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O\YNEIi BUILDI'R Df, !TARATION <br />I hd.by dmnn u.d.r ,.nalty oa pdjury rh.l I m .&mfl 6.m rh. Conlndor L,ic.ns tis tur rnc folloBin8 r.No (5(.701 1 .5 <br />D6in6s ed Plofdsion Cod.)r Any Cily or Counly which r.qut6 a pgflir lo cocrrud, a[d. @prcv.. d.,nolth or r@ait ey <br />$ruclue rior ro irs issudce. also r.qun6 lhc alplicd ao! .uch pdnir ro frlc a si8ncd sr.l66t that h€ or s\c is licmed pwanl <br />lo rt€ provisioN ofrh. Cont,ctofs Lic.ns.d lzw (Chaptd !. Conn.ncins wirh 56rion 7000 oaDilisio.I ofth€ Busin6 d <br />Prefsioos Cod.) or tha hc or sh. n cr@pl thdcftom d rh. b6sis for rh. dll.scd .r6np1ion Anyviol.liooofse.lhr T0ll5 bre, <br />applic.nl for a p€mil subjdtsthe opplicantloacililp€nallyofnotnorclh lilc hund.€d dolles ($500). <br />l. 6 oNns of the FoFny. o! m) cmph)6 wirt sas6 a then $E contpsaion, *ill do th. {ort {d Eslrudueir mt <br />inrolhi or offs.d foi sal. (Sd 7014, aui.B ed Proa6sio6 Cod. Th. (onlEclol s Lic6F ta\r do6 nol q,ply io d ownd ol <br />lne pmlEly who buildr or i'npro!6 rhqon. tnd Nho dos $ch s* hi'$.ll or hNlf or rhtough iis or ho osr @ploy.a. <br />prolidcd rhar such impovdMrs e not inldd.d or orsld for slc lL ho*6,s. rhc tlildins or invrov.lKr is $ld $ ithh on. ,B <br />orcooplard lhc Cntlo Buikl6 will har ie hrd.n oltrevins thd h. or shc did nol boild or inpmvc lhc pmpqly for lh. purposc ol <br />_1,6orndorlhr ptupdy. m crclusilcl, co,ba.ring Rilh licmd .onr.clos Io co.sirucr th. proj<r (Sd.7044, BB$a <br />and Frot6st'n Cod. t h€ (i,nta.rors l.icens€ t * do6 nor apply to d o$ n- o f rrop.ny {ho builds or improv€s I h6aq <br />a.d who $m6ds for such Fojcds wnh a Co.lraclo(s) li.d$d puuwr ro rhc Conlr.crors Licce liw). <br />_ltuncrc rpr uM€rsdio. . B & P.(.folrhis rc6on. <br />D8t€ Onn€r <br />T(IAtrDBS:CAIUEIIAION <br />DECLAAAIIAN <br />I hd.by arnn und( !.flalty ol psjury ooe oflh. rollosins d.clealio6, <br />-l <br />havc ed rill mainlain a Cdifrcalr of Congr ro S€lf-lnsur. for wDrk.B conD.nsalion, s Fovid.d for by Sclioo 3 700 ollhc <br />L.bor Cod., for ih. psfolrMc. of ri€ worl aor which lhc pduil is isu.d <br />t h,vcand Nill mai .in uork€.t compdsdrion iBumncc, s rcquncd by Srxon :t700 of rhc Lab6r cod., aor lnc lqfomecc of <br />.nier dd Fli.t nunrbd € <br />({ <br />/dr1oo1-r/ <br />-l <br />cd'6,rhar i. rhc p6fo@ncc of lh. $ork lor which thii pdmir i! i*u.d,I sh6llnor mploy ypmon in dy 6eno <br />$ 3 io b..otr subjar ro (h. Mrk6' omFMion l.ws oacalifomia. d ase lhd il I should t .onc aubj..l lo lh. <br />voltds co'npBetionpmvisiosofSeliotr 1700otth€ t2bor Co(lc I slDll.lonhsilh codpl, sirhih.epmvilioN.. <br />wARNlNcr Failm lo su€ wor*e' co,npmatio" colsss€ is unlawlul. ud shrll subjet & npbrc <br />'o <br />aimiMl FEhis dd <br />civil 6nes up ro onc hundred lhoumd doll6 ($l rhc coe oaconpe@lion. d&naacs 6 provid€d for th€ <br />( <br />DECIASAIIAN <br />I hscby artrm und€r D.nahy of Dcriury lhal I an lic€nsed undd Drovision oichaDld , (co,n.@.in3 wnh S&1ion 7000) of Division 3 <br />md 9r' <br />Y3O JO <br />r'(-- <br />CANSIAUCIIANIEIDjNGIGIIC! <br />I hqeby amnn unds p€nahy of pqjury lh.l rh6e b a coisruclion lndog aSmct for lh. pdfommc oflh. Nork lor *t!ch thD Fnil i <br />isu.d (Se.1097. Civ. C.) <br />Af&lcaNfDlclaaauo! <br />I hsttly arm undd paahy oa psjury onc oflh. follo*ins d<lmlions: <br />Dc@lirion Pmils rb6ro! Notincarion F.ddl R.g, hriou Gnl.40, Pd6) <br />R.q0n€d Ldrd of Nolifietion <br />-t <br />c61iS thar I have rqd rhis applic.xon dd srar€ rh,r rhc abo\ c inn,m1albn i codd I a8le ro coDpl, wil h all Cny aid Counrr. <br />ordi.an.6 ud Starc La*s Elatins kr buildinA rqxMturn6oirhisCiry dCounryro.nrd uro.rh. <br />abovc nEntioned propely fo. <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <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)ll/.t, /tul> <br />Walls (Rouqh), -,/la \% <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough)t/y/1 >t)66 <br />Rough <br />Service Meter <br />FINAL L\'1\\1 <br />^-tMr\)Notes, Remarks, Etc <br />^-,t!-r4,v <br />ELECTRICAL.INSPECTOR RECORD <br />Pole Bases <br />Meter Release <br />L.nds's AddI6 <br />- <br />-l <br />csliay llEr the Ldsal rcsulalio,s r.sadins sbGros ranoval 6c nol .pplicabl. ro rhi! pNjd.