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BUILDING- INSPECTOR RECORD
<br />SITE.WORK DATE ID/SIG.COMMENTS oWNEII BUII)I]R DEI-C AATDN
<br />I hcrcby rfinn undcr lci,lry ol pcrjury rh.t I n crc.rl, ri.rn lhc c.trrrcr,N Li.chc Ltrw tur rhc rollosine rcrs. (Scc.70rl.5
<br />&ninc$ nd Prolc$ion Codc) Any Ciry or County whi.h rcquns r Fi,nir ro consrflct. alrcr, inl)rovc. dcmolhh nr rcnJt rny
<br />{tucroE. pri)rb ns nsuancc- ako rcqun.s lhc ll)plic.nl ior nrh pcnnilro filc a sisncd (lrcnEor lhal hcorshc is liccnsed pursuor
<br />h rhc rcvi\ions ol thc Conrractor's l-iccnscd tjv (chvrfi 9. (-lnnnEn.irr qilh sc.lbn 7u)0 or Divis n I of rhc Bu{irc$ lnd
<br />Prclc$ions C.dc) or rhnr h.or\h. i\crc lprrhxrclronlndihcha\tforrhcrllclcdcr0nprion Atryli{nariMofSc.ri,nTO-ll5hyaiy
<br />xp!licanr ror apcrnrir sul'r!cls rhc 0U,lic!nr ro acirilr'cnalirol,rot nNrcrlEtr lilc hundrcddolla6 (S5m).
<br />l..s owtrd ol rhc rrcFny. or m, cnrn,F.\ with slgcs a\ rhct v,le co'npctr\dn :. wrll do rh. sork d rlf, {mruE (
<br />'hnintcrdcil .roftrcd lor ek lS( 7(}14. auimss and Prohs\i(,n\ codc Thc Cotrtd.tofs Li..trsc Liw docs norapplr lo,tr oqncr or
<br />rhc f,Rrtdt sh, hrilds or inlPu$ rlltB)n. and sho docr such wolk hinrrll or hcrcll or rhmugh his or hcr own cmployc$.
<br />,rovid.d rhrr such iDtmvctrrfismnn i rctrdcdorofl.rcd li,rsaL lll h.w.vcr. rhchikliuor inrpovcmnl is \okt *iihi',onc ru
<br />ol.onpkrb6. rlr Owi.r Build$ *ill hnvc rh. hrdcn oflrovinE rhd hc or shc did rer hlila.r nlrlnovc rhc pDrcnr lor rhc pu4-s of
<br />_ l. r\ owncr oi ihc |) ol.ny. rr cNlusivcry .onr cring wirh li(n*d cotrrr.ln b co.rru.r th. lnicd iscc 7t!u. Ilu\ircs
<br />rid ftinG\in (i'dc:'l hc C.nracttr i Li.cnsc L!* doc\ tror rt'Ilyn, ano$ncr ol pn,pcny*ho I'uilds or nnpovcs rhcrcon.
<br />and who co nds ior such t]m]c* qirh r Coir b(t li..nscl pu.lur rhrh.Cofutr.rtr\Lk.tr{tis)
<br />;:;"i'r]iu ion-. a &PC lorrhtMsn
<br />Il[cta&tro!
<br />I huclry nflnrr unJcr |xnxlryofFrlury om or'rM ftrlhi*i[E rlcchrurir)nsr
<br />Ihrlc trlwill'nrinrrin rCcnificrrcofc.nscnr lo S.ll:lnnrrc l.r workcr' .ompctrrrri,,n. providcd tur hySr.ri .lT00ofrhc
<br />bI,r Codc. r{n r1r pcrrormarcc o I lhc &rk lor wnich ,hc pcrn hisucl
<br />lhn\c.nd trill nrni.t n poikdJ .onprnsaooh iNunncc. r\ Equimd btS.cri{ ]70Oolrhc Ltrbrtr Cod.,lar rhc FrLnndncc ol
<br />rhc work Lrwhichrht p.nn ls is\ucd Mysorkc '.oi,pctrqrrnnr iNurri.ccadidr rfrlBri.y n.rh.r du
<br />Poticy Nunhcr:_
<br />-l
<br />ccnilrrhrl nrrhcttrloirMtrccofrhc work for ahirhrhis p.rfrn is i\su.d.l shallnor cnlploya.ylc6otr ir rnynN.cr
<br />$rsrobc..ftsuhFcrbrhcsorkdi.on\xn\!ri,rn[wsofCllifinnia."ndugrccrhrriflshouldhccomso],j.crhrh.
<br />work.*.ompcnsurn,prorhionsofS..ri.n:l?(X)ofrhcljktrG c.l shall, fodhRiih .annplr wirh (ho\c tmv$i.trs.
<br />W.4RNINC Irilurc Io wurc rork r{ comlcns i r covcrrec ir utrliwful. ..d shrll snhrccl M cnlploycr lo lriminrl Forhics lnd
<br />civil lincs u! lo onc hun,lrcd rhousrnd doll0s ($l(x),(xxD. n rddiriotr b rhc coi oa conDcnsatiotr. dr FAcs as pr]vidcd n)r rhc
<br />Scri,,n loln ofrhc ljbn Codc. inrcrc< ind ar.rmy ( rN\.
<br />,,,., z )f lt* ^"",,-",,-.
<br />-rt1'\,.zvJ^T \!tV'' rflNsrn t'rwrurlon
<br />DECI.ABATIAN
<br />Ihcrcby dlltn uMcr rcnrlryofp.rrury rh.r I rm lletr*l und.r [.vnn ol Ch.Ucr 9 ( connmNitrB Nirh SLrtion Tu)o) ol Division :]
<br />oi rhc Bxsitusnnd Pn'fcidrn\Co.b. urlmylicci\c i\ in lull ktrc. mncr{ccr
<br />C!}ILIItrIJCIIONIINIIINC.ACENII
<br />I hcrcby dfl,nn und.r F.rlryofpc,ury rh thcr.isr.onsttu.rn,nhndingn8ck!forrh.pcnirilrumrof$.workfor*hichrhispcirniti\
<br />issucd rS.. lt)97. Civ C )
<br />AIIU(ANI.IJ'1;LABAIIU!
<br />I hftt'yrrinmuktcr pcnalry ollrrjury onc orrhc roll,,*nc d.rl rrn,N
<br />Dc n,lirion P.nus A\b.nor Norili.dnrn Fcdcral R.grhrn,n\ ( lirlc 10. Pan6)
<br />Rrqtrtr.d txrrur of Norilicrrxr,
<br />l.cnifyrhar r hc ltdcral rcgu lar i( )D\ rc!?rdi.E alh.{orr.nrvrlrc Dor J!fli.Ihlct)rhis l,n,jc.r
<br />[\h crniiyrhd I tu,. rdd rhi! af,,li.dion dxl srJrc rh.rhcabvc nrtunniridr
<br />^.odccr
<br />I !sLr kr(,nplyrirlrllcrryrnd counly
<br />inoENand Slrrc tjpsrcl,tin8lo huildir8.otr{fl.tn,n. d h.r.hyaurh"izcrcprcsctrr.tirc}olrhnCityr.rlCounlyr.cnreruFnlhc
<br />1r ntu fonrd pn,J[ny ln i'rsp.crnr pu'Fxcs
<br />noo,"un, o. n*"n, .',*nouo", !!
<br />pemirenanrrprin,:}( Mt}Ld'TAr4 VU
<br />tlrls
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />SLAB Floor
<br />Sublloor/VenVl nsu lation
<br />Roof Sheathing l.' IV"E.J ,/e-A-d"fztP
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />D all
<br />Ext./lnt. Lath
<br />Brown Coal
<br />lvlasonry
<br />Pool Fence
<br />T-Bar
<br />Handica p Req.
<br />Deputy Final Report
<br />Engineer Final Report
<br />Flood Zone Certif .
<br />FINAL J2etd
<br />Certificate of Occu pancy
<br />Remarks Etc.
<br />+
<br />Li.cnsc C hss:-Liccn sc Numb.r:
<br />-
<br />DIt.: C.nIn lo.
<br />UFER Ground
<br />-7-?l-E <vq)
<br />Notes,
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