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APPROVALS DATE ID/SIG.COMMENTS OWNER BUILI'ER DELCARATION
<br />I hcrchy fifln uMcr pcnohy ol rcrjury lhd I am excmpl fmm rtc Coor,rcior' l-iccn* taw lor rhc followioS rcason (Scc 7031.5
<br />tsusincs and Prcle$i.n Code): Ao, Ciry or Cox , which r.qrncs a p,ann lo connruc'. allcr. imrrovt, dcnmlish .r Nrair d.t
<br />{ru.!ua. Irior io irs issuamc. lko rcquncs lnc amlic.nl lor surfi [Ermit to iilc , sicftd rarcnrn h,i tr or shc t licensd plNonr
<br />k, rh. F.vision! 6f rh. C.ntr.rofs Li.c.sd tjN (Chafrcr 9. Commcmins *nh Sccrion 7(l(XJ 6f Division I ollhc Busirrc$ 8nd
<br />Profcssions Cod.) orlhd h. or shc h cxcmpl thercliom and thc bosh n, fie alkscd cr.nfrion AnyvioldionofSdionT0ll.5l,yan,
<br />,!mrfo hr rIlcrmiruhi(h rhc rrplicanr ro r.*'lr.ndl,yn' nur tr'crh.n livc hunJrcd dnllu. '5500'tJ
<br />,l&1, !\ unn$.lrhe !tunci), nr my cnrhlm! wirh qucs !r thcn sok compcisarnri. willdo itf work atrd lhc stnrlw k ml
<br />''nrcrtAl oron'rrrd ror elc(S( 7ur4. tsu$m$ rnd Eof6\ions Codt: Th. Conterols l-ians Lrr docs nor amly to owmrof
<br />rhc lr,Fny utx) huilds., irprovcs rlEntr. a.d wh. dfts such s* himscllor hcMlf or rhmuSh hii or h.r osocmployccs.
<br />,roridcd Ihor sucn impm!€rnrs rc nor inrcrdcd uofi.ffl ror ele Il hovcRr. th. t{ild ins or inphvctunr h k,ld wilhin onc y.a
<br />of 6,rflciii., rhe owmr Bnikl$ will h.{ tr bordctr of rovinB thd hc or she dil m! hiu ot inp6\t tlE pmlrnt tor lhc purlEs of
<br />,. * ovncr dr r pmFny. .,n cxclusilcly conra.rins wirh li.cn*d conka.tns r. en{ru.' rh. pmJct ( SLr 7l!.1. DBim$
<br />ofti Pn,tssion Codc: 'l hc Contrct, s t-i.cis.l-aw does nDr.tply ro dn otrncr.fFopcn, wn(, bnilds or inpovcs rhcrcotr.
<br />ond who .onrn ts lor such rmjecB wirh o Conrracto(n liccnscd nlrum brh.G,ntidoas LiceoscL,w)
<br />I ib la q,
<br />I hc(hj rnirn, utrd.r I)cnllryofltijLiyonu ofrhc nnL^ving d
<br />-l
<br />h.vc ud wjll'ni ,ir aCcdincarcotcooscnr lo Scll lislrc tuworkcn con1P.n\ahon. as providcd torbySccrion.lT0oorlhc
<br />Labd cod.. ror rhc p.rrormrcc ol thc vo for which the pcrnil is nsucd
<br />I hrvcrnd qilln[i air workcr\'conrpc'strrin i'rurrmc. rs rcquncd hysccrion]70Ootrhc l.!borCoJc, ntrrh. tEronnrn.c ot
<br />rhcworkr'orwhichrhnp.rmiri\i\\edMyw..Ncomt.urt insur,rc.cmti plicynulllt'c.rc
<br />4*d;-r",*
<br />*orkcrl .onDcnsari{nr poli\n,ns
<br />rof'hc wort for*hichriis p.rmir h hsncd
<br />'kd. snp.n$rion lowsorC.lifornii. and 13
<br />|.fsc.rion 1700 ofrhc tiln codc.I sholl.li
<br />I shallnrl cmpby lny lEi\on inrny'nmn.r
<br />rcc rhar ia l sh,old lE o r srbjr{( x' ltr
<br />)nhsnhco'ntly *irh rhos piovirhns
<br />WARNING: Fdilurc tu *.urc workcs' dDpcnsorion covcogc is unh*tu|, ind sldl suhiccl an cnrPlotet r. ninrinal Fnaki.s rnd
<br />.'!Ll lik\ r p k, !i. htrtr(
<br />Iid :ffi,'""
<br />rhc con olco pctrr0rion. damr8e\ a\ providcd f.i rh.
<br />H h,i
<br />\._)
<br />ftn.inE inh Sdion 7000 r or Divhion :1
<br />(,,
<br />I hcrchyrllirm n,lcrnctrrlrtol triln!rhrr Irnr li(trlcd u ,lcr
<br />AIPLICIINLIECIANAIIO!
<br />I Ny dam undcr penrhy ol pcrjlry one olrhc folldwinl JNlmli.trs:
<br />Dcmlilh. Pcrnrirs-Asb.(os N.lification Fcderal Rc8ularions (Tnb 40. Pan6)
<br />Rcqutcd Irncr or Norifrdion
<br />:cnily rhir th€ fcd$dl rcguLrions E8&1i4 ustrstos r.nFvalarc nor lprli.al,h b ihis rn
<br />Wrtilyihrl Iluvcrc.dlhisrpplic!ri{ni tsl{arci1 r
<br />'herk)vc
<br />i.tunr i({i is.orc.t.I{arcc
<br />.hylurhoriDrcFrcs arivcso
<br />rlbvc rcirioncd |r pcny 6r i
<br />,\ppliunl or AE.trl Si8onlure
<br />0t
<br />ro comdy wnh dll cilya.d Counly
<br />lrhis Cny a.d Coumy ro cn'cr upon
<br />'h.
<br />".,"
<br />,nlnlu
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/leter Release
<br />Rough
<br />Service Meter
<br />FINAL tt[l*tlrt,9D5lt
<br />Notes, Remarks, Etc
<br />ELECTRICAL.INSPECTOR RECORD
<br />Sub-Panels
<br />ol rhc ll$incs ind Pn,lcsion\ Codc. Drxl nryliccn\c i\ in fxllfu( d clTc.r
<br />I i.c \. ( h$ I (.tr\. Ntrtrrltr
<br />lr'rc
<br />(]ONSTRIJCTIoN I T'NDIN(; A(]ENCY
<br />I hcEty uflirnrundc! rEnalryofprrrry rhrr rh.ru is tr con{fl.rirtr hndirS rScncy lorlhc p€rronuN. or rhc work for which lhh rrmi n
<br />issucd (Scc.:1097,Civ. C ).
<br />I cnJcr',\ N,,n
<br />trnd.as Addrcr:
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