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APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Light Standards <br />Spas, Pool, Fountains <br />Si gns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding i Groundinq i UFER <br />Translormers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rouqh) <br />Rough <br />Service l\rleter \ <br />FINAL il') -tE Ole z 1 <br />Remarks, Etc.\_-/ <br />OWNER BUILDER DELCARATION <br />I hcrchy afln undn ,.n,ky or p.rjury rhrl I .n cre Ul fmm thc Cont,octoN Liccnsc Lrw lor rhc followi.S e0en ( Se ?011.5 <br />Dusinc$ afrl Prolcssiotr Cod.)r Any Cily .r C.lnry *hich rcqutcs 0 Frnrit lo conslruct. alter. nnrrovc. dcmhh or rc|En 0ny <br />(tuclurc- !ftr lo ns nsuatrc. oho rcqutcs rhc amlicanl tor ruch pcrnri h nb I sigtud noreBnr rhot tE or shc h liccn*d pur\uflnl <br />lo lhc rrovhion! or dE Contacroas Liccnrd Ir* (Chryrcr 9. Comnrcmins trirh Sc.rion ?(xx) ol Divnion I of Ihc Busin.$ a6d <br />Prcfcstrns Codc) or rher hcorshc ncxcmrt rhc.crrom rd rhc l,nsis ror rhc lllcled crcmprion. Any vidhrion of S&rion '70:l I 5 by flny <br />ap,'licrnr ror. n r.'ir subrccr rhc atpli.ant r. !ciri,pcnrxrornor mEthin,ivc hundEddollm ($5m). <br />_1. .s owncr ol lhc lxoFny. or my cmflotes wir h $as$ as rhcn st conrpcnsrt,n, will do rhc sort ad ltE shrd@ f nur <br />nncrd.d or ondeJ ir sb (Sa.7044. Aurire$ ond Profcssions cod.: Thc Lronrd.ror'r Licdns bw do$ nor ,rpry ro 0. ownd or <br />rhc pmpcny wln huilds or inlmEs rhcEnn. nnd eh. dds sh h* himrelfor hcr{rfor rhoush hh or h.r owncmplorccs. <br />[ovidcd rhor such i'nptuvcmnh m ft, inrc dst or onbrcn ior {lc I( horrrs. rhc huilding or impmrrBnr h $ll yirhin onc ,rd <br />or..mphrk n, rh. Osn* Blildcr will hle rhc hui{lcn of tmving rhd tE or sh. dt nor huikl or in!.,ovc rh. Imtriy ritr rhc Nqh{ or <br />l.,soumiorrhcIro'tny.!mcxclu\ivclyconrracrin8wirhliccnscdcontmcrnsroconnru lhc pmlcd lscc. ?041. ausncs <br />rnd thrtssinr Codc ThcConlmctofsLi.c.scLrwdocsnorapplyrorio*icrofprof.nywhohuildso!tnprorGrhcrcotr. <br />ond who .ontrB rd su.h pmr.rh wirh a Co Eck,n n li.cncd l,urulnr to rh. Co ncrols Liccnsc tjw) <br />-l <br />amcxcmlr ltrder Sccti. <br />u0atr[&ur1]MfENrall0x <br />,l[cldaAlroN <br />I hclcby rfinfl utuld Ic. lrtorl.rjrryoic orrhc roln,sitrs dechrarior\ <br />I hrvc md will tun trin i Ccn ificarc or Cnrsnr h Scll lnsurc lor {ortcB comFnsarion. as DovidcJ lor by Sccrion l?0O ol lhc <br />tihoi codc. r.r rh. Fforroncc or ih. work fo. * hich rhc pc.nnl b iisucd. <br />Ihrrciffl{illnmi rir sorkcrf .onrFtrsfiM nsur! .c. \rlltoncd[rSccrion]7(X)olrhclrtxrrC.dc.ftrhcpqfodrnccol <br />rhc torl lor*hich lhisFrnrir ir isrucd. M,w.rkcrL.o rll.nsttion i'rsurncc cnricrn'ldF,licy trtrn1bcr rc: <br />rper: _ <br />I ccdify rtut in rhc Frftrm8rcc olrhc work lbr whic[ rhi Nirnir is nnrd. I (h!ll noi cmtlo] nny ncron in.try nmnmr <br />{i s b bccoflr sbicct !) rh( trlrkcn cl,npcisrrim laws olCali{omia. and agruc rhar ifl lhould tEoN sthJ.d h rh. <br />{orkcrr conrF.s.tn,tr truviriotrs olSccrnJn lTllO ofrhc tjtxrr C{)dc.l shnll. fonhwirh comply virh rho* tR,risions <br />IVARNIN(; [rilu.c k, {cdr workcri <br />;:*t*{ai'fi't'** <br />hwtul- lnd shall sunrcct !n cmnlolrr h .nminil ,rulras and <br />ion ro rhc .od ol c.nrpcns6rn,n. danqcs us I,rolidcd r'or rhc <br />I l[rchy lfirnu !r ncnrlryoirclury thd I pnr'nionof Chtrfrrrqr..nnnrD(i',9 $ [Sccrn T(XX))ol Di\i.iin,:] <br />ol ltc llu(irc$ {nd PnnasnorsCodc. nid lyliccisc i\ i', full nn.d ud.lf.cr <br />mber 6$t\Q <br />q <br />I hcchyrtlir r!iJ.rp.mlrtof Ir'jrryrhrr <br />issuod iscc ll)!7 Civ C ) <br />.lhtr lc"din8 lscncy lorlhc pcraonuncc oirh. sork lnr trhi.hrhi{ rEnni n <br />APPLICANT DECLARATI(IN <br />I hd$, armud.r Fnalr, oapcryry otu ofrhc folL*in8 delralions: <br />Demlilion Pcrmits-Asb.(os Nodnc.lion F.d.ral Rcellitions lTnk 40. Pan6) <br />-Rcq!ft <br />d Lcllcr of Noliiiark'n <br />l,vrhxl rll r.,ld' ,.N ]ri on\ins ,\h(sror rcmvll m N lnplicrbE h tht rrciccr <br />rhl rhcrh'r. inlnnturn)n ncotrc(r I rgd k, rcnlrl]" *irh rll cirr" rid c.unrt <br />trNrucri(r. rftl hcrchy rtrrh.rh r.lr.* rnrivN ol r <br />.4id.4A 'Astt <br />*"?)i[,'d <br />ELECTRICAL-INSPECTOR RECORD <br />Pole Bases <br />Ivleter Release <br />Notes, <br />{