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ELECTRIGAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Ow-Build6 D$lurtioo <br />I horcby affim unda pcndty of pajurythetl m qcmpr fom thc ContnltoB'Lim$ Irw for thc following rmo (u.7031.5 Burinor <br />md Profosion Code): Any City or Cdtrty which requiu r pcrmit to @Em(t, dt r, imFovq darDlirh or rcpdr uy rtrudw, Fitr to itt <br />isorm, rls rcquirc OE rpplim for $ch pqmit to 6lc . rigr.d rbtcmtf th.t ha tr rlE is lieilcd punuit to th pmiriou oftlr <br />Cotrtr&dq's Liccru€d Lrw (Chrptq 9, Comtriog with S6lior 70OO of DivirioD 3 of tbc BuirB Ird Profqriou Codc) or thrt hc or <br />shc i3 dcmpt thsc&om rad thc bsir for rhc dlcgcd acmption .Any violrrion of Setion ?031.5 by uy rppliom for r pcmir sbjcsrt th! <br />rpplicrnt to a civil pcnaity ofnot m thu ftvc hundrod dollu (t500). <br />_1, d ow of thc popqty, or Ey mploya with wrga r thcir rclc ompcnutioq will do the work Id dr ttructe is mt intqdcd <br />or offacd for slc ( Sc.7044, Buciur .rd Profcrriqnr Codc: Thc CoffiEtq't LieE Lr du nc ryply to u ow of thc popety <br />*to buildr or improve tlso4 ud *ho dq mh work himrlf q hsrelf or tlrorgh hir or hc m cmploye, pwidcd rhn sch <br />improvcmcnts e not incndcd or offqcd for nlc. I[ howr, thc building or imprwcmcm is sld within m yu of omplaio4 thc <br />Omq-Buildcr will hqvc drc burdcn ofproving thrt he or tbc not build or improvc for thc purporc ofulc). <br />_I, a ow of thr p.opsty, rm qclurivcly @trtrrdia8 with liccned @nrrctors to @rot uct thc prcj@t ( S*. 7044, Burinos ud <br />Prcfcsion Codc: Thc Coamdor'5 Lienrc hw dG rct rpply to u ow ofpreprty who buildr r improu thcon , rnd vho <br />ontnas for och prcje'ts *ith r Contnctq(r) licored purumt to thc Cont &tor'i LieM lrw.). <br />_I m cxcmpt undc Saim -B &for t <br />Da@: <br />W <br />I hqeby rffim uods pculty of pcrjury m of thc liollowing dclutiou; <br />_l hrvc .nd will Mintrin r Ccnifiotc of Coffit to SclGlluc fo rcrk6' @mpcBtion, r prcvidcd for by Scaio 3700 ofthc <br />l.ibor Codq for thc prfomre of rhc wort for which thc psmit ir isrcd. <br />_l hryc ud will mrintrin eorko' @mpoutior insun@, I <br />work for which this pcmit ir iucd. My workm' mpcnstion <br />rcquircd by Scction 3700 of thc Lrbor Codg for thc pcrfomne ofihc <br />inruue mio ud policy numbq [G: <br />a.d* <br />Policy Numbr <br />(This stiotr necd not bc @mplded if thc p.mit Onc hun&od dollu (t100) or lcs) <br />_l c€niry tlut in th! pgforrrc of thc work fq which thir pomit is isod, I tldl rct cmgloy my pcru in ey m6 e s to <br />beme sbjcd to thc wrkm' @mpcn$tion hws of Crlifomi!" sd rgre dfi if I rheld bore rubjca othc wukm' <br />@opcnslion provi3ions of Setion 3700 of tht bbor Codg I tlpr <br />WARNING: Frilurc b itrc work6' <br />fin6 up to orc huodrcd thouslrd dollB <br />ud ihall sbjet e <br />(5100,000),in eddition to thc rcr ofcompcnstioq demrgcr u <br />the Labor Codq intercs ard domsy'r fd. <br />LICENSED CONTRACTORS DECI.ANATION <br />I hcreby afrm unda pcndty of psjury tht I m limrcd urds prcvirion of Chepts 9 (omcrcing with S*tion 7000) of Divirion 3 of <br />thc Burincs rnd Profcrsiono Codc, ud my licce ir in fuli forc ud cffct. <br />Licctrg Liens Numbs <br />Datc:Corrm <br />CONSTRUCTION LENDING AGENCY <br />I hqrby dlim unds pculty of pojury tlul tlEe i, r @rfuction lcnding rgocy ftr tlE pafme of thc work for whictr thir pcmir is <br />isued (Src. 3097, Civ. C ) <br />I-cndq's Nmc: <br />Lcnder's Addrcs: <br />APPLICAN'I"S DECT,ARATION <br />Dcmlition PmitsAsbc*or Notifiotion Fodol Rcgulrtions (l-nlc 40, Pln 6) <br />_ Requircd btta of Notification <br />- I 6ify thrt th. fcdfll rcgul.tiorr rc8fding ubcxor @vrl e @t rpplicrbla to rhit prcjs. <br />_ I c€ti& th.t I hsvc rcrd thir epplicrtim &d itrtc thr tlE sbow informrlion it @rrc{a. I rgre to rcmply with all Ciry ud Cq$ry <br />rcprcrnrtivcs of this City ud Conty to <br />abovc mcntioned propcny for <br />Appli@r or sgmt sig <br />Pcmitt@ n!mc <br />building <br />.Jo <br />upon the <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 F-XPIRED <br />Air Conditioners <br />Roof Top Equipment AIIG 2 Z EUI: <br />Factory Wired Unit .-adr6"gt) 4-l <br />Walls (Conduit)sAl "-1ll ,2frt( \-t / <br />Walls (Rough)I ltV* \-/ <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL <br />Notes, Remarks, Etc. <br />03.31.06 <br />t