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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS <br />Site-Work <br />Underoround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />JVleter Release <br />Rouoh <br />Service Meter It t <br />FINAL 3 / rt /c,o .zlN)-t '.ft ) <br />Notes Remarks <br />OWNI:R Bt]ILDER DEI,CA RATION <br />I hcrcby affirnr under pcnrlly ol pcrjury lhal I am excmpl lk)nr lhc Contrach$' Liccnsc lrw for lhc folk)wing rcasn (Scc.70-]1.5 <br />Busincss tnd Profcssk)n Code): Any Cily or County which rcquircs a pcrrnit lo conslruct. altcr. improvc. dcnrolish or rcpair any <br />slruclurc. prior lo its issuancc. also requircs lhc applicnnt li)r such pcrnril lo tilc d signcd slatcnrcnl thal hc or shc is liccnscd pursurnt <br />b lhc provisioDs of thc Conlractor's Liccnscd Law (Chaplcr 9. Commcncing with Sccti([ 7(XX) ot Divisi(,n 3 of thc Busincss and <br />ProttssiotrsCodc)orlhillhcorshciscxcnrpllhcrcl'rcmandlhcbilsislorthcallcgcdcxcmption. AnyviohlionofScctionT0.ll.5b!any <br />applicrnllbr:rpermilsuhjcctsthc apf,licrntt)acivilpcnilltyofnotmorclhanllvchundrcddollars($5(X)). <br />-1. <br />as owncr of lhc prolrf,y. or nly cmpk)yccs with wagcs as lhcir sole conrpcilsation. willdo thc work and lhc slMlurc is nol <br />inlcndcd oroll'crcdlorsalc(Se.TOl4.BusincssandProfcssionsCodc:ThcContrilcloasLiccilscLawdocsnolapplytoimowncrof <br />thc pn)frny who huilds or improvcs lhcrdrn. ilnd who d(rcs such work hintsclfor hcrscll ()r lhrough his or hcr own cnrpkryecs. <br />providcdlhrtsuch itrl)rovcnEnlstrctrotiilcndcdorollcrcdli)rsule.llhowcvcr.thcbuiklingorinprovcnrntis$klwilhin(,nc)rir <br />ol cotrrplelion. lhc Owncr Builder will hilvc lhc hurdcil ol proving lhnt hc or shc did n(n build or inlrovc thc pmlrny li)r lhc purfbsc ol' <br />\illc). <br />-1. <br />ns owtrer of lhc p()peny. aill exclusively conlrilclintl wilh liccDsc(l conlrcclors () conslrucl thc pr(iccl (Scc. 7{).14. Busirc\s <br />uml ltoli:ssion Codc: 'l_hc C()ntrilclor's [-iccnsc Law docs n(x al)ply t(, an os'ncr ol propcrly who huil(ls or itr]provcs lhcrc()n. <br />and who c()nh'ncls lirr such pr)jccls wilh a Corilracl(,r(s) liccn\cd purNuanl k) Ihc CoDlrtrclor's l-iccnsc ltw). <br />-lamcIeDlplundcrscclion-.B.&P.C.forthisressonlhlrOwncr: <br />\VORKIIRS' CoNIPI,:NSAI'I()N <br />DECI,ARATI()N <br />I hcrchy alllrnl undcr pcnahy of pcrjury onc of thc following dcclarations: <br />_l hilvc and will illaintain il Ccnificrte ofConsent to Sclf-lnsurc for workers cornpensatirrn. as providcd for by Scction 3700 ol thc <br />tibor Codc. for lhc pcrformancc oflhc work for which thc pcrilrit is isslcd. <br />-l <br />hrvc and will nrilintrin workcrs' compcnsalion insurancc. as requirc(l hy Scclt)n .i7(D ol lhc L{hor Codc. for thc pcrfortrrilncc of <br />thc ur)rk for which lhis Jrcriltit is issucrl. My workcrs' conrpcnsnti(rr insurilncc caricr aml Jxrlicy nunrhcr arc: <br />( <br />P(,licy Nunrbcr Exl)ircs: <br />-l <br />ccaili thnl ii lhc ncrli)riluncc of lhc work li)r which lhis pcrnrit is issued, I shlll not cmploy rny Jrcrson in sny imnncr <br />so as kr trcontc subiccl lo thc workers' coiltpcnsatt)n hws ofCaliforlin. and rgrce lhfll if I should hecr)mc rubjcct lo thc <br />workcrs'conrpcnsalionprovisionsofSccttrnlT00ofthcLakrrCodc.lshrll.li)rthwirhcoilrplyrviththoscprovisions.. <br />(ivil llrx\ lrlJ t{) (,ilc hundrcd lhou\ilnd (l(,lhr\in ilddition lo ol cornlcn\nli()n. tlarnagcs as provi(lcd li)r lhc <br />Scclion -1076 ol lhc Lalx)r C{xlc. inlcrcsl ilnd <br />,,,", '\ / (, AL <br />l)ltcl.,\tt,\t l()N <br />I hcrchy illirtrr undcr pcnalty of pcr.jury rilt p()visi()n ot ('hrl)tcr 9 (c()rlrncn(ing $ilh Scclion ol I)ivision.l <br />of thc Busirrcss nnd Profcssions Codc, and my liccnsc is i[ tirll lbre ilrl cffcct. <br />al}Tq\al.icensc Chss ,iccnse Nunlhcr: <br />o",",2\l LLf -L D \A^*;\ <br />I hcrcby aftirm undcr Ftnalty ofpcrjury <br />issucd (Scc. 3097. Civ. C.). <br />IJndcr's Namc: <br />is x colstruction lcnding agency li:r thc perlbrtrtancc of lhc work tor which this |rfinit is <br />[rcndcr's Addrcss: <br />APPLICAN'I DECLARATION <br />I lrcrohy allirm undcr pcnally of pcriury o[c of lhc lbllowing dcclarations: <br />Dcmolition Pcrnrils-Asbcstos N(ilificntion Fcdcral Rcg!htions (l itlc 40, Part6) <br />-Rcquircd <br />If, tlcr of Notilication <br />I ccflify thill thc rcguhlions rcSrrdin! :l\h!\los rcrn()!'rl arc n({ tpplicahlc t() thi\ p()icct <br />-I <br />rhar I rcrd this rpplication and slnlc lhrl lhc rlx)vc inlirnnilti(il ir corrccl. I agrcc nr cr)[tply wilh illl ('ity nld ('ourty <br />rrrd tnws relaling to building construclion. uxl hercby autlxrrizc rcprcrcnlalivcs of lhis City and Counly k) cntcr uF)n thc <br />alrove purposc\. <br />Applirant <br />Pemitee na\ <br />Iropcrty for <br />rc\.-tq ** a./t\/ r D