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\ <br />CAL-INSPECTOR RECORD (r|D <br />APPROVALS DATE ID/SIG.COMMENTS Omcr-Buildcr Dch.rion <br />I hcrcby rffirm undcr pcuhy of psjury thrt I m cxcmpr fom thc Controcloro' Lien* Llw for rhc following rcen (s 701I 5 Busincss <br />ud I'rofcssion Codc): Any Cily or Couily which rcquircs r pcmia to @nstruct, rhcr, improvq dcmlirh or r.prir uy structuc, prior to its <br />irsurre, rlrc rcquircs thc ippliqtlt for $ch pamit to 6lc a signcd strrcmcna dut hc or lhc ir licctr$d pursuet to thc provisiom of fic <br />Contractor's Licensed Law (Chapter 9,with Section 7000 of Division 3 of the Business and Professions Code) or that he or <br />exemption .Any violation of Section 7031 5 by any applicant for a permit subjects rhe <br />rpplicrnt b s civil pcnrlty ofnot morc thm fivc hundrcd dollm ($500) <br />---1, ro omq of thc prcpqty, o. my smploye with wrgcr rs rhcir rclc ompcnsrtion, will do thc work rnd rhc ctruquc is mt intcadcd <br />or ofcrcd for slc ( Sc.7044, Busimr md Prcfcrrionr Codc Thc Cotrrtcttr'r Liene Llw dG nor rpply ro D omcr of rhc prcpcny <br />who builds or improve Ocmq md who der rch work himrclf or harclf u tluough his or hcr our cmploya, providcd thsr such <br />improvcmcnts arc rct inrcndcd or offcrcd for de. If, howcve, thc building or improvcmcnt is sold within onc yc{ ofcomplction, thc <br />Owrer-Buildcr will havc thc burdcn ofproving that hc or shc trot build or improvc for thc purpor ofnlc). <br />-1, <br />s omq of th€ propqty, rm qclusivcly onraaing with lienscd ontrrctors rc oorna rhe projet ( Sff ?04.1, Busincss md <br />Pofcsion Codc: Thc Contncbr'r Li@o$ Irw dG not spply to m omcr of propoty who builds o improve theron , md who <br />ontrrcts for uch prcjetr with E Contrrdq(3) liccnsad pur$rnt to thc Conrrclor'r Licens l-rw.). <br />_l arn excmpt under Scction .8. & P.C. for <br />o",. l{-[4- t j o*no <br />I herr:by affirm under penalty of perjury one declarations. <br />--l hrvc ud will mrintrin r Cstifiotc of Corenr to Sclf-lnuc for rcrtss' mmpcNtior\ !s providcd for by Sarion 3700 of thc <br />Lebor Codc, for fic pcrfomane of rhc wotk for which thc psmit ir i$ucd <br />-lhaveodwillmaintsinworkcm'ompcnsationinsurancc,ar <br />rcquircdbyScctionST00ofrhcLlborCodc,forrhcpcrfomaneoflhe <br />work for which this pcmit is isucd. My worhas' compcnution inrurue cenio rnd policy number ue <br />('arrir:r <br />Policy Numbcr: Expirca: <br />(This scction nr oi bss) <br />_-- I ccrtifu that in the pcrformancc of the work for which this permit is issued, I shall not employ any person in any manner so as to <br />becantc subject to the workers ' compensation laws of California, and agrce that if I should bccome subjecr to the workcrs' <br />;:jj jT e'rT i <br />- <br />i,'ri'-,i W with those provisions <br />WARNING: Failurc o surc workcru' @mpcnlation covcragc is unhwful, md rhrll nbjar m cmploycr to eiminal pcuhics ad civil <br />6ncs up to onc huodrcd thourud dollm (S100,000),io sddition 10 $c @sr of @mpcnsliot\ drmgct I provid€d for fic Sdion 30?6 of <br />thc kbor Codc, intcrEt ud rttmy's fB. <br />I.ICENSED CONTRACTORS DECl.ARATION <br />I hcrcby afrirm unda pcmlty of pcrjury that I m liccnrcd undcr prcvirion of Chrprs 9 (@mcncing wifi S6rion 700o) of Divirion 3 of <br />thc Bulircss and Profcssionr Codg rnd my liccuc it in full force md cffer. <br />License Class: <br />Date: <br />License Number <br />Contractor: -- <br />CONSTRTICTION I,ENDING AGENCY <br />I hcrdy affim unda pcmlty of pcrjury $.a thqc i3 r onstructiotr lcnding rgcncy for thc perfomrncc of thc wok for which this prcrmil is <br />issuad (Ss. 3097, Civ. C.). <br />Lcndcr'r Nrmc: <br />Lender's Address: <br />A PPI,ICA NT'S DECI,A RATION <br />Demorition Permits-Asbestos Notification Federal Regulations (Title 40, Part 6) <br />_* - Required Letter of Notification <br />__l csdry thrt th€ fcdcrrl rcguhtionr rcgsding rsbcsror rcmovrl rc not applioblc to this projet <br />- <br />I @niry thar I hrvc red thir rpplicrtion ud $8tc thlt thc sborc infom.lion is @rd. t lgre ro @mply *irh all Ciry rnd County <br />ordinances and State laws relating to building construction, and hcrcby authorize rcprescntatives of this City and County to enter upon the <br />above mcntioned property for <br />Applicant or agent sig l)atc ll- <br />IPermittee name (print):iuKl <br />tu t7 <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 I Grounding / UFER <br />Transformers <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 EYEIII lEn <br />-, <br />ll I rID I' <br />Rough nFntt 20?t <br />Service Meter -J ,-1 -.FINAL )ruyl\., O-+O, Zt u, 556, 667 --lfg)t\e{rrf4o ) <br />Notes, Remarks, Etc.wv V <br />Torquing