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APPROVALS DATE ID/SIG.COMMENTS OMr-Buildd D..larrim
<br />I hcr.by ailim undcr p.nqlt, ot pdjury thrt I 6 €xmpr fom tfi. C,nrr&iou Licdr. Law aor rh. followin8 Bon G€ 7o3 l 5 B6in€s
<br />and Prcfdsin Cod.) Ahy Cily or Cout, which
<br />'!quir6 ! pcmit to cdmc( ah6, improv., &molbh or rcpat d, sficruq rior io iE
<br />issudcc, dlso rcquiE thc lpplicul ftr su.h p.ftn to filc a sign.dslat.hat fiat hc Msh. ir li*nrcd p!6ud ro rh. proyisiN of rh.
<br />Conradors Ltas.d tle (Chapto 9, CMhddns with S6tim ?000 ofDivisio.l oatn. B6ines &d Prcf4ions Cod.) o, Oal hc o
<br />sh. is clmfl lhacfroh dd {'. ban fG lh. all.8.d d.mprio Any violation of Sccli@ 703I 5 by y atplicdl for. Fmn subjeE fi.
<br />appli@l lo acivilp€nalty ofnot mor. thM fiv. huhdEd doll6 (ltoo)
<br />_l, d omd oa fi. prcp.r9. or my mployB *irt was6 s rh.n sol. cmp.nrlrio., will &' dc york &d thc srru€ne i! nor irbd.d
<br />o. olIfrd f* salc ( Se.r0/4 BNins sd Prof6i@ Co<L, Thc Contuior's Licd. Lle .lG nd rpply & & oqq ol rtc popcny
<br />who buil& or imFovB .h.ltfr, ed who dc such wo* himclf or h6clf G ifirough his m hn sn @ploys. providcd lh4 such
<br />impmvmai. e nor i.hdcd or ofcrcd for s6lc. It howcv.r, 6c buildinS d imprcvao! i3 !o!d vi$io oc y@ of cohpl.riol rhc
<br />Omd-Buildd *ill havc thc burd., of provirg $.r h. o sh. .or build or imprcvc for thc purps. of$l.)
<br />_1, s ownd of$. p,op.dy, ffi dclBiv.ly .ontsactirs with licdsd.Mr.doE to c@rtr&t O. p@jccl ( S.c 704a, BBin.$ ud
<br />ProfNis Cod. ,lc Cmtr&tor's Li6s. k* dc not a?ply lo o oMd of proFry sho builds d ioproyB thaw , ud who
<br />cdr{cE lor such projdr wilh a Cont&ro(, li@sd pu6u&t ro lhc Contrerors Licdsc L.w )
<br />_l m.xcmpt uhd.r S.cton _,B & P C for rhis r.6on
<br />WORI(XIS COMPf,ITSATION DECLARATION
<br />I h.rcby .mm unda paalty olpojury o.. olttc lollowinE dmlmd@
<br />_l havc od will h.inlain , Ccnific{t oaconsdt to Scltlnsurc for pork€E'conpcm*is,6 provid.d fq by Sccton 37oo ofrh.
<br />Labor Cod.. ,tr ih. pdao1@cc of $c *ort for which th. Fmn is ku.d
<br />I hrvc od *rll n.int inwdk6 composdion isumcq 6 Equircd by Selron l?00 of thc Labor Cod., f.r rh. pqfftue of t.{ort ao! ohich lhis ptun is issu.d My wortm compdsation i6u. .c cmid &d policy nlmbcr u.
<br />PolicyNufrbr Expn6:
<br />(Iris s.c_lion nccd nol b. @mplded if rh. p6mn ir aor Onc hundrcd dolls It I o0l or 16,
<br />;fy urd in rh. psromea ord? *o,k
<br />tirm. subjc o th. wnk.u conrcnsro I
<br />aor which lnis p.mn L issu.d,I shall
<br />aws of Califomir, dd aerc. that ia l
<br />comp€n$tid provisions oaS& o.l ofilc L.Ibr Cod., I sh.ll, fonhwirh
<br />L-
<br />WARNING Failurc ro !.cur. wo crs comp€nsion cov.ragc is
<br />fin6 up to on. tuodrcd dioBed dolld (l I Oo,Om).in .ddidon lo l]lc 6t of @6p.ro.1
<br />thc Lahor Cod., inrffi drtrm?sac
<br />dmag6 a provid.d ior thc S.ctioh 10?6 oi
<br />I hdcby afiim uda !.nalry of Fjury lhal I d licascd lnddprcvisio of Ch.p6 9
<br />dr. aurin.ss ed Prcl6sions Codc, Md my lic.nsc is i. lull lorcc ed.ff.ct
<br />I h@b, rflim 6d6 p.nalty of Fjury rhar rh4 s t 6sru.tin l6di,8 !g@cy aq ln. pdfolfuc of lh. *ct fq whach Ihit p.mir i!
<br />i$u.d (Sc. 1097, Civ C.).
<br />ATETCANIIDEQAAAUAN
<br />Dmolition PcmiB-Asb6l6 No{ificaiio F.d.ral R.Buldonr (Tnlc 40, Pan 6)
<br />_ n.quiEd Ldtd ofNodncrio
<br />I nily'that dr tcddal rc.uhtions r.rarrt.r Bb-tG-,/'J calt 0rr I hav. rcrd rhi! .pplic.lo ed $r,r. rhar locomply wnh.ll City trd Counry
<br />odinac6 dd Star. Laws r.larinS lo buildine
<br />rbov. m.nrion.d prcr.ny for inspetion purposq
<br />City ad Couniy to .nta upoi rhc
<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 />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rou gh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />EXPI RED
<br />Rough
<br />Service Meter FLB I IUIJ
<br />sAftrc 8-43. :lg0 556 66
<br />Notes, Remarks, Etc
<br />ELECTRICAL.I NSPECTOR RECORD
<br />FINAL
<br />D.rc OM6
<br />Landq ! Ad&6!
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