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BUILDING. INSPECTOR RECORD
<br />SITE-WORK DATE ID/SIG.COMMENTS
<br />Set Backs
<br />Forms/Steel/Holdowns
<br />Erection Pads
<br />UFER Ground
<br />SLAB Floor
<br />SubfloorA/enUlnsul.
<br />Roof Sheathing
<br />Shear Wall
<br />Framing
<br />lnsulation/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 ,.fr/^a \
<br />17 I Y) l, /
<br />,/7- \-/
<br />FINAL (-.YY lrD Doe. 7D-l ln7
<br />Certlficate of Occu pancy
<br />Notes, Remarks, Etc.
<br />t hcrcby rfirm und€rpardty ofpajury thrt I m cxsnpt fdm aho Corrraoo'Licarc lrw for thc following rcor;6c.70! t.5Burinc$
<br />ud tr,ofoim Oodc): Any Ot, d Csnty which rcquircr r pcntrit !o conllrc$ dt6, inrplovc, dmolith 6 tcprit rny *ructurc, piu to lts
<br />irrucg rtro rcquirs thc rpplicut fr ruct p6mit to lilc r tigcd tiumot tha hc tr thc i! licild PuBWr to thc ptovilim of thc
<br />Conrtcta.t Ucdod tr (Ch+ta 9. Cmciog piu S6rim 7000 of Dlvirim 3 of thc Buinat ed Profilionr Codc) s rhrr ho d
<br />rhc ir crmpa $q!ft,ar rnd rlrc bsir fc thc dlctcd danprioi .Any violijon of Scctio 703 I . 5 b,y uly rPpliffit fr r pcmit tubjcu Oc
<br />rppliclrr o r civil pcndty of mr m thlt fiw hmthod dollm (t500).
<br />_1, u mc of drc propcrty, c my mploya vidr wr3a u rhcir rolc compcnntim, will do thc wqk md thc lnrcrw L not intodcd
<br />r ofimd fc de ( SE.7O,!4, Buino ed Prcfodw Codr: Thc Cmmac'r Llmc Lrw du not rpply to u omd of thc proDcny
<br />?ho buil& tr imFova thcd. rd who dod ruch wqk himclf a hmlf o thmujh hir c ha own crnployccr, Fovid€{ thrt tuch
<br />implvarano e mr lntadcd or ollcrtd fq rdc. If, howcvcr, rhc buildir8 or inplvcmat ir rold within oc yu of complction, thc
<br />Omc-Buillr will lrrw thc burda of provinS thrt hc c rhc oot build c impovc fc thc purporc of ralc).
<br />_1, !t owna of tho prcpaty, m crclurivcly comrcrirq vtth licanod coruEtmr o mtttuct thc prcjcc1 ( Scc. ,044, Buinc$ sd
<br />Prcfanior Codc: Tlrc Cillr8tor', Limc lrw (b6 nor rp,ply to e M6 of Drcpcrty who buildr tr imFoyc, thctu , ed who
<br />murctr fm rmh pmjcctr dth r Colttctff(r) Ii6urd Fr]luut !o thc Conrrac'r Licatrc Lrw.).
<br />_l m qmF ud6 SEti6
<br />-B.
<br />& P.C. fc thir rum.
<br />Detc: - Owncr:
<br />@llrcby rftm udaparrlty of pajtrymcofthcfollriry delmtim:
<br />-I
<br />htrc ed yill miildtr r Catifioto of CfiEil to Sclf-larm fc wqltd' mF$d6, a providcd ftr by Sed6 3?oo of lhc
<br />l,rbc Qd., ftrthc Asfanrutcc of tho wqL fa which thc Filril ir isucd.
<br />-.?/-t hrw ud will minuin wqlrco' cmrpanlion iuurlrcc rr Equlrcd by Scarim 3?00 of rho L$c Code, fu thc pcrfomuce of thc
<br />Git fc *hicIt rhh pcntt b ilucd. My ri,rka' cotnparnttm lmimco crnic ud policy numbr &:
<br />Policy Numbcr: Erpiresr
<br />(Thie recrion n.a or lesr)
<br />-T
<br />in thc pcrfornrancc of the work for which thir pernrit
<br />of Cdiforniq and
<br />ir irsuc4 I in ury mulncr so !s to
<br />becrme to the 'compcnration lawe rgreo that thc workcrr'
<br />3700 of thc Lrba Codc, I forthwith
<br />L
<br />WARNING: Failurc to rccurc work3:ru' compcruation
<br />fines up to one hundred thousend dollan (3100,000),in
<br />the Labor Codc, interest and utonrey'r fcer.
<br />is unlawful, urd rhall subject an to criminal and civil
<br />rddition to tho cort of compcrsation, damager as povidcd for the Scction 3076 of
<br />@
<br />t hmby rflim unda p6dry of pajury th{ I m lic.rud rdqpmvitim of Chrptd 9 (@mncing with Scction ?000) of Diyision 3 of
<br />thc Buinu ud Prcfsim Codc, ud my liffic ir in full fre sd cf,st.
<br />Liccnsc Liccnsc Numba
<br />Duc:
<br />I hereby affrrm under penalty of pcrjury that thcre a sgcncy of the work for this permit is
<br />Civ. C.),
<br />Lender's Addrcss:
<br />Dcmlitim pnnit-Arb.ro. No.ificdm Fcdcrl *ffi
<br />_ Rcquircd l*nc ofNodfic.tion
<br />I ccnify Oar thc fcdcd rcjulrtior qrdint sbcrbr rsnovd,G nd rp,plicrblc to fii, Prcjd.
<br />flGfi ,lnttt rvo Hd thir rpplicrrim md nllc thrt tho rlovo hfqmdo h ml I grcc ro emply rirh rll City sd County
<br />ordinancer and Suto Lrwr rcleting to buitdin3 conrtnraion, urd hereby suthorize
<br />abovc mentioned propcrty
<br />Applicant
<br />for
<br />rcpnfcntrtives of thir and to entcr upon the
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