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APPROVALS DATE COMMENTSID/SIG. <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 />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service Meter <br />rri$reJ#FINAL I ,ltY-w 7-r) <br />Notes, Remarks, Etc.I <br />-t <br />OWNER BUILDER DELCARATION <br />I hd.bt afrtr,n und6 p6aly of pdjury lhal I d etopl from lhc cont.ctoR l-icds. lja lbr th. lolloviry rcen lS< 701 I 5 <br />Rusins 'd Proldioo Codc): Any Cily or Cou.ry *h(h r.qun6 a Fnnn lo conslrucl. all6, inpro(, tknolish or rqrt m, <br />stucrdq rBn lo ir. 6tu&cc, rlso r.qui6 th. spplket for such p.mit kr fils a sisncd sldclMl rhar h. ot slE is lic6$.d pGuar <br />ro thc provtioE of rhc Conr,.rd s Li..trsd Lrw (Chrprs 9. Commcncing wirh S..lion ?L{O of Division .l oao. B6inN md <br />Piol*ioB Codc) or rhar hG orshc ir.x.mpl th(c6om ed rh€ b6is lor lhc allcscd qdplion Any riolarion ofselioo ?0ll.t by y <br />applicanr ior a p.mn subjEls the applic tlodcivilp€.alyornolno(rhdnvchuodr.ddoll s(1500) <br />-1. <br />6 ownr o frh. p6p.ny, o! my enployc with w.E6 6 rheir $le mnrp.ns3l nJ.. *ill do fi. $orl 0.d Ih. sndue ; nol <br />intsdad or ofio.d for sl€ (58.70{.{. BBi6 dd Po tsio6 Cod.: Tn. ConrEclors l-icdsc ljr do6 mr a9pl, ro d or,( of <br />thcpopdry \lho t il,$ or impm!6 fi@fl, od \vho do6 sch N* hinsclr or hKclror rhouah his o. hd oM mploy.6 <br />prcvid€d thar such inpmrddc ft 6r iddddl or of6rJ lor eL lf h.$ 6q. $e huiklins or iqrovmr i. eld wilnin onc !@ <br />olonpl.tion, fi. ORnd ltuildc rill havc th. htrd ofp.ovins lhal h. or shc did nor boild ot in{rcv.lhc pDpqly for lhc PUrF* of <br />I.so*nsolrhcp'rFny.a ex.lusivcly cobta.rinB wnh li.cnsed contoctoEto conslrucl lfic r,.i(r (sec 70,14. B6ins <br />and B.tesion Cod.r 'rhc Con'raclois l,icms€ l,.r do6 nol apply ro d ownd olpropdy who builds or inprov.s rhrmn. <br />and Bho conr.a€c fo such rol{b sith a co.lr&loi9 licmed purstr..llo lhe( oimcntrt t-iccns. La$) <br />I mc\empl undcrS€clion-. a &PC lor rhis re.son <br />Dr(r: OBner: <br />!llBEEB$.cQIil8E!l41lO! <br />DEC!,ANAIIIIN <br />I hd.by amnn utrdr t nlkt olFjory oo. of the follo\ving d(lmtioB: <br />-l <br />harc an<t sill @imai. a Cdiicalc of Colsat 1o Sclf-lreur. for work.^' 6nrp.n$rion, 6 Folid.d for by Selion 1700 ollh. <br />Labor Code lor lh€ Irffolfuc. olrh. vo for which fi.l16bn b issu.d. <br />-l <br />hav. ed will rai6rai. wD*c^ comp.Gation iNuBnce 6 rcqun.d by S(rbn I700 oarhc Labor ('od.. fo! th€ pdlome.. of <br />rh. worh aor whi.h rhi pmnn is ies,ol My workd comp€.salion iBlrdc. .did od poli., nu'nb.r 6e: <br />f,:ifythar in lhc Erfomancc ol thc wort loi whichthis pdnn is issued.l shallnor onpl,,yanypmon inanym no <br />l.Jsobccomerub6rrorh.w.Hdi.ompe'saron'.Hntcaton'a.uda!'rrhar'fldruldb.(om.rubi<hh. <br />\dFaF.omBrarionpnrisroNofSdion37OOolrheIdbn'.o'jeIshill.tunh$rhlnrnplt*rhth.Mportst.ns <br />WARNINC: [ailu,. ro suc sor!ft' coqmrion .ov.rag. is uf,hwlul. &d shau subjg*z& mploFr lo oiminal pcE]ri6 dd <br />civil liocs up to oo. hutuircd thoMd doum ($100,000). <br />Ssiion 1076 ofrhc t,atFr Corjc. inrd6r dd anonEy s lc <br />in .ddnion ro rhc.o* or tr. daDises 6 I'ro\idcd nr thc <br />DICI,AAAIIO! <br />I heby amm und6 pcnalry of pdjury Oar I @ lteN.d u.dd Folision olchapts 9 (.ond6.ing {th Sdiotr 7000) ot Division l <br />oa the Busin* ud l'ref6io6 Codc, ed my liceM $ t lnll forc. tnd .,Idl <br />2-9'th <br />,.,", - I I L-iL <br />cQxiralJcrloNr[lDllc3cllcl <br />I hoc6y amnn undtr p.nahyofp.rjurylhal lh6cis a coNruction lddinE nlscy lor lhc pqfomaflce ofthc*o for which lhis panil G <br />issu€d (Se 1097, Civ C.) <br />atrl.rcaNlDlctd84llo! <br />I hdttt altm uidd p.f,ally of Fjury orc of lhc lollowins dEleatioal <br />Dcmohioo Pmns Asb6los Noriicario. F.dml R.Sulatioos(Tirlc40, Pan6) <br />R.qut.d Ldrd oaNoi6cdbn <br />I cdiry thor lh. I€dcral rcsuhtnrB Esadins Gberos rooul ar. no' .ppli.abk ro rhis p.qet <br />-lcslilyrhd <br />I have rad rhi! 0ptlicario.ion is cor.cr. I asrd 16 cooply wnh aU Cnyod Counly <br />ordinanc$ and slirc l.assddinst)3othonucr.lr6drariv6 ofrhB ( hyed Counlyto 616 upon tht <br />abov€ morioncd propcny for <br />Pernile nrrc (prnrl): {,S "",,.1r <br />p la <br />ELECTRICAL.INSPECTOR RECORD <br />lr-t-)g <br />L.ndd s Addr6 <br />I1 <br />. -T------