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APPBOVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARAIION
<br />I hcrcby lmrm unds pcnrlry of p.rjury rlur I !h cxdrpr fnn rh. Conradon Liccns. Low ior lh. l'ollowinS m$n (Scc ?03 1.5
<br />ausincis ,id Pr.r.*ion Cod.) Any Ciry or Counry *hi.h rqriEs a Frmn lo con(ruc1. allcr. inlltrovc. .hmlish nr En3t ony
<br />srrucruc, Eiorro irs issuoncc, lho rcluircs rhc oppticanr lor such pcrmir ro filc a riE*d shretum rh,t rE.i dr ii li.cn*d pursuanl
<br />to lhc pr,vst,ns oa tlE contlclors Liccnrcd Law (chapr.r 9, conDc'trins wirh Seclion ?OOO of Divhion :l ofrhc Bu.inccl aiJ
<br />Profcssnns Codc) or lhrr hc or shc iscicmpl lhcrcfrclnond lh.bssis forrhcallcscdcxcmpri,n Anyvn,hri.nofSe'hn7031.5$yrtry
<br />,mli.nnr ror d ,.rmir subjdrs lhc {tlic,nr ro a civil F.dxy or n.r
<br />'mrd
<br />lh,n fivu huMrcd dollds {S500).
<br />-1.
<br />0s oqrcr ol lhc nmleny. oi m, cmplorccs with wo8cs $ thcn $t c.nDenslrion. will do rhc wort ,Jrl rh. sMurc i5 tur
<br />inrcndcd or ootred for uL {Sm 7044, Bulikss ud Poi€s\hns Codc Trr A,nra.ktr s Li.cnsc bw dms mr arfly to an owncr ol
<br />rhcnolEny ph t{ilds or iqnorcs rhcNn- a $hodessu.hq)i(hinF.llorhc.sclforrhrcuAhhirorhcro8..mployccs.
<br />[.vid.d rh sxch iflpmvc'Enh m mr inrcnd.ld n otlcBl for s.L. Il h.wercr. lh. tuihing or irynrnEil h sld wiihin on. ,td
<br />ot con{,lerhn. rhc Ovncr Btildcr will hlr rlE hrd€o ol rovins rhll h. or ste dil Nr boild o, inpow rh. tm,triy lor tlh purl[$ ol
<br />_l- as o*ner ol rhc pmlreny. r'n c{.lusilely conkrr ins sirh liccn\cd conrkds t, ..hntucr rh. pfoj(r (SN 7tH4, 8u!irc\s
<br />,nd P.ofs\b.Codc:Th.Cunt(ktr\Li.cnscLawdocsnorapplykJrnow.cr.lpropcrlyrvhobuild\ornnpmvcsrhcrco.
<br />.nJ eho cotrhd s ror such lojlds $ilh r Conracto(s ) lienscl puru0nr ro rh. Conrrrcrois l.i.ene ks )
<br />-l
<br />amcxcmpt un&r Scdion-. A &PC hrlhis,clwn
<br />l)ulr Orn.r
<br />lllarE&:ialuf,NsarlQN
<br />Dt ct -8 !ll)N
<br />I hrchr_ rfttn tn cr |*nrlry offtrrlury o c ofrhc follo{nrr dccl rJri(rr:
<br />I hrv. dd willraintrirdCc ,fi.rrcolC.nsc r' scll lnrur. fir wolkcF omptnsrn'n. as poviird tb' by sftrnn .lTu) of tlt
<br />ljhor C.de. tor rhc Frrormkc of rhc *or* rd which rhc pcrnir i\ i\\xcd
<br />Ihavc.lld willmai, ai,r workcrt comncns io iNur.,r.. is rcquned ny 56l io. 17OO oi rhc bhor (1 c.t rrhcptrrornhf,cor
<br />thc Bolk t'rwtri.h'his p.irnn is tsu.d Mymrkcs comp.trsdiotr insuriNc c.dcr ond policy numhcr uc:
<br />I.ctrilyrhal inrh.l,crfornun c ofrhcuork for ehi.hrhir p. ni is i$ucd.l drllnot cDrloyony p.non intrny mMi.r
<br />s, Nro lEcom $hFr ro thc wortc6 omncnsdk,n hss oaCalifirnir, od rgd rhd ifl sh.uld b..o.B subrct lolhc
<br />wnrkcs corrl'cn$tion provhnlns ol Sccrion]T0O.lrhc Lahn Gdc.l shlll. rodhwnh.. rfly wi'h tho$ 0relisions.
<br />cilil finc\ up t' onc hu rud rhorsrnd dolt ^ (Sl(X).o(n|irion ro rhc c.( of con{Ensarion. darogcs {r pmvidcd for rhr
<br />S(.li(nr 1076 of rfu LrhrC(dr. ir (r.{ rtrrl I
<br />€- 7azot u
<br />DECI,ASAIIO!
<br />I tuEby rlfirm undcr pcnalty of pc,jlrr rhs! I an liensd ondcr pm$krn ofCh,prd 9 (conmn hB *iltSslion 7000)ofDieision:l
<br />ol rn axsiftsr dnd Pmfcssions Codc, ord my liccnsc is in tull forc and cflal
<br />1.1o -Zo t B
<br />CONIIBI]CIT]NIINIIINCACENCI
<br />I hcrcby 0rtrn undcr Fnalty of pcrjrtry lhol rhcE h 0 coNlru.rbn lcndinB !s.rc, fo. rhc Frfomte of rhc sork for whth lhis Fr rt is
<br />k!u.d (scc 109?, civ c.)
<br />AITLTAXLDECI.d.BAIIAN
<br />I rrr$y drm undcr t nllry ol tcrjury ore ol rhc folbNi.l d€larar bns
<br />D. mlirion Pcrn rsAsh.sos Norifi.0rion Fcdcr.l RcBul.rions (Tirlc 40. Plna,
<br />Rcquirctl l-cocrol Norill.nri)
<br />-l
<br />ccnifythd rhc icdcral ESulorio$ reBMling oshc(os rcmovrl rrc mr arpliclhlc ro rhir prejdr
<br />-l.cnilirhor
<br />I h{vc rc{d rhn atlltaiion and skrc Ihar thcabvc int dn,n h.ordl.l rlrerocomtlypilh,llCil,ond Counry
<br />orditrloccs md SrrE Laws rclarnr ro bundo! cdNrucrioLlnd hcrcby llrhorir rqtr.scnrarivcs ofthh Cityrnd Counrylo cnr6 upotr lhc
<br />abo\c mnri^md rmp.ny rn, !n.;"d,q61,ih".". nr( \,/ \/
<br />Appricor.rAscnrskmtrn: t *...-:* ^.,5:lO-2!!Z
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monumenl)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduil)
<br />Walls (Rough)
<br />Ceilinos (Hard & Solfit Rouqh
<br />Ceilin gs (T-Bar Rough)
<br />lt/leter Release
<br />Rough
<br />Service I\/eter
<br />FINAL 6-7-/g -l)e {vlb(rr)
<br />Notes, Remarks, Etc
<br />ELECTRICAL-INSPECTOR RECORD
<br />Communications Cable
<br />Air Conditioners Policy Nlnbcr:-ExpiEs:
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<br />I
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