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APPROVALS ID/SIG.COMMENTS OWNI]R BUILDER OEI,CAIiATION <br />I h.r.by.mnn ndn F6alr, of rrjlr, rhar t m .r.mfl frod rhe Conra!.loE' Licd. b{ aor rh. follo\ing .@n (S( 70-11 5 <br />Ausin6s .nd l,rolBsion Cod.): Any Cilt or Counrt qni.[ rcquns . Fnnir ro conrrucr. ah6. inpole &molish or rcpqn iny <br />srnrcrur€. pnorro ns isuancc. also r.luircs rhe applicatrl for srch p6rnn lo filcasigncd sr,lmsr rhar hcor shc is liccnscd pursuo <br />ro rhe provbbB oa rhc Co.tacror's l-ic.n*d LnN (Chaprs 9. Colnhcncins Nirh Sdion 7000 oa Divisi.n I ofrhe aEinN dd <br />Prol6sions (-od.) or lhar h. or rh. is.rmpr lhdefron ed rh. bas,s tor rhr all.!.d crolplion Any liolalion olsrlion 7011 5 byey <br />q,plica fora!.rnrnsubjclslfic.pplicanlt.acivilp.nahyofnolmorclhanfiv.hundr.ddollds($500). <br />l. 6 os.d oflh€ pi!p€.ly, or my erdoyB rvilh *aAB 6lhcir $lc com!.Nrlion. u'illdo lh. qok md tfic slndrrc n nor <br />imdl!! or orTcr.d tu elc (S( 7044, Busin* and Prefsio6 Cod.: The Comradors Licc r. I-aw do6 not apply $ an ov.d ol <br />rhe p'!IE1y \rho h,il& or inlprovs lh(an. ud vlF do6 srh so!{ himscll o' hcrself or rhmulh his or hcr o$,n epk,)r6. <br />provided thol such i,rprommls m nor inloded G oll6.d ftr sl€ It fio\'6 6. ih€ buildiru or imIrovcimr is $ld rvilhh on. y@ <br />oa.ohpldidn $c oM.r Buildo sill hav. rhe hidd .f p6\ins $ar h. or sh. did iol blild d nnprok thc prtrpcly for rh. purpos ol <br />l. 6 o$nd olrhc pmpdy, m.rclusiv.ly.ontacrin! sirh lic6.d..itra.l.E <br />'o <br />coBtrud thc pmjel {Sc 704.4, Ausi.ds <br />and PD&sionCod€: l he Contraclors Lic s€La\do6nolapplyloano$'nsofpropenyrvhobuildsorioproveslhdcoi. <br />and $no.onrracGlorslchpNj(asilha('oitaclo{rlto*lp6uMr$rh.6nkr.to.sLicdeLaw) <br />I ancr. rfl u d( S(tioi <br />Drl.: Orn.r: <br />wo RxFls collP&\srrTr(\\ <br />DEClAaAI]g! <br />I hseb, ailirm undr p.nahy of pEjury ofl. ol the aollo\vin8 dslrario"sl <br />I halc md $ill nmnrhir . Ccnifi.alc olconsar lo s.ll-lns r€ ao, $o,lm compas.l ion. 6 pm\ id.d tor by S(tion 1700 of the <br />tibor Cod., for rnc pGfomanc. oar hc *orl aor "tich rhe lnrn n i$urd. <br />I havc and will nainlain worl6 compcnsalion iBumn .. 6 r.quir.d by Sdl ion 3700 of lhc hbor Code. tor lh. Dsfo c ot <br />rhc sork lor shicl lhis p€mn is isudi. My s,or*6 compmation iosumcc camd t d policy nudb6 &.: <br />canid: ' 1.L/Yc4 S.JV. <br />PohllNuD,hcr / A0trJ co1?t?3 <br />I c€niry rhar in rhe prioman.c ofrh. \vork for {hich rhis plrmir is irsuerl, I shallnot mpld) rny pds.n in any msna <br />e a to h.coft. subjer 6 the $ ortm' .ompeMrion l.$s of calia.mia. .nd +c thal il I shorld bdom. subjd lo lhe <br />r0lk6' compasation u oyisions o I Salion l7c$ ol rne ktrlr Codc. I slnll. ionhsnh conrply wilh lno* provGions.. t <br />rtril fii6 up n1 otu huidrd thotrsrDd d.llrs ($100-000)add n,. ro rhc cos oa.onpc@rion. dd.g6 a providol lor rh. <br />S.ctirr:r076 ofrhc I rh(tr Codq inrr.\t rnd rr <br />I heEby amrm trnder penallyofpoiury'hn' I dn eision olCh.pts I (comn€ncinx \ilh Sdion 7000) otl)ivision l <br />ol lhe tsusines ond Prcfsionsaodc. Md my licds. is in fullforceddcaLcr <br />os/63 <br />/*a'r- <br />I hseby ailtrm und6 p€n.lly of psjry lh.t th6. is a oBr <br />issu.d (Se 1097, civ. C ). <br />lmdio8 .8ocy for thc pqfomuce ollhc xort lor n hich this p.rnn b <br />ASIIICANLAECIABAUQ! <br />I 'Eq+ arm und6 p.nollyof psjury on. of lh. aolloNins d(loalions: <br />Dcmolilion Pmtu-A,hcros Norincarion F.daal RcSularions (Tirl. ,10, Pd6) <br />Requned Lqrs olNotificd n <br />I cm ily th.r rh. ledqal resulfllions rc8fl d in8 6bek\ r c.Fral arc noi 0pplicablc to nris prcjeci <br />I ccrify thd I harc rsd rhis lppli..rion ml iar. rhar rhe rbovc inlomarion is co6d I alre ro snrply wnh aU City Md comrt <br />ordinancsd st0rc l-aws r.larin! ro buil md hd.trt iurhorni r.tY6cnlai iv6 olrhh cit! d Counly lo did u,mn th€ <br />aborc mmrion.d pr,pcny for irrdr <br />\pplicrnr o, '\!rtrr SiBnrrtr'c J,," /-6''2oza <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 />Bu ilding <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />tl I <br />Rough 7lill)u{/&ltlbtit ,J <br />Service Meter t, <br />FINAL lllt/r{)E)llru H.lt ;;d6 <br />Notes Remarks, Etc <br />ELECTRICAL.INSPECTOR RECORD <br />DATE <br />Sub-Panels tz/r/2o"o <br />t/6 /zozo <br />B