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APPROVALS DATE ID/SIG.COMMENTS O\INIiR BUILDCR DELCARATION <br />I hs.6, amrm u.dd pdaliy ofpdjury thal I m cxdpt from lhc Conlraclo6 l-ic@ L!* fo. rh. tollowinB rNn (sc.?011.5 <br />aui.6s ard P.oassion Cod.): Any Ciry or County {hich r.qun6 r Fnt lo consrucl, ak6. improve dcnoli.h or !€rgt &i <br />shcrsc prior to its isu cc. olso r.qun6 lh€ ryplrcer for such Fnil ro 6L a 3i8n.d satmat tnol h. or snc is licos.d pu6udn <br />b rn€ plavlsios oflh. Conrractor's Licen*d lrw lchalro 9. Commmcing wnh Sdion ?000 olDivision I oflhc Buircss dd <br />Prof*io.s Cod.) or rhd hc o. sh. i! .r.mpr rhftfrom ed rh. bsis lor the all.scd cxdFion. Any liolalio, ol Sdion 701 I 5 by e, <br />applicant lorarmn subjdBth. arplica ro a civil p.nrly o anor n$rc lne fiv. hund,cd doll6 ($500) <br />l. s oM6 olrhc Fop€r1y. or 6, coploy6 wth wag6 6 rh.ir $le comFsarion. will do lh. work and thc anud@ i nol <br />inradoj or olTded ror ele (56 7044, Busins md ProlNioc Code Th. Conlnclois Licsc Law .to6 no' apPly rc M oMr of <br />rh. FlDdy wno buildr or ilrpmv6 tfiqdr ud who do6 $ch sori hims.llor hmclaor thrcugh his or hd otrn mPloyc, <br />proliddl rhar such ihFoma e mt inlod.d or oltged for *le. lr, hoNdd, lh. ttildine or impmv.mol is sld wilhin onc y€t <br />ofcompl€rion. thc oxnd Buildq will have rhc budo oiprcvrg thd h. or she did nol brik or improvc th. plipdy tu, U. pulFs of <br />I, s ovns ol th. Fopdy, dn cxclusivcly conrraclins eilh licdLid .ontaoou ro co.ltld lhc pmj4l (Se. 7044, Dsins <br />srd ftDtosion Con.: Tfi. Contraclors Liccnsc L.w do6 rcl a0ply lo d owno of propqiy wno builds or improvB lhdo.. <br />and $,ho conhEls tor such Fjc.ls with a Co.rraclo(s) li.ds€d purstrt lo thc Contmclols LiccM Lrw) <br />-l <br />m .xdpr @dd Sctio, , B. & P.C. aor lhis ra$i <br />D.t: Onner <br />vaa[E8s:tall8Etsarx)N <br />DtictdBA]la! <br />I ha.by amrin ond.r Fnahy o f pdjury one o t lh€ folbwins d(l@lio8: <br />I hav. dd will mainlaio a C.rrificalc olconhr to Sclf'lBu. hr tro&6 cof,pasation, a pmvidcd tor by Strtion 1700 o I lhc <br />Lob.r code lor the Flomucc of lh. *ort aor di.n lh. pqnn is Bu.d. <br />\A ha!. a.d sill nainrair wortrs comp.Balio. irouran€., 6 rcquted by S*lion :]7OO oflh. bbor Codq for th. pE omsc. ol <br />:::'*H"#',"H^l?r- <br />conp.rearion insurmc. ceid Md p.licy numbd e.: <br />"^o"",*, 40747ll .-0,*, 2ll I 2_O <br />I ccrrily thal i, rhc p.rfomunc€ oflh€ sork lor shich lhis p.mil is su.d. I shall nol mploy any psson i. any nencr <br />s d to beohc subjftr ro rhc M,t6' cohp.c'rion lsws of Califomi.. md a8re lh.l if I should be.odc tlbjftl ro tlt <br />wo*6J.onpc.tio.provisioBofsclionlT00oalh€LaborCodc.lslull.lonhwithconplywirn$orptovisioN. <br />W RNINC: Failur€ lo wu. qolt6 conpqEalion covqEse ii nnla{lul. Md shau subjd d ploF lo oinioal IEEltis &d <br />civil fincs up ro on€ huodr.d rho6dd dou6 (t10o,000). in.ddnion lo th. cosl ol comrEelion, dn.sd d piovidal lor lh. <br />S(tion l07l orrhclilxtrCodc inrerN tud <br />Ds,e Zl tclLo <br />DEC]dAAIIA! <br />I h@by am.m undd pdaliy ot p.rjury rfid I m liccns.d und.r lrovision ol Chapt6 9 (.onmmcing eilh Sdion 700)) oi Divisiotr 3 <br />of rh. Busi.6 ed Potsio6 Cod., ed my lic€N t in fullrot ddcfrer. <br />b,Clo, CLo g7-G1rq <br />Its o **^*., D^,59a Ce rFaFtar:', <br />colirBuclloxLDNuNslc.ENrf <br />I h@by afm undd Fnally o f Fjury lhal thr. is a onsruclion kndins asdcy fot th. p6aol]jdc. of ln€ wort for *tich tht pann i <br />issucd (s6.3097, civ c.). <br />APPI,ICANT DECLATUTION <br />I hddy a6m uDd6 Fn.lty of pqjury onc of thc followins ddladioc: <br />Dcnolition Pmih-Arb€tos Notificarior F.d(al Rcgulalions ( lille 40, Pan6) <br />R.qut€d Lcrtq ol Nolifidlion <br />-l <br />.6liay thd lh. f.ddal r.glldions rcgsdinS sbdlos rmoval e nol appltablc !o lhis ploj.d. <br />!&c.niry lhal I have @d rhi appticarion ad sral. lhfl rhc rbo!. inaomalion ie coret. t aBre lo omply wilh all Cily dd Counl, <br />.rdinancB md shre hws rchrin! to buildin! c ( ad hs.by aurhor;. ftrresratile o f rhis Cny and County lo ols uDon lh. <br />.bov. morioned prcpcny for iND<rion <br />Applicr r or A8e.( si8nil(E <br />tv\W,^," tl lg lzo <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Itileter Release <br />Rough <br />Service Meter <br />FINAL 1 <br />"'7\'?.o <br />d)ffn 1.nE >'1 <br />Notes, Remarks, Etc rl <br />Rev.08-07-2015 <br />ELECTRICAL-INSPECTOR RECORD <br />I <br />L.ndq s Addr6s: <br />-