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APPROVALS DATE IDiSIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Lile Salety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding i Groundinq / UFEB <br />Translormers <br />Torqueino <br />Sub-Panels <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar Rouqh) <br />Ivleter Release <br />Rough <br />Service fvleter <br />FINAL "rlt.t \I,.UtVl fi1, <br />Notes, Remarks, Etc.I <br />OWNf,{ BUTLDER DELCARATION <br />I hc6by rfllrm undo ,.n,k, of Frjury th.t I am excm!" fmm lhc Co rrcroF l,tc.se L.s for rh. rollowinS Ea$n (S!c.7031.5 <br />Busin.ss ard Prolcssion Codc) Atry Ciry or Counr, vhich Equnc\ r rE,tur i(, snntu t, .lrci in ro$, dcmlkh or rc]Et loy <br />(rucru.c. Fior ro irs hsuarcc, al$ rcqltcs rhc applic r 16, \u.h pcmir ro nh o siemd sr.rcmnl lhal lr or she is liccntd lnra{ad <br />ro rh. tmvhions ofIE Conh.lor's Lianscd Lru (Chaflcr 9. Comtuncins uiih Sc.rion IxD of Division I oa rhc Busincs !.d <br />Prufesio.s Codel ot thar hc or shc h cicnfl rhcrrrom dd rhe h$h for rhc .llc8.d cxcmption AnyviololionoaS$rbnT0ll5 bya., <br />{tli.rnr aor a pcmil subFB rhc rpplicanl ro a civil pcnllrt ol nol mrc rhon 6vc hundcd dollrs (35m). <br />-1. <br />a\ owncr of rhc pn,rEny. (tr ny cnplo)rcr *nn wn!.s as thcn vrc .onpcnsotion. uill do thc work dl rhc {mlm ( nn <br />inrcndcd or ofleed ror $lc (s.r 7044. Busincss nnd Profcssions Codcr Thc Conhclois Licc.r ljw d.cs nol {t'plyro u owmr of <br />lhcrrrerEny who builds ar nnnrovcs rhcNn. srd who docs such MnI hi'nsclforhc^.lforrhrough hh or hn osnenployccs. <br />ntulldcd rhar such in!.oEnr s arc n.l inrcndcrl o. ofl'csl for slc Ii bowclci rlt btiHi.g or itrqrowm.r k sU *irhin om )aE <br />ot.aq,lcrir. rh. owncr Build$ will har lhc b{dcn ol prcvi.B tha hc or shc did nol hild or irq,n,w Oc pmFty ror rlT purlDs ot <br />-1. <br />as owrcr of rhc t otEry, rm ci.losiv.ly .o k .ring wirh li.cn\cd .onrlcbr ro conslMt thc pmFr (S.c. 7(x4. Busftrs <br />od Pnfcssbn Codc. Th. Conra.rols Lice.* trw docs mr otplr lo anowncr ofproFny str hxilds o. imPtorts thcrotr. <br />and *ho ontrrcts lor such roj.rls *irh a Conrmb(n liccn\cd flAunr brh.co.lrlcrols Liccns ljw). <br />-l <br />amcr.nrpl undcr Sccrnr <br />Dole: - O*n.r. <br />wrrxrrss' corrlPrrillrrtin <br />I'ECLABAIII}N <br />I hcrchyafirnlnder Penalry of D.rjuryon.of 'h. <br />rollowi.s d.clm'io.s: <br />-l <br />hlvc.In'illrMintuinuCcniic,rcorConscnrtr sclr lnsuic roi workc6' sDrrnsation. as [ovidcd r(xbyscciion]70oofthc <br />trbor Codc. for lhc l)erlbm c of rhc *ort {or *hich rhc pclmil is ksmd <br />_lhrlc and sillfrai.rai. w.ikcn comp.nsotion insurincc. as rcquircd hy Sccrion]Tmof rhc tibor (.odc. for lhc P.rfommc of <br />rh. *o fq which rhis ncmit is isucd My worlcB onpcnelion insu6N €trict and Inlky nomlEr dc <br />Poli.yNumbd: Expncs: <br />I ccnift rhnr i'r rlr Nrf.nhtu. ol rhc work lor qhich rhi\ Ennil is istrcd. I shrlln.r c rtlo), rn, Nr$r ir rfy nufncr <br />{' $ ro t'.conrc uh]cd k,rhc+ortcr co'npctr$rn,n lJ*sorCrliror.ir. aM rlrtc rh iil \hotrld t'ccon'c stlic.rL,rhc <br />workcr( compcnsrlion provi\ions ofSc.tim 17fi)orrhc Lnhn C(xlc.l shrll.li,nh*ilhcn'nply *irI rlx){ pt)vr\idN <br />WARNINC Failu'c h r.r. w.ikcr' conrFnsnl <br />.ivil finc\ op ro onc hunddl rhou{nd doll s ($ <br />covcmlc h uh\,aul- and shau srbh.r u cnl,loyer to aininul r*mllts snd <br />rt. in addirn,o h rh. con ofconrr.ns,i.n. darn8cs rr px,vilcd r'or rh. <br />SNrion 3076olrhc bhor C,xlc. intcrc{ a (E:-. <br />D!!!.!-E{t!(2! <br />I hcrchy imrmundcr Dcnrltyolpcrjury r r p6visi{'n oICh0pts 9 (comm(n'g wirh Sc.rion 7m0) ofDivision 3 <br />l60 l \i <br />Dr(€ 7 /tr r( <br />I h-rby atlirn undc! IEnolty ol pcrjur, rhrr <br />issucd(se 1097.civ c.) <br />lcndirsa8crcy,hrrhcpcrfornurr.dof rhc*orkhrrnichihnPcmi n <br />APIIICANLIIEII,A&T.IION <br />I holhy {fmnnd$ pcn,hy ofp.rjuryonc oflhe fouo{ins dcclduri.N: <br />Dcmlilion Permirs Astr{os Norifi.arion Fcdc.r I R.gu ht ions (Til lc 40. Pan6) <br />-Rcqun.n <br />Lcrrcr o, Norifornln <br />ipflirrbk lo thn pnj.rr <br />ion hcorer I apxe ro.omply wnh rll Cnr.nd Colnry <br />iizc rcpresnlarnls ofrhh Ciryand Counlyto cnrer ulx n rhe <br />Drre <br />ELECTRICAL-INSPECTOH HECORD <br />Air Conditioners <br />D*. 2ft f /ts <br />of rhr Bu\i'r$ n d Protrtnor\ (-d.. n,xl nrr li.cnse is h tulllnrcc rrl.llrd <br />tt <br />I