0205-108 (RR)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 isin full force and effect.
License #. Lic. Class Exp. Date
/Date ' ` "�` Signature of Contractor
OWNER-BUILDEW60 L"AATION
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 isnot intended or offered for
sale (Sec: 7044, Business & Professionals Code).
( ) 11 as owner of the property, am exclusively contracting with licensed
contractors to constructrahe project (Sec.• 7044, Business & Professionals
Code).
O I am exempt under Section B&P.C.•for this reason
Date Signatureof Owner
WORKER'S,.COMPENSATION DECLARATION
1. hereby affirm upder penalty of perjury -one of the following declarations:
O 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 f& Which this permit is issued.
1 -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
permlt;is' issued:'My workers' compensation.,insurance carrier & ;policy. no.' .are: .
Carrier 1�'atf? RAN]) Policy; '0. Opp- IOtt°0{iE�d
(This.section need not;be completed if.the permit valuation is -for $100.00 orless).
O 1`certify.that inathe performance of the: work for uVhich'this perniit;is issued -'
I'shall not employ any personJn any manner_so as to become subject,to the.
workers' compensationlaws of, California,.and;agree that'if I1shouldbecome
subject to the workers'. comperisation provisions of Section 3i(30,of,the Labor
.Code I shall forthwith comply with those prowslons: ,
/Date' kT Applicant -
Warning:
y,
Warning:, Failure to:secure Workers Compensation coverage Is unlawful -and
shall sdbject an`employer to criminal penalties and civil fines up`to'$100,000, in
'aadition'to the cost'of compensation, damages as provided for"in:
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
_ _
I[=! Fr!
Exhaust Fans
O.K. to Wrap
17
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 r'j�(70_}=
BLOCFCWALL APPROVALS
Final
POOLS r SPAS
steel —
Set Backs
Electric Bond
Footings
_
Main Drain
Bond Beam
Approval to Corer
Equipment Location
_
Underground Electric
—
_
Underground Pibg.
Final
Gas PipingGas
PLUMBING APPROVALS
--
Test
El�tric Final
Waste Lines
Heater Final
Water Piping
— —
Plumbing Final —
Plumbing Top Out
_ _
j
_
Equipment Enclosure__ —
Shower Pans
Sewer Latera
_ ^_
—
——�
O.K. for f=inish Plaster
Pool Cover
Sewer Connection
_
_
,Encapsulation
Gas Piping
_- —
--
Final
,
'
Gas Test
Appliances
I
+_ -
-
Final
Utility Notice {Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 1
Underground Conduit
Rough Wiring
Low Voltage Wiring
--� —
Fixtures
Main Service
_
Sub Panels
Exterior Receptacles
G.F.1.
Smoke Detectors
Temp. Use of Power
Final --
Utility Notice (Perm)