ivlasonry
<br />Pool Fence
<br />Handicap Req-
<br />Deputy Final Report
<br />Engineer Final Report
<br />I
<br />FINAL .{//,{/lt (/ ,l I a),\
<br />Cerlilicate of Occu anc
<br />Notes, Remarks, Etc./ry
<br />COMMENTS
<br />\3 /C
<br />T-Bar
<br />Flood Zone Certif .
<br />r ,4.
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