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DATE ID/SIG.COMMENTS Ownd-Buildd D.clraio
<br />Ihmbyalfimu Lrpd,alty of Fdury lhar I d.x.epr fom$. C@lrf,rm Li6,. kw for th. follo*inB r..s (*.7031.5 BGin6
<br />.rd Prcl6io Codc): Any Ct, 6 Coory shich EquiB r Fmn lo @struct, .lt r, imFov., d.molish o rcpair e, srtuctrc. Fior ro ili
<br />i$uuc., als ,cqun6 dE appli.sr for ruch Fmit 1o fi1. . rign.d sl5l.ru rh6l hc or sh. is licascd p@umt to $c lrovisiom of dE
<br />Cor,dtrt Licosd r,w (Chc/a 9, Commacing wilh S.crio 7000 of Divisi@ I ofth. BBiDs ed Prcf@ioB Cod.) d th h.d
<br />ih. is cxmF thd.ftom Dd rn. hsis fd $. Jl.g.d .xdprio Any violariM of Sdtion 701 I 5 !y d, arplicd fo . pann subjat ttc
<br />agpli@r |o a civil Fnal9 oa rd mm lna fiv. hudr.d .Llla (1500)
<br />I, 6 owncr of thc propdrr, or my mployG with waa6 E lh.ir sh cmp.nrdio., will do ttc work ud lt. s1ructE ir nor inhd.d
<br />or or6.d ar s.1. ( Se.?044, Buins ud Prcfdsios Codq Tn. Cor&lor'i Licdsc L.* doq nd .pply (o e Nna oi rhc prcF.ry
<br />who buil.b or inFov6 tned, sd who dG such pd* him.la d n6df tr ihrdgn his 6 hr .M 6ployB, provi&d lhal such
<br />imlfovmdts e not inhdcd or of.r.d fd 5r1.. lf, ho*nd. d. brildinS q impmvmot is sold wi6in dc yd of conpl.lm, th.
<br />Oend-Buildd will hlvc th. buda ol proving Ihd hc or ihc nor build o inprc!. fo. $c purpcc of sal.)
<br />_1, a owna of$. proFriy, s cx.lsiv.ly cotulin3 with lic.ns.d contretN io cons!rucl lhc projat { Scc 7044, Buin6s ed
<br />Pioldid Cod! Tn. Cmtra.loa! Li6s. kw dG nor .pply ro oM6 of propdty who buil& d improv6 tha.o , ed who
<br />c..rrca fd sucn prcJ6B with . coEa.lo(, lim.d puEwr ro thc conr.ctor's Liccnlc L.w )
<br />_l m .xdpl undd Sccliq _,8 & P C i* dis raon.
<br />WORKEIIS COMPENSATION DECLARAIION
<br />I h.r.6y af6m un.ld p.nahy of D€rjury qc of 6r follovins dcclmtions:
<br />_l hav. sd vill haintain a C.difi@rc of Cor6r ro S.lf lnruJ. fd wo*6 omp.nsdion, a prcvid.d ftr by S6ti6 3700 of U.
<br />L.bor Cod., for thc p.rfmec. of th. wo* as which lh. pmit is i$ucd
<br />I hav. ddwillmainbin wntcE comP.nsrtim insursc., s !.quircd by Sdion 3700 ol $c L.bor Cod., for thc p.rfmMc. of $.
<br />wdl fo. ehich rhis p6mn G is!.d My wortdc cmpasalio insurec. @i6 &d policy nuhbd e.
<br />Policy Numbr
<br />-Expic:
<br />A,r*^^
<br />not b. .mpld.d if tu pmn h aor Onc hun&.d doll6 {l 100 } or l6s
<br />lhc pqfom6@ of thc work fa which lhis p.mil 6 i$ucd. I
<br />b.cd. subj.d lo th. wo G^ compcnsation laws ofCali
<br />lT0oolthc LaborCodc,I shall, fo w
<br />WARNING Farhrcro scur.*ork.u c@plhetio cov.ra8. is
<br />fio6 up lo o.c hund,.d thoaed dolla (t I00,0m),ii additioi ro lh. cGt oi cohpasalion, d.mag6 a prcvidd for lh. S.cdon 3076 of
<br />fic L.bor Codc, inr.r6l ed anoh.y's f.6
<br />I hccb, amm und6 p.nalty of p€rjuly lhal I e licaEd undd prcvisio ol Chap6 9 (
<br />ln. BGina3 sd Profssims Cod., Md my lic.nsc is i. lull lor.. ed cff.cr
<br />-o
<br />C.LN,iIEUEI]OILIIIDITC-4GINCY
<br />I h4b, .fiim u..Lr p6dly of ,qury th.1 th@ is . @nrhcd@ Iadin8 .gocy fc rh. p.rfmc. of $. wa* fa *hich tltu pcmir ij
<br />i$t d(Scc a097, Civ C )
<br />AIELICANI]LPECI4IIIION
<br />D.molilion PmiE-Asb€ios Notification FcdcEl Rc8llalions (TnI.40, Pan 6)
<br />_ R.quiEd L.u.r of Notific.tion
<br />-ffi thal thc fcdcral rcgulali@s rcgadinB abstos
<br />th l hav. Eidlhis ipplic*immd3d.
<br />Md Slalc Lsws r.latinB to buildin8
<br />abovc mcnlion.d prop.rty for inspcclion purpsd
<br />City 6d Couty to d1.r upon rh.
<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)EXPI RED
<br />lvleter Release
<br />Fh.B ^I ZUE
<br />Rough SAMC 8,43 2
<br />Service Meter
<br />FINAL
<br />ELECTRICAL]NSPECTOR RECORD
<br />APPROVALS
<br />Notes, Remarks, Etc.
<br />Da:c _Omd
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<br />Lndd's Addr6 _f------T------
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