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ELECTRICAL.INSPECTOR RECOBD <br />APPROVALS DATE ID/SIG COMMENTS ()wNER Bt'ILDER t)t).CARA'I tON <br />I lErcby aflrilr under p€nrlt) of pcriury lhal I iuD etcnrpl frotrr the Contru(lon License bw for fie following reasn (Scc.703 1..5 <br />llusincss arkl l'rolbssion (ixlc): Any Cily or Counrv which rcquircs a lEnnil lo construcl, altcr, improvc. dcrnrlish or rcparr any <br />slruclurc, prior k) its issuarce. olso re(pires llre apflicill for such Fnril k) filc a sigrEd slatctrEtrl lhat lE or she is liccnsd pursuailt <br />to lhc pmvisions of lh(' Contrachr's l-iccnscd Irw (Chaptcr 9. CornrncncinS wilh Scclion ?txx) ol Division J ol-thc Busincss and <br />Professi(,nsCode)ortlrrlEorslreiserenrl)tthcrefronraultlEbasisli,rtlEallegcdcxenrptiotr. AnyviolaliulofSectionT03l.5byaily <br />npplicrnlforafEflnitsubjcclsthe rpplicatrttorcirillrnxltvoInottruelhatrfivchundreddollars($5(X)). <br />_1. as owncr o,'llr prol{-nv. or my crnf loFcs wilh waScs as thcir elc cornpcnsalion. will do lhc wok and the slM@ is mt <br />intandcil or offcrcd for ulc (S(.7(X4. Busircss and Prcfcssions Cole: Thc Conlractor's Liccnrc llw docs nol apply to tui owlcr of <br />thc pmFEdy wlx) trrilds or inproves lherdn! ntd wlx) d(Es such work hinrself or lrrself or through his or her own enDloyees, <br />providcd that such irnpr(rwrEnls ilc ftn intcnlcd or olTcr!'d lbr sh. ll. hwcvcr. 0E buikling or irirprovcrrcnt is skl wi$in one yce <br />ofconplctiln, rlrc OwrEr Buildcr will luve the burdcn ofpnivinS lhd lE or shc did nd buill or inrpruve rlE pmpdy for llE purposc of <br />ele). <br />_1. as owDer ofthe lrr)pcrly, ilnr cxchsi\ cly colrilcli[8 with liccr)sed conlrack)rs lo conslrucl lhc pNject (Sec. 704,1. Busirress <br />aud ttull'ssirr Code: 'l [e Corilrrck)r's l-iceilse l,rw does not aplly kr ail owner of l)rofany who builds or inrproves thcreon. <br />and who coillracts li,r \uch pr,iccls with | (l)ntracktr(s) liccnscd pur\uant r) thc C(,nlractor's Liccnsc L1w). <br />-Idrlcxen)l)tuildclSectirrn-'B,&P.C,tiltIlisreason' <br />IVoRKI.;RS' CONI PI]NSA'I'ION <br />DECLAR,\TION <br />I hqchy allirilr un(lcr Irc[alty (,1 Nriury onc 0l thc li'llowi[g (lcchrati(nrs: <br />_lhavearxlwill nDifitainaCenillcateofC(rNentbSelflnsurefirrwrrkers'con4rcnsation.rs pruvidcdforbySectionST00ofthc <br />lntx)r Codc, for lhc pcrfonruncc o[ thc trork l'('r qhich llE frcroril is issuc(|. <br />_lhaveundwilltrHirilrinworkers c([rpetrsaliotritrsurre.as requiredhySecliur]T00oflheLahorCode,fortheperfornu,rceof <br />thc uork frrr wlrich this Frnrit is irsut'd. My uorkcrs' conrFnsatir)n insururce cmicr arrl yrlicy runrhcr u'c: <br />Policy Nunlh€r: llxpircs: <br />_lcc(ilylhatiDthcFrli)ilDaNcolthcwrrrktirw[ichthrspcrnritisissucd, Ishall notcn4rloyanyprsonitanynranncr <br />so ds lo bccorrc suh.icct !) lhc workr'rs'cornpcnsrtion luws ofCalifornia, and agrcc that iI I should hccorE sub.icct to lhc <br />workers' conrlrcnsation prrvrsions of Section .1700 of the Latrcr Crxlc, I slrall, fonhwith corlply with tlo* provisiuls.. <br />IYARNING: Failurc k) secure workers'conrpensrtion covcrage is unlilwful. rnd shall subject dn cmployer to criminal pcnaltics tnd <br />civil fims up trr one lrumlred lhousand dollars ($100.000). in adrlitiur tr the cost ol compensation, danrages as providcd for rhc <br />Scction 3076 of thc LllNr C(xlc. inlcrcst and albrNv's lccs. <br />LICENSED CONTRACTOR <br />I)HCI,ARAl'ION <br />I hereby ilflifln undcr t)cnnlly of pc{ury thnl I anr licensetl under pr<)visior of Chnpter 9 (cornrEncin8 with Sectiotr 7000) of Di\ ision l <br />of rhe llusiness and l'roltssions ('odc. rnd 'ilv license is h full tl)rce rnd c,fecr <br />l-iccnsc Numberi <br />Cohtmctor' <br />CONSTNUCTION LENDING AGENCY <br />I hcreby al'llrm undar l{nall}, ol pcrjury that thcrc is n construclion lcnding agency for thc pcrlbflnAnce ofthe work lor which this [rcrrnit is <br />issuerl (Scc. 3097. Civ. C.). <br />lrtrdcr's Address: <br />APPI,ICANT DECI,AIIA'IION <br />I luehy trflimr under ltnnlty of lEr.iury onc of thc lirlk,wing decluali(,nsl <br />Dcnnlition Pcrmils-Asbcst)s Notificati()n lrcrlcral Rcgulations (Titlc 40, Pal6) <br />_Rcquilcd lrllcr of Nolilicali(,n <br />_l ccdily that thc lcdcrnl rcgulntit)ns rcttullinS a\tEslos rcrm)val a( not applicablc lo lhis projcct. <br />ordinanccs nnd Stalc liws rchling n) buildinS construction. iud hcrcby authorizc rc[r'scntalivcs of this City and C]ounty to cntcr uF)n tlr <br />aborc rEntioned pF)pcfly lor inspecli(n purF)*'s. <br />Applicilnt rI ABml <br />l'crnrilcc trnnrc <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rough) <br />lrleter Release <br />Rouqh n <br />Servicetvleter 2,/l</Z -.a'11H 7-7) <br />FINAL /2//ts/z ? -i\ryn <br />Notes, Remarks, Elc. //- /(/ <br />lrndcr'. 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