9907-390 (SFD)LICENSED CONTRACTOR DECLARATION
I. hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals *Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
63`7252 2912(9
Date tib Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended,or offered for
sale (Sec. 7044, Business & Professionals Code).
( ). I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.C. for this reason"
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one: of the following declarations:
( ) I have and will maintain a certificate of consent to self insure for workers'
compensation,_ as. provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( I have and will maintain workers' compensation insurance,, as required by
Section 3700 of the Labor Code, for the performance of the work for which 'this
permit is issued. My workers' compensation insurance 'carrier &'policy., no. are:
Carrier Policy No.
LOYAL Ire;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
=
Underground Ducts
Forms & Footings
Ducts .
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck%
�U� U6 •
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
—CJ(j //
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
G_
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final,
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
- _ Go
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
r
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
-4-7- Ud
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
LOW Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 6U
Utility Notice (Perm) (j