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DATE tDistG.COMMENTS OWNER BUII,DER DET,CARATION
<br />I hcrcby rmrn undcr,)cnrhy of peaury thrt I m.r. r0r fion rhc C..rEcbn l-iccnsc trw ror rhc rolbwinS 6$on (Se 70:ll 5
<br />Busincs !.d Prolcssion Codc) Any City or Cou.ly which rcquios a ,.nnit ro co.(dct. 0llcr. nnrnv.. dcmlkh or rcp0n rny
<br />sru.ruE, J,i, b ns hsuaicc. ahd r.qnircs lhc q,plicatrr for such lcmil lo ljlc a sisncd srorcm lnar hcor shc h liccnEd puNotrl
<br />ri, rhc pmvisiotrs ofltr Contnclois Liccnscd tjv (Chrrr.r 9. Comncn.in! wnh Sc.rio. 7000.f Oivisi.n I ofrh. Burin.* a6d
<br />Pmr.ssions Codc) o. rhlr hcorsh. ncrcmfl th€rcfrom rnd th. bnsh forlhc ollcscd cxcmpln'n Any viokionofScctio.?031.5 hyuny
<br />aflli.i forapflnil subjccB rhc imli.a.r ro !.ivilp.n!ll!ofnot nn,crhri filc hund..ddollm (Stoo)
<br />l. r osncr ol rh€ l,orEny. or my enulo)es wirh wr8c\ $ thcn b[ onpctrslri.n. will do ll* work d lh.(urEn mr
<br />i c cJ or ollcBl f.r slc (Sd.7O4,1. Bxsim\s dd Prufcsions c{d. Thc Co mctr's Li.cns. Law docs n.r rrtly l. itr .wno of
<br />rhd pn,Fny *h. buinh.r i'nprorcs rhcanr {Jkl who dcs snci so* hir\cllor hcn.llor thmugh hh or h.r oanc'npk'y&s.
<br />rovidcd rhlr su.h impnrmnls .rc rn i.rcndd or ofcrcd for slc ll lFwcvcr. rhc hoildiry or h{'mrcrn is {ld silrrin nc ttar
<br />ol conlpLriof. rtu Oqocr Buil&r will hr\r rh. bur&n olpovirU rhar bc o! \hc dil mr hoild or iryror rhc pft,pcny fd rh. llqsk of
<br />l.!sowtrcrofrhcFrNdy.r.r.rclu\ilcly.onkncrirywirhli.cn\.dconr!.r,*roc.nnru.rrrrptuic.r(sc!104-4.AuqNs
<br />rnd |\trLslbn c(dc: 'fhe Conlrackn s Licctrsc Ln* docr noi.pfly b {n osmr olropcny sh. builds or iarprolcs rhercon,
<br />and who oirtu N lor such pmlc.rs wirh trconrrid{n(tlicc.scd pur\ulnr rorhco,ntrtni |-ien* I!w)
<br />I Mr cxcnrl undcr Sc.rtr,
<br />Dnler ()*n.r:
<br />woRxFRs, c()]trPiNsair(N
<br />DECI,I"BAIION
<br />I hcrcbyrlltmundcr FnnlryorFrjuryomorrhc ri,lk,winrdc.lnr,rio \:
<br />I hav. &risillminrain r Cdn ifi.ard of Co.scnr h sclf ln\tE lorsorkc( q,mncnsdn'n. rs lftvidcd for by sccrbn 17ff)oflhc
<br />l-'htr Cl c. r(n rhc p.raormrce olrhe eork tor *hich rhe peln t is hsucd
<br />_l hovcafld will mainhin workc comp.nsnl,on insunmc. N rquind hy scd nrn 17fi) of rh. tjhor Codc. for lhc t'crfomurcc of
<br />thc *ork lo! *hich
<br />'his
<br />pcmit is issucd My worktB .onpn{rion i6surd.c.dicr od lDlty numher ecl
<br />crrrr: ' l'* r-1'; lc/'.7
<br />l\nry Nnnrhcr . Lrti,cr
<br />-l
<br />ccniliihd in rhc lrcrfornnNeol thc wolk,or whichrhn FnDir is issucd.I shrll ml cnrploy rtry p.rcn h any m.trncr
<br />$Nk,hc nc slhFd lolhc*orhe6 compcnsllion laws ofcrlifornitr. tr asrcclhlr ilI should hccom ubjcd rolhc
<br />so.kc^ Ll,mpcn\rlion pnvnn,ns otSarion l?(xrofrh. titnr C lc. I .h.ll. fodhsil h coqrly wi'h lhoc lmvhion\ .
<br />WAININC lailurc t,, scurc sor kc6' .onDctrsll im ovctulc i! unlosrul. rtrd $!ll suhi.t m cmploycr to annhol Fmllics md
<br />.ivil fin.s up b nnc hund'cd rhou$nd lollrrr lSlIx).{XX). ir nddiri(r I
<br />sd.rnrn .l(|76 !frhc Lrhn a{ic, i'rrcrcsr and (lrorEy s ltcs
<br />u,,.. ' )P ^2?'/ 3
<br />ult;xsrlrelJll&lllaa
<br />D[('LARAl'ION
<br />I hcrcby uftlro uid$ !.nrhyorpcrjxry rhdr I unr li(nsd undcr pmvisn,nolChrprcr 9 (comnEncins sirh Sccrbn 7fi)) .r Divi\i.n .l
<br />or rh. Bosinclsnnd Pmfcs\ions Co.le. a nr) lj.cnsc k io tulliorcc flrl clld
<br />c?i)s ?r'/"?
<br />I;AIEIIIJI:IIONIENDIIG.AGENCI
<br />I hcEhy am n undfi Ftrrky of pcrury r har rh.rc h a ..n\rocrt'n hndinE agcry f{r rhc r*rfonNr.c of rh. qork fitr $ hi.h rhi\ Jrmii i\
<br />isued (Scc -1097. Civ C.)
<br />lIItuclNLDEcl. aAIIoN
<br />I h.tby afim1trndcr pcnally oireritry onc ollhc iollowinE dNlrirnnrl
<br />Dcmnithn Pcnnir! stEsros Norli(alion Fcdftrl R.!trhr bns tTirlc 40- Pd6)
<br />-Rcquircd
<br />t trcrolNorllcJri
<br />_l ccniryrhm rhc ltdcrolrcrllart,nr rcs0rdins 6h.slos rcnrvrl 0rc flornmli.$lc b rhn thj{r
<br />Z,t,o,,n,,hr\c rcxd rlrArml'.rto d n,ir rhd rhr rhrc i'rftnfrfotr rerm b confly *irh rll Ciry rnd Counry
<br />d\orrhh( iryrdd C.u ly t, .trrd uJini rh(rrc tiws rclarir8 ro htrildirScorrrflcrio[ nid hrr.byatrr
<br />n',r,,..,r,,,, a-"r, a,rr,,,".. X *,.- r z9|/t
<br />P.miremmc(prinr): X -/(.</t 1-L/<
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dam pers
<br />Communications Cable
<br />Building
<br />Bonding / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Rool To p Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />It/eter Release
<br />Rough
<br />FINAL I ,ltt ht\tufifi-tKl,/-INotesRemarksEtc
<br />I
<br />ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS
<br />Under Slab / Floor
<br />Air Conditioners
<br />Service Meter
<br />l Llc' . A'iJr($
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