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DATE ID/S!G.COMMENTSAPPROVALS <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 Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service lt/eter <br />FINAL <br />Notes, Remarks, Etc. <br />Owncr-Builds Declaation <br />I h6cby affm unds penalty of pejury that I m cxmpt fom thc Contracbre' LiccNc Law for thc following reon (se.7031.5 BNin6s <br />md Profssion Codc): Ary City or Cowty which rcquirc a pmit to coNtruct, alt6, improve, dcmolish or rcpair ey structuc, prior to its <br />issuucc, also rc4uir6 rhc applicmt for such pmit to filc a sigtrcd statmmt that hc or slrc is licffid pm@t to thc provisiom of thc <br />CoDrrctor's Liccns.d Law (Chapt6 9, Com@citrg with Setion 7000 of Division 3 of thc Buiass md Profsiou Codc) o, thal hc or <br />she is cxcmpt[Eeftom ad $c basis for thc allegcd amptioa .Atry violatio! of Setioa 7031.5 by my applicut for a p@it subj€ts thc <br />applicayfa civil pemlty of not morc thu 6vc hudred dollm ($500). <br />l(* o* of th.prcpsty, or Ey cmployc with wag6 6 rhctr slc compcrctioq will do thc work ed thc slrucluc is not iilodcd <br />Kr offocd for sale ( Sa.7044, B6in6s @d Profcssiom Codc: Thc CorEetor's Liffi Law do6 not apply to a omc of thc prcpoty <br />who builds or improvc thqon, ad who doc such work himclf or hcclf or tkough his or h6 ow cmploye, provided that such <br />improvmcnts dc trot intcndcd or offacd for salc. If, howcvq, the buildhg or improvmcnt is sold withil onc yo of complaion, thc <br />Ownq-Buildq will havc thc budcn ofproving that he or shc lot build or improvc for thc purpo* ofsalc). <br />_1, 6 oM6 of thc prop6ty. m cxclusivcly conracting with liccEcd coouactoE to coshd rhc prcjet ( SG. 7044, Buins ed <br />Profsion Codc: Thc Conmdor's Lic@ Iiw do6 not apply to u omo of propay who buil& or improve thooa , ad who <br />conracs for such projdts with a Contncto(s) licocd pmumt to thc Contractor's Lic6c taw.). <br />Im uda Setion P.C. for this reon. <br />I hoeby affm undo pcnalty ofpcrjury one <br />_l bavc md will maintail a Cdilicatc of CoE@t to Sclf.Isuc for work6' compsation, s providcd for by Sction 3700 of thc <br />l:bor Codc, for the pafomocc of thc work for which thc pcmil is issucd. <br />_l havc ad will maintab worko' @DpcNtiod iDsuacc, r rcquircd by Section 3700 of thc tabor Codg for thc p6fo@c of thc <br />work for which this pqmit is isucd. My wod(s' compcmtioo iasuuc ceiq ud policy oubq uc: <br />Policy <br />need not bc complctcd if the pmit is for Onc hundrcd dollm {00) or los) <br />cdiry that in the pcrfomilcc of thc work for which this p6mit is issucd, I shall not oploy my pasoo in uy mmd so 6 to <br />subjet to thc workc ' ompcusatioa laws of Califomi4 ed agre that if I should b6omc subjct to thc workm' <br />provisions thc labor Code I foflhwth comply thosc prcvisiom. <br />6 <br />WARNTNG: Failuc to seuc work6' coEpsation unlawful. md shall m cmploya to oiminal pcBltiq ad civil <br />fE6 up to orc hudrcd thouud dollm ($100,000),in addition to thc cos of compmalion, dmag6 I lrovidcd for thc Setioo 3076 of <br />thc Labor Codc. irtsst ad anomcy's fe. <br />LICENSED CONTRACTORS DECLARATTON <br />I h6cby affm undq pcnalty of pojury that I m licc$cd udq prcvision of Chapra 9 (omctrcing with S@tiotr 7000) of Division 3 of <br />thc BwitrN ud Profssioro Codc, md my liccu is in full forcc md cffar. <br />Liccrc Liccnsc Numbq <br />Datct Cotrrdor: <br />[.ods's Ad&sl <br />CONSTRU('TION l,ENDING AGENCY <br />I h6cby affm und6 pcnalty of pgjury that thqc is a coNtruction loding agcncy for thc pofommcc of thc work for which this pmit is <br />issued (Se. 3097, Civ. C.). <br />Lcnds's Nme : <br />APPLICANT'S DECLARATION <br />Dmolition Pmits-Asbcstos Notificatiotr Fcd6l Rcgulations (Titlc 40, Part 6) <br />_ Rcquircd tatc of Notification <br />I eqil{that thc fctaal rcgulatioos rcgadiag 6b6tos rmoval dc not applicablc to this projdt. <br />,2( caity urat t navc rcad this applicatioo ud statc that thc abovc infomatioa is cortrl I agr@ to comply with all City ud Couty <br />'ordimcs md Sratc Laws rclathg to buildiog corotruction, ud hocby authorize rcpracntativcs of this City ed Couty to atq upoo the <br />abovc mcntioned inspetion <br />6 / )/za<rdApplimt or agat sig. <br />Pmiuerc(priil) <br />ELECTRICAL.I NSPECTOR RECORD <br />Word\wp5