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APPROVALS DATE ID/SIG.COMMENTS O\'/NER BUII-DER DEt'ARAAION <br />I hecby amm undd pftalry ol pdjury tha I @ .rcmpl nom the CodracloE Licsc L.w lorfic lollowiog een (St7031.5 <br />B8ir6 and ProfBion Cod.) Any Cny or Coudy which rcqutB a p6nn |o connucr. allq, improv., &molish ot raon ei <br />srdclurc, pnor lo iis isuuc.. also ,.qut6 0E appli.d lor soct pasil lo lilc . sisn.d stalmcnt Iha! hc or srE B licmcd pmu&l <br />ro Ihc provisioB ollhe Cortrcrofs Licm.d Lw (ClEptr 9. Co'm€lcins vilh Selion 7000 oaDivirion ] oflh. BBi.N ad <br />Polcsions Cod.) or rhar he or sh. is d.,npl ih@6om d rhe b6is for rne au.red q@Oio.. Any violotion ofs6tion 701 L5 by any <br />applicanr lor a pmnit subtatsrhc applic. loacivil,@lryof .ol morclhm 6v€ hurL€d dollds {S500). <br />1.6 owns ofrhcprcFny, orny mploy.6 snh was6 s rhcn st cotrrp€Nalion. vill do !h. uo.t dd $e $n{l@ 6 @r <br />i.rlod€d orolIold aor ra]c (Se.7o44. Bcins dd ProlsioB Cod.: Tfi€ Conlractois Lic@ t w &6 nor .ppl, to m oMd of <br />lhc prerdy vho build. or improE lhson. atj vlB d(6 such @* hnns.laor hmlt or rhrcu3h his or hd oM cmploy.6. <br />prcvid.d tbar $ch imProlarcr s N nor i on d or o,fq.d tu, ek. lf. novds. dE hriui.s or inpro\mr is $ld $idin on. t€r <br />olcompl.rio( lh. O*i6 Buldo wiU bav. 0E bu.d6 olrroving lhd lE or slE did ml huild or iop.ovc lnc proFty for th. p{rpos ol <br />I, s own6 oithc pop€ny. an €xclusively conlracl ins wilh licdc{ co.tadoB io cotr(tud lh. pmj€ct (Sa. 7044, BsD6 <br />ad fillBsion Cod.: Thc Conlradoas Lic€nsc rr* do6 not dpply lo e owns of propdly who builds or inproy6 th6@n, <br />and vho ofltEcls for such prcj€c1s pilfi a Co. Dclo(s) Iictus! F @l ro rh. conu?crols Lic€G LapI <br />I mcrmd udE Sauon . B & P C for rhis r@o <br />Drt.: Omer: <br />tlotrE8gcaMrlNlallaN <br />DECIASAIIQN <br />I n6.by a,Im unda p.n Iy or psjury o.. orrh. rollo*ina ddlMlioB: <br />I hav€ ud pill mainrain a Ccnifical. olconsd to Sdfisu.. aor roikgs com!.6alion, a previdcd lo. by Sdion 1700 ol $c <br />4;;for lnc psfom ce offie $'o . ior which lhc pdnn is isu.d. <br />willm6i .in wort6 comFNarioD iBuranc.. s rcqunld IA Sdion 1700 of rh. kbor Cod.. fot th. pdfomec€ ol <br />peflnit ir isu€d. My wort6 ronlpqstion insuracc ceir and policy.umb6 6c:.Afile.i Lr'l t t\4ut^ a.!1L ? <br />LU 3 "btf lo"t-<O <br />I cdil) Ihar io rhc p.rfomancc of th. wort fo, stich rhis pcmir is iisucd.l sn ll f,ot mploy uy pmn in 6y non6 <br />F 6 lo t .om. srbj.l lo rh. work6' cohpesion bws of Calitomia. ad asrd lhal il I should b..om. $bjd ro rht <br />mrt6' co,npmalioo pmvisions of Scction 1700 oflhc L.bor Cod€, I shau. ionhwirh comply wnh lhos. prcvnions . <br />$ARNINC Foilurc to su. workcE coDpcnsalion covsa!€ i! unlawful, dd s[o]l subjat e Gnploye! to riDinal poahi6 dd <br />civil li..s !p ro on huddr.n thoMd dolls ($100,000), in io. ro $. c6{ oa conp.sarion, damr6 6 provid€d tor lh. <br />satio.1076 olrh.bborCode ims6t and allorEy s 16 <br />-3 t-70 x <br />DI:( I,\R\IIoN <br />I hmby amm undd p€.rny ol psjury rhal I d licosd undr Drovsion of Chaptq 9 (ommocing with S..lion 7000) oI Division l <br />or lh. BNs6 sd PofsnB Cod., ud my lrcm. E h tull forc. ard .afd <br />,"*..*,'c4b///D ,*.*.q7 zaL/{' <br />o," ' /->l-ZD .-,-"-F <br />( oNst'RUcuoN t,ENDtN(; ACItNCY <br />I nd.by ailifln nnds p€nihy ol pdjury that Ih@ is a on$tudion L.din8 ,edcy lor thc pqfomucc oflhc wort lor *hich this Fnn is <br />iss!.d (Se 1097, Civ. c.) <br />Gnd6 s NaDc: <br />- <br />AETI.ICANLOECIABAIIA! <br />I natt, allm uidd paaliy oi psjury on. of lh. lollowins d..l&riotu: <br />Dcoolnion Pmns-Arbelos Notill..tio. Fcddal R.8ul.lioN (Tnk 40. tsl6) <br />R.quircd L.ttd of Notifi€ation <br />ns sbck's rmoval ec nor rpplicabl€ ro this prcj.cl. <br />. rhar rh€ abo( idfomdion is.orel.I rgre to comply wilh .ll Ciry and County <br />drd hcrcby aulhorn. rcArdonalivd of this Cny ud Counly lo cnlE upon dE <br />abvc nsrioned pop.ny for imperion <br />Applicinl or g.nt Signrlure: <br />b( <br />V <br />C'12-',,'? <br />' I -3/ -zr- <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 / Groundinq / UFER 2-lo-zt *l Lo> <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 Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release 2 - lp'?,D€\r 1o) <br />Rouqh 1?--lo -?)t2-4 to) <br />Service Meter 2-b-?.o g,--<tDt <br />FINAL Lne-1t <br />Notes, Remarks, Etc. <br />-+ <br />ELECTRICAL.INSPECTOR RECORD <br />Rev.08-07-2015