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APPROVALS DATE ID/SIG,COMMENTS OWNER BUILDER DELCARATION
<br />I hcrcby rr6rn u nddr pe n ry or Frjury 'h,r
<br />I m .r€m!'r ron
<br />'lE
<br />Co.rlscio^ Lilrns Lrw f(tr lh. lollowing rcastr ( SN 7trl l.5
<br />Busirrss tr.d Prclcsion Codc)r An, Ciry or Counry which rcquiEs a pcrnir ro onsru.l- alrs, improw. dcmlth o, rF bt
<br />nru.turc. prhrto its nsuoncc. aho rcqxircs rh. ipplicatrr nn such FnnI io filc! siSned ralcmor lhar hcor shc n licenrd pnrsur
<br />tu lhc ,mvisnrns ol thc conrrelofs Liccnscd l-ow (Chryrcr 9, Commcocio! sirh sc.tion 7000 of Division I oflhc 8uri.c$ ,nd
<br />PmicssionsCodc)orrhlthcorshci\crcnp hcftrionandrhcbari\rorrhcrllcgcdcrcmrrion.AnyviolationotSdhnT0.rlrbyan!
<br />aptlionr for r |c.nrir suhjccr\ rhr {dicrnr to , civil !.mhy or Rn lxft ttun livc hun'lrcd d.llur ($500)
<br />I. as owmr of rhe roFny. or flry cmployccs with wa8cs $ lhcir elc ompcnelio.. wiu do rhc wtrk dnd !r* (nlim is mr
<br />inlcnH or otlcrcd for sL lS€.?044. Busircss and Pmtcssion\ Cdc: Itu Grnrucrols Licctrs ttrw docs nol ollpl, ro d oetur of
<br />rhc pmllcny wh. builds or ir{,mwr rh.Mtr. old *ho des suh wo* hinrlfor hcrclfor rhmlBh hn or h.r own.mpby.ca.
<br />ttuvid.d rhDr rnch inptuwftnt d ml inlcnd.d or oilcrcd for sh Il howcK. rhc bildins or itrpnrrce is sold {ithin onc tre
<br />orcotr{kikd rhc Owncr Buitdr $ill hlw rtr hlrdco ol Dmtns rh,r hc o. shc did ft, boild or i,Irnw lhc pmpsl, {or rh. p!ry*or
<br />Xl. sowmr olrhc rmpcny, a cr.tusivcly.onlraclinr rirh liccnkd conrraclon ro onslrucr rlr pmj.rr (scc 704.,r, Busrcs
<br />,nd Pmlis\ion Corlcr Thc CirnrE roas Li.cnsc Liw des nor rptly lo nn owncr oflrolJcfly*lt, builds or imProvcs thcrcon-
<br />rnd sho conm.r ld su.hpmjcchw'rhaConrrocrons) licctrsd pururnr hrheConk,.tn \
<br />-l
<br />lm.rcn,pr utrJ.r So.rn,n . Il & P C
<br />DICLABAII!.IN
<br />I hcr.$y atlirnrrnd.r p.nalry.fpcrjurrodc ofrhc f(,lk,win( dc.lrr ion\
<br />-l
<br />hlvc and *ill mintlin rCcdili.ni.ofCon*nrlo s.lrln\urc rur workcrs onrf,netiotr. as providcd for by s..tnrn.1700 ollh.
<br />Lihor Codc. for lhc pcrformncc oI rhc hd ao! qhth rhc pcrmir is ns&d
<br />_lhorclndwillmninuin*orkcs.ompcnsarioninsxhncc.,s.equnrdbtsuclio.lT0oolthcLtrhorOdc,i{trrheponJrmnc.or
<br />lhc $ort lirr whict lhirrcrnrir is n\ocd Mywort$ comp.nsariotr insuhNc.rdicr d policynunrbcrm:
<br />P'nicyNumbcr
<br />-E[pnc\
<br />_l ccnify rhar in rhe pdformtuc of rhc work fd whi.h rhh p.rn r is nsucd. I \h!ll noi cnpk,y nny P. on in .ny mMrcr
<br />v, ds ro b.rom subi$r iorlrc *orken compcnsorion larsol California, Bf,d aad rhdr ir lsh.uld t$om suhid tolhc
<br />workcrs Llmpcnsrrian pn,vri{,ns olScclioa 17 )ollhc Latry c^alc.l shrll. ronhwirh co'n/y with lh.c lmvhions
<br />WARNIN(; I'rilurc ro rculc wnkcr c.mpcnsrrn,n covcrrsc i\ unhstul. and \hdl subjccr loycr ro dmind pctuhic\ Lnd
<br />doma8c\ 3s In,vi!.d fr rhccivil tincs u! lo onc hundrcd rhotsrnd dollrs (S100,(XX|), in a.ldir
<br />Sccrion 10?6 olthc ldtnrCodc. inrcrc{atul omcy'{fccs
<br />D.r€, {- S -, e
<br />LICEIISLC!)XIAACIAB
<br />DECIAMIION
<br />I hcrcby.filrmundrr p.nally of,'crrury rnd I !m licctrxn undcr rmvision ofChap{.r 9 (.ommncinB with S<lion 7000) otDivisidn,1
<br />ot rhc Bu\in.$ rd Piorcsions Codc. ard my licens is in tul! ,orc. ond ct{dr
<br />Liccn\. Clos\r-Lictn
<br />CONEI&ITEU}LLENDTNGAODXCI,
<br />I hcrby !fiirn undcr Fn,xy of pcru.y lhal llErc is a con(rudion lendins sscn.y for rhc ,crrormncc of lhc work lo, which rhn Fmn ir
<br />hsucd (Sa.1097- Civ. C )
<br />ATTIICANIIJLCLAf,{IPIT
<br />I lndry
<br />"ltirm
<br />und$ p.tr,lry of pcrjury onc oi thc lolloqing dccl alions:
<br />lxmlirion Pcrmits AslFnos Nolifi.di,n F.dcrdl R.tuhrnff (I irlc 40. Pan6)
<br />-Rcqun.d
<br />knc.orNniar. ion
<br />l.c iryrhrr rr fcd$rlatuhrion\ rcSrdinr rlhc\los rcnDhl irc norrpplirahl.n) rh$ l]n,t cr
<br />lcdlrlirhd I hrvc rcld rhirapp n..rcd I rSra loc.mnl, wirh rllCiryrnd coun'y
<br />drcicnr.rir$ olrhn Cirt otrd County lo cnrcr uIn. rh.ordindmc\ rtr Srdc Lrusrldin8 to 6u
<br />rhr. nrrrn)ncd pn) nvntr iNpcc
<br />,\ppli(hnr or \xrnr siIn lurr
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab i Floor
<br />Bondinq / Groundino / UFER lo-L1-tb ,4zn
<br />Transformers
<br />Torqueino 1o.zs-r&a?t+fl.-\^.1-.-:.f, *^f^4-
<br />T
<br />Air Conditioners
<br />Floof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Itrleter Release
<br />Rough rc1t-tx Zc2'l
<br />Service It/eter /o2?-tq 4c a4
<br />FINAL /z-3-/B fuan z.r- Z*-/
<br />Notes Remarks Etc.z-t 22
<br />ELECTRICAL-INSPECTOR RECOHD
<br />Sub-Panels
<br />t ndcis Nam:
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<br />t= e-/g
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