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APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm I Dampers <br />Communications Cable <br />Buildinq <br />Under Slab I Floor <br />Bonding I Groundins I UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />lVeter Release <br />Rouqh <br />Service N/eter <br />FINAL <br />Notes, Remark s, Etc <br />I hcrchy nlfirm ilndcr fcnalty of pcrinry that I !m cxcmpl from lhc Contrxctos' Liccns I-{w frrr thc folkrwing rclson (Scc 7(1.11.5 <br />Busincss nnd Profcssion Culc): Any C'ity or Counly qhich rcquircs a Jumil lo conslnrcl. allo. imFrcvc. dcrmlirh or rcprir nnv <br />slruclurc. prior kr its issuuncc. nls rcquircs lhc alplicnnt for such lErmit lo filc a sigrcd stalcrrcnl thil hc or shc is liccnsd pursurnl <br />lo lhc n.ovisions of thc Collrackr,'s l,iccnsd ljw (Chaptcr 9. Comrrcncing with Section 7ffn of Division 3 of thc Burincrs and <br />Pmfcsri(rnrCrxlclorthothcorrhciscrcfiptthccfromilndthchf,sisforthcnllcgcdcrcnrption. AnyviolnlionofSclhnTo.ll.Shyeily <br />alplicanl liir tr pcnnit suhjccts thc lppliclnl lo tr civil pcmltyof mt mE lhrn fivc hndrcd dollars ($5(n). <br />-l. <br />ls ownerol'thcpropcrty.orlnycnrployccsrvithrvlgcs:rslheirsoleconrpensalion.s'illdolheq'orkanrl thcstnrlurcisnol <br />irtlclrlerl orofl'ert'rl lirr s:rle (Scc.7(I44. Busincss and ftofessiorrs Codc: Thc Corrlractor's l,icense I,trw does not npply lo an ou'tter o[ <br />the pnrperty who hrrikls or inrproves lhercon. llxl who drrcs srrch u,ork himsclf or herscll'or throtrgh his or hcr own entployccs. <br />provirlerl that such irrrprovenrnts nrc not intcrxled or offcrcrl firr s:rh. If. hou,ever. thc huikling or inrprovcnrcnl is sold s,ilhirr one )rflr <br />o[corn;rhlion. llrc Owner Buiklcr will havc thc hurrlen of proving that hc or shc dkl rxrt huikl or inprove the pnrpcrty for lhc purynsc ol' <br />s:r lc l. <br />-_=1. :tso\\'ncrol'lhc pro;"rcrly. :rrnexclusivclvconlrircting u'ith liccnscrl conlr:rclors lo conslnrct ttr: projcct (Scc. 70-14. Rttsilx:ss <br />:rrrl PrnlbssionCorlt': 'l'hc (bntr:rclor's l.iccnsc l-aw tlocs nol applvlo anowncr o[proJrcrtvu,ho huikls or inrproves lhcreorr. <br />itntl s'ho ('onlrircls lor such projccls rvith a Conlrnclo(s) liccnscd prrrsuanl to lhc C'onlraclor's l-icensc l;rrvl. <br />I lrtt crcrnpl ttrrrlc'r Sccliorr . l]. & P.C. firr this rcason. <br />l)nte: - - ownet' -w,Rxurct carntpunsau,n <br />DECLARATION <br />I hcrehy nlfirnr rrnrler pcrralty of pcrjury onc ol'thc following declarations: <br />-l <br />hnvcandu'ill nminlninnCcrtificateol'Consentto.Self-lnsurcforu'orkers'comlrcnsation.ns provirledforhy.Scclion.lTff)ol'thc <br />,ry" Crxlc. l'or thc perlirrmancc of thc work frrr which lhc Jrcrmit is issucd. <br />y'l h,,*'"nncl rvill rnaintninworkcrs'cornpensntioninsurance.as requiredhvSection.lTff)oflhcl.ahorCotlc.forlhc'lrcrfrrnnnnceol' <br />G work ltrr which this pcrmit is issucrl. IVty u'orkcrs' conlpensalion insurance carrier unrt Jxrticy nunrhcr nre: <br />cn.,i",,--S {bk* --,A/-al,;ryt mpa n.; <br />p,ricyNrr,*er:_BAUw C/0\SAb q \ _--_--F.xpircs: .t)-lL5-tU L <br />__l ccrlil'V that in thc pcrl'orrnancc o[lhe rvork ftrr which this permit is issued. I shall nol enrploy {lny pcrson in any nlanner <br />stt its lo heconrc suhjecl lo lhc workers'cornpens:rlion lnws of Californin. and agrcc thnt if I should hecome suh.iect lo the <br />workers' coltt;rcnsrlion provisions of .Scction 37ff) of thc l,atrrr Codc. I shnll. fonhrvith cornply with thosc provisions.. <br />WARNIN(i: lhihrrc k) rccurc wrkcrs'conrpcnsntion covcmgc is unlou'lill. anrl shall suhict an cmploycr ro aimintl Irn.ltics rtr(l <br />civil litrcsuphonchtrn(lrcdlhoustrn(ldollnrr($lfi).fiX)t.inarltlitiontothccostofcompcnsatior.(larruFcsssprovidc(ltbrthc <br />Scction .1076 oflhc Illxf C(xlc. iilcrcst trnd atkrnrcy's fes. <br />,",", cli/,J[ Lal- , Apprienr: X,ru i ,' -ll^n ,t] ls L --I,ICENSI'D CONTRACTOR <br />I hcrehy nllirm un(lcr pcnnltyof Friury rhnr t nnr,,."n** ffiChrpts 9 (()mrrcncing with setbn ?0(x)t of l)ivisi.n l <br />of lhc Busirlcss xnd Profcssions Codc. aill ily liccnsc is in frrll forcc xrd effcct. <br />l.iccrrsc ('l'ss: (\ <br />r)nre: 0'\lCilt\ <br />Applicnrrl or Agenl Signnlure: <br />Pernrilee nnnre (prinl ):v\L Hct <br />r.icenscNrrmhcr: 43-59 ) L <br />('onrrncro ,, -g-p r V=/-- Lgfis f'r "Ch t,\Inz- <br />n",u,-oQ fitlft <br />,^) l.L <br />C(INSTN,UCTION LENDIN(: AGENCY <br />I hcrchy offirm undcr Fnrhy oflErjtrry thtrt lhcrc is s conslnrclion lcntling agercy for thc Jxrfonnnncc oflhc wrk for which this prnrit is <br />issu(l (Scc. .1(Ir7. Civ. (:.). <br />lrndcr's Nanrc: <br />l.cntk'r's Arklrcss: <br />APPLI CA N'T DECLARA'IION <br />I r*un:hy allirrn unrlcr pcnnlty of Jrcrjury onc ol'thc folkrwing dcclarations: <br />Dcnrolitiorr Pcrnrits- Ashcstos Notillcat ion l;cdcral Rcgulations (Titlc 40. Pail6 ) <br />__Rcqu ircrl lrllcr of Notil rcat ion <br />_l ccnify thrl lhc fc(lcrnlrcg[ltrlions rcgaftling rshcsros rcmval flrc not Oplicahh ro this pmjccr- <br />ILll ccnily thit I hnvc rcil(l this xppliciltion aftt srnrc lh{t rhc nhrvc informnlion is corcd. | ilgrc ro (rnrJrly wirh trll Cily and Counry <br />ordin0Ncs ilild Slnlc laws rc[ling to huikling construclion. ad hcrchy nillhrizc rcprc$nltlircs ol this City nnd (:ounly lo cnls rtFn lhc <br />alxrvc rrrcnlionctl propcrlV for purJmscs. <br />ELECTRICAL-INSPECTOR R ECORD