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APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I h*.1ry altm !6do peml!, ot pdjury rhd I m.rmpl &o,n rh. Conrado* Lic@ Law tor lhc lollovios r@n (Sd?oll5 <br />Asin6s and Prcfsion Codc) Any City or Coualy which r.rlun6 a Dsnn lo cocttud. tlld, iniprc{.. dcmalish or Epon ! <br />slruc1u.. rior ro its i$udc.. also rcqun6 thc arpli.d for suci p6rn lo fiI. . si8ned sardnar that hc or she is licoEd pum l <br />ro ri€ proririos ofth. aontreroas Licetucd L.w (Chaprd 9. Conm€ncioE wnh S<rio. ?000 of Divhion I ofihc Rusines 8nd <br />PrelBioB Codc)orrhar lE or shc b er@fl rhdeftoo &d rh. b6B for ih. all.g.d .$nption. A., \iolationols..lioo 70ll.t by lny <br />aprlicanr for a pdnii subjds th. rpplicanl ro acivilpo"ltyofnot noic than fivc hun&cd dollrs {5500). <br />I. s oqns ofrh. p'op.nr, or 6y .6plo,6 *nh $,96 &s rh.n $E .onpftilion, will do lh. ro.t d lhe nrrtr1@ t nor <br />inrdial or oit6.d for sL (Sc.7044. Busi.s ed Prolsiod (\d.r Tfi. Contraclois l-iccE LN do6 .o! arpl, lo m o\ nd of <br />rhe popdy who buil& or impovB rh@n. rd who &6 such sork hifts.lfor hmlfor rhooBh his or ha own mployc. <br />prcvid.d thar such impromts e not inlod.n or oltdd for $1. ll hoN6s. rh. boildiry or imFovdol i. sold within .n. )d <br />ofsmpldio( rhc ow.d auildd trll, n!\. fi. hrd.. ofpro\i.a $sl he or sh€ ditl ml hrild or inurore lhc D,llcly ror rh. ptrls* of <br />I. sownaolth. pmpdry. m cxclusivcly co.hacrins *ilh licosd conlmdoEto Nosrtocl rhc irojd (Se. 7014, ttErn6s <br />and PDlsbn Cod. ]'he conh.ror's Licms. Li! do6 n.r rpnly ro d otr.6 o f prop.ny who builds or nnpror 6 lhrdn. <br />and who conrE:ls for suchFoj.cls *nh a Conrraclo(s) li.oscd p6@r rd rh.contr.rors Li.G. tis). <br />I dr.xempt under S(rion .a &PC lor rlris ir':Bon <br />Drr€ owmr <br />!QAKE&::CO[IEE!!Af&! <br />DECI.ATAIIO! <br />I hdeby.fim undd r.mhy of psjury onc ot th. followin8 ddl&atio6: <br />lhalcudwillmainlainaCcrrificaleofCotrsorto Sclllnsurc ior work6 coo\*Nali.n. a prolid.d lor bySErionlT(,YJoilnc <br />L.bor Cod.. tor ltc psfomscc oflh€ $o,[ tor which lhe pmii is i$ucd <br />I havc and {ill mainrain *orldt corp.Barion iNum.oi s rcqoned by sdion l?00 ol lhc Labor Codc. lor rhc Ffofrhc. .f <br />rhc worl lor which rhb pmil ir i*u.d. M, wort@ cornp.Balion ircumc. cari€r od policy nunbs d€: <br />hnicyNu'nb6: Erpt.s <br />I cdlify rhar in thc paaomanc. ofth.*ork for vnich this Fmit is i$u.d.l shall rul dploy any po$n in tny m.nnd <br />$ s lo bc€om€ subjsr Io rhc porL6' comp..saiion l.s,s of Califomia. dd agc. 6ar if I 3hoold b..om€ subjal to lhc <br />worl6 compoelio. pmvi3ios ol sdrion 1700 olrhc L.bor code.I sh,ll, hdh*ilh comply wirhrhoFprovisioa.. <br />WARNINC lailurc to Ku€ wort6'.oopcMlion cords. is unlrwful, md shdl sobjci an 4plord lo oininal poEk6 &d <br />.ivil ,in6 up to onc huodred rhoe.d doll6 ($100.000), in .ddi(ion ro rh. cosr of.o'npensalion. damascs as rrovid.d for lh€ <br />Serion 1076 olrh.l$orCodc im*cr od rtrofty s ac. <br />Appu6nr:_ <br />LICENEECqEIBACIOA <br />DECIJ86IIO! <br />I hd.t, anm unda pdalry of pdjury lhal I on licslr.d ondd Fovision otchap!6 I (coh'ndcins with S61io. ?000) of Division l <br />oa lhc EBin6 ed PofdioBcod., ed mylicds.tin tull lorc. dl cilrl <br />cadsraucrlaNi,ElDtdc_Ac&lcl <br />I hmby arnrm und6 p.nahy of pdjury lhd rh6. is . oisltuclion Lrding agocy for th. Ffollruc. of lt. wo* tur which lhis pdnil i3 <br />isu.d (Sd.1017, Civ. C.) <br />A TUCANLOECIAMIIQ! <br />I holty Bfrm undB polhy olpdjury on. ofthc followins d(lualions: <br />D.molition P.miteA3h6los NolifiEliof, F.ddl Rcguldios Gnk!0. P.n6) <br />R€qun.d Lard orNotifqrion <br />I csl ily rhar thr f.d6al r€sular ioN rclddins s rsovil 6c nor E,pricrble ro rhb pmjd <br />I cd,ay rha( I havci@d this {pli.alion d slorcr infom.lion is cotrer I .sre ro comDly virh aI Cn, a.d Contrly <br />r.prsiariv6 oflhis cny &d counrlro dr6 lpon rh. <br />alaNe m.nr i.ned pruprdy fff idp..rion <br />ADplicrnl or ,lEenl SiEnilur. <br />{-"*",*fi_t1 <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 Rouoh <br />Ceilings (T-Bar Rouoh) <br />Meter Release <br />Rough <br />Service lrleter <br />FINAL g-u-/7 ,DcltJl -q <br />Notes, Remarks, Etc <br />ELECTRICAL-INSPECTOR RECORD <br />oildan.6 and Sr.r.1.\6 rclaring to brildinr