9904-129 (BLCK)LICENSED CONTRACTOR DECLARATION
CO I hereby affirm under penalty of perjury that I am licensed under provisions of
f— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14LSU Professionals Code, and my License is in full force and effect.
O M" License # Lic. Class Exp. Date
I LU
o Z r- Date% Signature of Contractor �S t Qtf
(D O <
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OWNER -BUILDER DECLARATION 4_
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ C i 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 property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
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C'')() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
O N
D)
Z WORKER'S COMPENSATION DECLARATION
C) Cc I hereby affirm under penalty of perjury one of the following declarations:
U-) < p () I have and will maintain a certificate of consent to self -insure for workers'
X Llf LL
— compensation, as provided for by Section 3700 of the Labor'Code, for the
O, Q performance of the work for which this permit is issued.
m Q I X 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 IM I— permit -is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
00
r- CAL t1V.XAft,4 lily Sk�iZ *11A
g (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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I s all forthwith comply with..those provisions. �.
Date: ( <! �t Applicant—
a i
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 -
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
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
r
Main Drain
Bond Beam
— �. —4�
Approval to Cover
Equipment Location
t '3
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING P ROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.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)
\I