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DATE !D/SIG COMMENTSAPPROVALS <br />Site-Work <br />Underground <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 />Meter Release <br />Rouqh <br />Service Meter <br />FINAL Z/zd/'tn .M <br />Notes, Remarks, Etc. <br />OWNER RUILDER DEL(]ARATION <br />I hereby aflinn under penalty of perjury that I an exempl fiom lhe Contraclon' Licose Larv for the following reurn (Sa.70-3 1.5 <br />Businss ad Profesion Code): Any Cily or County vhich requira a Jmmit to coNtruct. altc. improve. donolish or repair any <br />struclure. prior lo its issuilcc. slso re{uir6 lhe applicant for such fEnnit lo file a signcd slatm@t that he or she is licmsed pursuml <br />lo the provisions of lhe Conlractor's Liccnsed Law (Chaptq 9. Cormrencing rvith Selion 7000 of Division 3 of the Business md <br />ProfessionsCode)orthatheorsheisexemptthocfrommdtheb6isfortheallegedcrmption. AnyviolalionofSeclionT03l.5byany <br />applicantforapennitsubj(tsthe applicanttoacivilpenaltyofnotmorethanfivehundeddollars($500). <br />__ I, ro orvns of the prcp€ny. or my employs with wa86 6 their sole compenstion. will do the u'ort md the structue is not <br />intmdcd or oflered for ule (Sa.7044, Businss and Profesions Codei l hc Contractor's Licmse Law does not apply to an ownfl of <br />lhe property who builds or improve thson. md rvho dos such uort himsclf or hmelf or through his or ha om employs. <br />provided that such imJnovonols re nol intode<l or offoed for sle. If, hoN's6. the t{rilding or improvcmmt is rld rvithin one }q <br />ofcompletion. thc Owner Builds will have the burdo ofproving that hc or she did not build or irnprorr the prcpoly for thc purpose of <br />sle). <br />l. 6 owns oflhe propmy. an exchrsivcly conlracting with licensed contractom lo construcl the project (Sec. 7044, Busins <br />and ProfessionCode:lheContraclor'sl,icense[,awdo6notapplyloilownsofpropenywhobuildsorinlproveslhseon, <br />and rvho contmcls for such proj6ts \\'ith a Conlracto(s) licmed puBuant to the Conlraclor's Licmse [arv). <br />--l <br />m exempl unds Srtion <br />Dete: <br />B. & P.C. lbr this re6on. <br />_ Owner: <br />6(! have and will rnainrain rvorkm compensation imurance. 6 reauired by Sation 3700 of the Labor Codc. for the pe fommcc of'lhe\vork for *hich lhis pmit is issued. My workos' cgmpensalion insuruce cmio md policy numbo ue: <br />cmi(: Lt"qr\ tlt tua\ <br />Policy Numba: Expires, <br />-. <br />DECLARATION <br />I hercby aflirm under penalty of poiury one ofthe following declaralions: <br />I have md rvill maintain a Cenificate of Consent to Self-lmure for $orks'compffilion. ro previdcd for by Setion 3700 of lhe <br />Labor Code. for the pqfomancc ofthe work for rvhich the pennit is issued. <br />I cenify that in the perfonnance ofthe work for which this permil is issued. I shall nol onploy any pason in any rnanne <br />so as lo become subjst to the workqs' cornpensation larvs of Cali fomia. and agree that if I should become subjsl to the <br />work6'cotnp€nsationprovisionsofSetionlT00ofthellborCode,lshall.fonhrvilhcomplys'iththorprovisiore.. <br />WARNINC: Failure h Hure $orkers' composolion co!'erage is unlas ful. and shall subjmt an anployo nr oiminal poallis ud <br />ciril fines up to one hundrcd thouund dollars ($100.000), in addition k) the cost ofcompcnsation. dmages o provided for the <br />Section 3076 Code. intqel and altomey's fees. <br />lh(cr ZO <br />DECLARATTON <br />I haeby affirm unda penalty of psjury that I an licosed undo provision ofchaplq 9 (commocing Nith Sstion 7000) of Division -l <br />of the Businss and Profesiom Code. md my licme is in full force md effect. <br />q,Z <br />l.iceilsc <br />_ Conarrc(or: <br />CONSTRUC'[ION LENDIN(; ACENCY <br />I hereby affrrrn undr poally of pqjury lhat thtre is a conslnrction lmding agency for thc pofonnance ofthe rvork for which this pqmit is <br />Licensc <br />Date: <br />issucd (Se. -1097. Civ. C.). <br />Lendq's Namcr <br />-- <br />Lender's Addrss: _ <br />APPLICANT DECLARATION <br />I hectry alfim undo poalty ofpsjury one ofthc following daluations: <br />Demolition Pmits-Asbetos Norificalion Fedqal Regulations (Tille 40. Pan6) <br />Required Ldt6 of Notifi calion <br />_ _l colify lhat thc lderal regulations regading dbestos rmoval are nol applicable to this prcjecl. <br />6+"miry rnnt I have read this application md state lhat the above infomatioil is corrst. I agre l ith nll City and Cour'to comply <br />f this Cilyard hereby authorize reprBotalives o and County lo ente <br />n"t", I all <br />Pernritce ilxilrc (prinl): <br />r, <br />ELECTRICAL.INSPECTOR RECORD <br />rll <br />Applicnil( or Agcnt Sigilnltrrrl