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APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountalns <br />Signs (monument) <br />Life S&ty /Low Voltage t-Fte Ffaryd+lampers il tqlrl <br />G-nrmunications Cable tt lu LY <br />I <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit x <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release .,,\ <br />Rough <br />Service Meter <br />FINAL <br />Notes, Remarks, Etc. <br />--7 <br />Omer-Builder D*luation <br />I heeby a.ftim undo p.rElty of pcrjury th8t I m acmpt fom the CootndoE'Liens Law forrhc following rcen (s.7031.5 Business <br />ud Profcsion Codc): Any City or Couty whicb requir* a pemit to @Nmq alter, improve, demolish or repai, oy shdue, prior to ils <br />isoane, alrc requtes the appliut for such pemit to file a signcd satement that hc or she is licered pursmt to the provisiom of thc <br />Contrador's Li@Md Law (Chapter 9, Comencing with Soion 7000 of Division 3 of thc Busincss ed Profssions Code) or rhat hc or <br />she is ucmpt lhere&om md the buis for the allegcd acmption .Aay viol*ion of Saion 7o3l 5 by ey applimr for s pcmit $bjccb the <br />applimt to a civil penalty of oot more thu 6vc hudred dollrs ($500). <br />-I, <br />s omcr of the prcp€ny, or my employo with wrgo as tlrcir rcle @mp€nslior\ will do the work rad the structue is nor itrteodcd <br />or ofered for sale ( S@.7o44, Business ed Professious Codc: The Conractor's Liccm Law docs oot apply to m ow ofthc property <br />who builds or improvs rhoeq md *ho dG sch work himslf or horlf or tlrough his or her om employc, providcd rh8t sucb <br />improvemcntr ue not intendcd or offcrcd for sale. If, bowever, the building or improvement is rcld within ooc yu ofomplctioo, the <br />Omer-Builder will havc the buden ofproving *Br he or shc not build or improve for thc purposc ofsalc). <br />_1, 6 owr of the property, m *clusively ontraaiog with liccnscd @nmdors to @nstrud the projd ( Se. 7044, Busitrgs ad <br />Profesioo Codc: The Conlrdor's Liccns Ilw do6 not spply to m omcr of pro;vqr who builds or improvo thq@n , ud who <br />@trtrm for $ch prcj*G with s Contmctor(s) limscd pusumt to thc Conmaor's Lien* t:w ). <br />I u €xempt undq Sdion <br />Dale: <br />& P.C. for this rwn. <br />WORKERS COMPENSATION DECI-ARATION <br />I hereiy alfm undo penalty ofpojury onc ofthe following dxlraiom: <br />_l havc utd will mintain a Ccnifiate of Coreot to Selflmc for workm' ompemtioq u provided for by S@tioo 3700 of drc <br />kbor Codc, for thc pcrfomae of tlrc work for which the psmh is ised. <br />_l have ud will maintaio workm' ompcnslion inrurue, u rcquired by Scction l70O of thc kbor Codq for thc prfol]Me of the <br />work for which this pcmit is i$ued. My work6' ompcn*ion inuue wiu ud policy numba ue: <br />1) <br />Grt ((, lt >- <br />ection not b€if the permit One hundred dollas {SI00) or lcss) <br />_l catify in the perfome of the work for which this pcmh is iscd, I slull m mploy uy in uy mmnq s s to <br />bame subjea to the workcrs ' ompen*tion laws of Califomia, ed age lhrt should baome to thc workqs' <br />ompenution provisions ofSwtion 3700 ofthe Iabor Code, I with those <br />\frurC F&ilure to we workes' ompemdon rcvuage is uolawful, od shall $bj€t m employq to qiminsl pcoaltiB ud civil <br />fins DPto one hudred thouwd dollm ($100,000),itr addition to thr o$ of compenstio4 damges u providcd for the Ssrion 3076 of <br />the hbor Code, intqst ud fiomey's fes. <br />LICENSED CONTRACTORS DECLARATION <br />I hereby a-ffm under penalty of perjury tha I M li@nscd mder provision of Chaptcr 9 (@mencin8 wilh Sdioo 7000) of Division 3 of <br />,*Busines and Profcsiom Codc, ud my licens is in full fore md effat. <br />LiceN Class ,*,*n*0. 4l\65 ( <br />PMIJ@Contrador: <br />CONSTRTICTION LENDTNG AGENCY <br />I hereby a.flim uoder penalty of p€rjury tist there is s @Nlruction lending agency for thc pcrfomue of the work for which this pemit is <br />isred (Se. 3097, Civ. C.) <br />Lendcr's NMe: <br />Lender's Addre$: <br />APPLICANTS DECLARATION <br />Demolition PermirAsbestos Notification Federal Rcgulations (title 40, Pm 6) <br />_ Rcquired Later ofNotili6lion <br />_l certify thd thc fidoal rcgulations rcgarding asbertos rmoval ec mr lppliablc b this projer. <br />- <br />I miS tha I havc rad this application dd smr that thc above infomdion is @rd. I sgre b @mply with all Ciry md County <br />ordinance md Sme Laws rdating to building oromcioq od uthorize rcprenadvcs of this City md CNty to qter upon the <br />above mentioned propeny for <br />/sppri*rt,e nMc (print)l I L:T> Sf L\t r,1{ lt/ <br />ELECTRICAL-!NSPECTOR RECORD <br />Rffid.dm 03.31.06