0012-071 (AR)LICENSED CONTRACTOR DECLARATION
U) (`hereby affirm under penalty of perjury that I am licensed under provisions of
Chaptef 9,(comrh'encing with Section 7000) of Division 3 of the Business and
C14 W °Professionals Code, and my License is in full force and effect.
O c) License # Lic. Class Exp. Date
�dB7
W 397975 P, Q71/2(
oZ to 1"14 Signature of Contractor - —"
(0 0
J U C) OWNER -BUILDER DECLARATION
WaLIJ r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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 pyolerty, am exclusively contracting with licensed
contractors to construct the,.project (Sec. 7044, Business & Professionals
Code). -�
ce) () I am exempt under Section , B&P.C. for this reason
N
O N Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
CQ Z I hereby affirm under penap) of perjury one of the following declarations:
In p () 1 have and will maintairi,,4 certificate of consent to self -insure for workers'
X W compensation, as provided Air by Section 3700 of the Labor Code, for the
O J Q perfofmance of the work for which this permit is issued.
m Q U (N I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d �permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Camer Policy No.
ao 5) STATE FUND 214-9A•0003ri13
�0
J
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the/
workers' compensation laws of California, and agree that if I should become
3 subject to the workers' compensation provisions of Section 3700 of the,Lali
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
y BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing O
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Q.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
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
Utility Notice (Perm)