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APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rough <br />Ceilinqs (T-Bar Rouqh) <br />lt/eter Release <br />Rouqh <br />Service Meter ,a--], <br />FINAL c/47- n /Lt('spt-lo)l zr7 I <br />Notes, Remarks, Etc <br />OWNER BU ILDER DEI,('ARA'TION <br />I herelry affirrn under penalty of pqjury thal I dfl crcmpl from lhc Conlractors l-icmse [.aN for the follos,ing reen (Se.70-11.5 <br />Busines and Profsion ('ode): Any City or County Nhich requira a pmnit to coNnrct. allr. improve. dmolish or repair any <br />structure. prior lo ils issuance. also requires the applicdt for such Jrennit to file a signed staternenl that he or she is licensed pursuant <br />to the provisiom oflhe Conlraclor's l-icensed l,arr'(Chapler 9. Conrmencing rvith Sation 7000 ofDivision J ofthe Business md <br />ProfessionsCode)orthalheorsheisexemptthsefrornandthcbasisforthcallegedexmplion Any\iolalionofsslionT0-ll.5byany <br />applicant forapmnil subjstslhe applicantto acivilpenaltyofnot morcthm fir,ehundreddollars($500). <br />I. ns o\r'nq of lhe ptrofaiy. or my employG \t'ilh uaE6 as lheir slc compmsalion. \'ill do the work md ltE slnrctue is nol <br />intode<l orofloedforsle(Se.T044.BusinesandProfesionsCoderTheConlractor'sLicenseLa\\'do6notapplytoanoNnsof <br />thepropoly rvhotlrildsorimprovethqon.mdwhodoesuchrvotkhirnselforherselIorthroughhisorhoomemploye*. <br />provided that such improvanmts ile nol intmded oroffsed for sale. lf. hos'qq. the building or impro\'trrml is rcld rvithin one yw <br />ofcornplelion. the Osns Buildq Nill havc the hrdfl ofFo\in8 lha he or she did not trrild or improle tlr pmtEty for lhe purFD$ of <br />ele). <br />l. as o\\'ner of I he propdy. tun exc lusilely contract ing s ilh conh'acto6 lo conslrucl lhe fojecl (Sc. 7044. BusinN <br />builds or irnprovcs thomn. <br />,icmc l,aw). <br />and ltofqsion Code; The ('ontractor's l-icense LaN dos nol orvne ofproperty who <br />and rvho contracts for such prcjecls \silh a Contmcto(s)lo ( ontrackf s I <br />I an e\empl undtr Sslion for <br />,,,"- l)'l-05'19 <br />t)tt( t.AIL\ il()N <br />I herebr alTirrn undcr pcnall) ofpsjur) ooe of follo* ing d<larations: <br />Ihaveodwill maintaif,aCertificaleofcoNotloSelf-lnsurelorwuk6s'compensation.o providcdforbyS(tionlT00ofthc <br />tabor Code. for lhe pqfomece of lhc work for s'hich lhe p6mit is i$ucd. <br />Ihavcandwillmaintainrvorkm'compensationinsurance.as requiredbySection-ST00oftheLaborCode.forthcpafonnanccof <br />the rvork for rvhich this pcnnit is issued. My works' compqsalion ireurance canir ad policy numbo ue: <br />Cmie: <br />Policy Number:Expires: <br />-.1 <br />cenify that in the perfonnance ofthe work for rvhich this pennit is issued, I shall not eilrploy any pemon in any manner <br />so G k) lrccoiDe snbist to lhe workq's'conlpensation larvs of('alifomia. and agree lhal ifl shoukl become subj@l lo lhe <br />workss' compssationprovisioro of Section l700of lhe titrer I shall. forlhrvith comply $ ith thow previsions.. <br />WAIININC: I:aillrrc lo sccurc $orkcrs' cornpeilsali()n is shall subiccl an crnpkrycr lo oininal poaltits and <br />civil lines up lo onc hundrcd thousmd dollars ($aLld it of cornpenvtion. ddnagc 6 1-ovided for the <br />56lion 3076 ofthc Labor Code. intffBt and atlomey's <br />I herehy affi rnr under pcnalty o f per iu y that I am liccnsed lrovision ol ('haptcr q (cornrncncing rvith Scction 7000) ofDivisioil -1 <br />of lhe Businss and Profesions Code. md mv licmse is in full force &rd eff6t. <br />Licensc ('las: <br />Dale: <br />I iecrrsc Nrrrrrlrr <br />( onIrilclor <br />CONSTRUCTION LENDTNC ACENCY <br />I hqeby allim undq tmalty of pqjury lhat lh6e is a conslruclion hndinS agocy for lhe pefommce of lhc rvork for * hich this pmnit is <br />issued (Se. 3097. ('iv. C.). <br />Lender's Name: <br />Lods s Addras: <br />APPLICAN'T DECLARATION <br />I hotll'affrm undo poalty ofperjury one ofthe follo\f ing d(ltrations: <br />Demolilion Psmits-Asbestos Notification liedsal Regulations (Title 40. Pan6) <br />Required tdltr of Nolificalion <br />I cdiry that lhe fedtral rcgulalions rcilx)val arc o({ rpplic.hlc lo this prcjccl <br />I celify lhal I hare read this application ud is co[(t. I agre to compl]- \ ith all ( ity and Colnty <br />ordinanca and State Lass relating lo authorize reprsmtativ6 of(his Cily aild County to flts uFxrn the <br />above Drcnlioned propeny for <br />Applicrnt or Agent Signature: <br />I'emri(ec name (pritr():tuBrpr A <br />alrx c <br />Datel rLll12 <br />ELECTRICAL.INSPECTOR RECORD <br />,,",", t01- 05'19 <br />PEDE