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BUILDING- INSPECTOR RECORD
<br />COMMENTSSITE.WORK DATE ID/SIG.
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SublloorVent/lnsulation
<br />Roof Sheathino
<br />Shear Wall
<br />Framing
<br />lnsulation/Energy
<br />Drywall
<br />Ext.i lnt. Lath
<br />Brown Coat
<br />Itilasonry
<br />Pool Fence
<br />T-Bar
<br />Handicap Req
<br />Deputy Final Report
<br />Enqineer Final Report
<br />Flood Zone Certif .
<br />,A
<br />FINAL K-x\u1a
<br />Certilicate of Occupancy
<br />Notes, Remarks, Etc.
<br />OWNIlX BUILDER l'EI,CAR TII)N
<br />I hclchy !ft-r.m hdcr l).ndlry or prrjury lhat I m cgn/ irom rhc C.ntd.n"r l-i.cnrc Law for rhc tbli.linC r.,$. (sd 70ll 5
<br />Bu\nEs Md Pi.rcssi,m Codcl Atry Cily or Counry shich r.quir.s , t flnit lo dnNlrucr. alrer- i.]J)mv.. rhtrslish or rc!)0t any
<br />(dclurc, Oiorro ns hsunmc- aho rcqun.s rhc q,tlicanr r.r *u.hrcrmirro lilea sisncd r'arcftnr rhrr hc or nE n liccn*d p!r$61
<br />k' thc pn'visnris of rh. (l,ntrdols Liccnscd Liw (Chrptcr 9. Codmncnrs wnh sc.rbn 7(D0 ol Division .r or rh. Businc$ and
<br />Pturcssn'trscodc) orrhrr trorshc iscxcnpr rhcrctionand rhc ba\n ftr thc ahecd cxcnuion Anyri{,lrrio.ofsccrhnT0.ll.5byany
<br />omlicml r'or. lennil subj$lsrhc aprlicrnr k,,.ivilrnrlry.rmr nbr hnn fiec htndrcddollds($50))
<br />L r\ owncrot rhc tblf,ny. or my cnll)loyccs wihwrgc\rs rhcn n,lt .o.]Nn\arbn. willdo rhe work and rh. ntunn i. mr
<br />i cRlcd orontrcd irtr eL: (Suc 7044, Busin ss rtrd ftolr$i,'is Colc: Tnc Conlncroir Liccn\c l-aw doc\ nol {rDly ro ano$ncr of
<br />rhc [,Nn! sls huilds.i i'nnrorcs dcF,n- nnd who d€s such *ork hi'n\clfor hc*ulfo hmuSh hh or hcr o$n ctrllk,y.cs.
<br />trcvid.J rhrr such imp ov.nrnh arc mr inrcndcd or oficr.i lff slc Il hoqNu. rhc building or iDprcwnE i\ v,kl { irhfl om ytd
<br />oicornLri .Ihc Owncr lluildcr willhr\t rhc htrdcn oftn,vin! rh,r tt or \hu did mr hork.t n{'m{ rhc Pmpcfly f(n rhc,roqr,{ of
<br />I. xs owmr orrhc ln,ncny, r c xcns ilely conhcr inS {irh lic.trsc{t conrnco6 ro con{rucr rhc Inoiccl(S( n}r4. BD\itr((
<br />axl lh,{i:$ion C (lc:-lic C{)nkrkx l Li.cns. t-rR doc\ nor eply k) r'}t.ivncr
<br />snd {ho c.nrnch r.r su.h lojccN wirh 0 Contmcro(s) lien
<br />w" e 7/zz /5
<br />t), t( I \Rrll0\
<br />I h.rcby rfintr,und.r |r.rlryorFrjury otrc or rhc hllowins dcchrariqN
<br />I ha!c mkiwill nsiNrha Co tilicatc ol CoNe t, S.lflnslrc r(, sorkoJ coqflr*(ion. !s Pmvided ror h!Sccrio lT00ollhc
<br />Itrlxtr CGlc,larrh. Frforntrncc oflhc sorl L,q'hichrhc ncrnir n is\Nd
<br />I hrvc rnd will mlinlanr ! nrkcrs .o nrrcn$r trn r nNut,Dcc. rs rcquncd hy Ssrion:1700.4rh. t-ftor codc. far lhc Frtorroncc or
<br />rhc workhr whi.hlhis!.rmir i\ l\rx.d Mywork.is .o'npcnsrth nrtrrrncccMier md Nlicynun'$.rnc
<br />I.cnilyrhrrinrhcl]crl'ornrncc{,frh.sorknrshi.hrhn]r nir i\ nsucd. I shrll mr cnllk,r" riy P.so
<br />r) xsr,,hccom suliccr t,rhc workcn'fun'N ner ion ltrw( of Crlifornin and rtoc rha! if I sl{)uld h..om
<br />$or[cr( roDpctr\iri(trr ptu visi(,n\ofs(htr37(IroirhctjEtrCodc. I \tu'll- f(trrh*irhc.nrp
<br />WARNIN(; rfllurc ro rcurc workcF .ompensrri{)n colcBlc
<br />.ivil l]lrcs u! ti orc hn.drcd rhousand dolla's l$100,00O), r
<br />Sccrioo 1076 ot rhc-&bor Cdlt. inrcrcn
<br />r",",Ory',28
<br />t)t.t( I \Rtt I()\
<br />I herch, animilndfi p.naxy.l pcrjury thd I rn liensn un<lcr pntvni(,n orChurq 9lcomnEncins qirh scdn,n ruD) olDivhbn l
<br />of Ihc Busircssand Protc$ions Codc. anl my li.cn* is in tull fore od cltt.r
<br />g]ISIN&IIQNIINDIUGA{jINII
<br />I hcrchy afilnundcr pcndiyofpcrjury rhar thcrc n r consrruclhn lcndi'rs rCcn y ror rhc |. lotnEncc ofrhc krr ror *hih rhh ncnnir i
<br />l(tr.d rS.e loi)7.Civ ( )
<br />ATIUCANLDECIABAIIO!
<br />I llrrhy.Rinnu dcrnenallyotperJxryon of rh. bllowinB d(hrur ions:
<br />D.rml(i Pcnnirs^sbcsros Notilicrion Fcdcrrl Rraul ion! (Titk.l0. Pan6)
<br />Rcquncd llllcr oI Nolifi cdi'n
<br />1..nilyn r rh.rcdcrnlr.Buhri!\r.t (lir!rlrr i.r rttli.rhl o I[i! rn+c(
<br />-l
<br />cc.liiyrhll I h.vc re"drhn {rliarn,n
<br />ordinrftcsnnd srarc Llws rcld i'r3 t, build i
<br />comd I i['cc r. c.n]tny wirh ill Ciryrn,l Cotiry
<br />rlc nrnri.rrd fmDcny for in\psrion
<br />lppricanrorAgenlsicmrure (:"*.':';zz;"
<br />str1
<br />Lrndd \ AdJr.(
<br />-
<br />p.mr.e n.m ( pri,0. //ZJ;'>2 /t4 a?r)
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