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ELECTRICAL.INSPECTOR RECORD <br />DATE ID/SIG COMMENTSAPPROVALS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL -,arCl tr-D <br />Notes, Remarks, Etc.| --.r <br />667 <br />^r'MCBr43'zv"' <br />- <br />' <br />Owncr-Buildcr Dcclaration <br />I herehy alTirm under penalty ofPerlury that I am exempt forn lhe Contraclors Lrcense bw for lhe following reason (sec.7O3L5 tjusincss <br />and Profcssion ('odc): Any Cily or Counly which requircs a pcrrnit to conslruct, alter. improvc. dcrnolish or rcpair any struclurc. prior to its <br />issuancc,alsorequirctheapplicanlforsuchpermiltofilcasigncdslalcment lhalheorshcisliccnsed puBlanltolhcprovisionsofthc <br />Con(ractor's Licensed l,aw (Chapter g, ('omnrencing with S*tron 7000 ofDivision I ofthe Rusiness and Professions Code) or lhat he or <br />shc is cxempt lhcrefronr and lhc hasis for lhc slleged cxemplion .Any violalion ofSection 703 I .5 by Any 6pplicanl for a pcmit subjccls lhc <br />applicant tr a civil penalty ofnot morc lhan fivc hundred doll0rs ($500). <br />_1. as os'ner of thc propen),. or my cmployees with rvsgcs as lhcir solc compensalion. will do thc rvork and the slructure is nol intcnded <br />or offerad for sale ( Sec 7044. Business and Professrons Code The Contractor's l-rcense L6w does not apply to an owner ofthe propcrty <br />who builds or irnptovB thcrcon. tnd who docs such work himselfor hcrsclfor through his or hcr own cmploycca. providcd that such <br />improvcmcnts arc not intendcd or offcrcd for salc. lf, howcvcr. lhc building or improvcmcnt is sold within onc ycar ofcomplction. thc <br />Owncr-Buildcr will havc thc burdcn ofprovinS thal hc or shc not build or purposc ofsalc). <br />__ l. as o*'ncr of thc propeily. arr exclusivcly conlracling wilh licanscd lhc proicct ( Scc. 7044. Busin6s and <br />Profession Code: _l-hc Conlractor's Licensc lrw does not apply to an of whq burlds or improve thcreon, and who <br />conlracls for such pr()iecls wilh s Conlraclo(s) licensed !he l,aw ) <br />_l am cxcmpt undcr Section .8. & <br />l)ale: <br />I hereby 6fl'irm under penalty ofperjury onc ofthe following dcclarations: <br />I havc and will mainlain a Cerlificalc ofCoNent lo Self-lnsure for workers' conrgrcnution. as provided for by Setion 370o ofthe <br />libor Codc. for th. pcrfonnaf,cc of lhe work for which lhe pcrmit is issrcd. <br />Ihaveandwrllnrainlainworlers conrpensalioninsurance.as requiredbySection3T00ofthel,aborCode,forlheperfornranccofthe <br />work for which lhis pcrrnit is issued My workers conrpenslon insurance carrier and policy nunrher are <br />('aricr: <br />Policy Number:_ <br />l lhis scction neid not bc complctcd lf rfrc pmlr rs fr,, ft*dollars l$1001 <br />I cerlili lhal in lhc performancr ofthe work for which lhis I shall cnrploy anv person in anv nrf,nner so as to <br />hecame suhject lo lhe workers' conrpensalion laws of('ahfornia.rfl td to lhe worlers' <br />compcnsal ion pror isioils ol-sccl ion l7(x) oI the <br />I)nte: <br />WARNINC l'ailure to secure workers'l. and shall suhjcct an ernployer to criminal pcnallics and civil <br />fines up to onc huf,drcd thousand dollars ($l <br />lhe labor Code. inl(est and attorney s fe <br />addilion lo lh. cosl ofconrpensation. dailrages as provided for lhc Seclion 11076 of <br />LICENSED CON'I'RACTORS DECLARATION <br />I hereby amrm undcr penahy ofperjury lhat I am licensed under provision ofChapter t) (commencing \vilh Seclion 7000) ofDiyisi(ln I of <br />lhe Business and Professions Code. and rnv license is in full force and cffect. <br />License ('lass:[-icense Numbcr <br />I)ale: <br />I herehy aflim undcr penahy ofperjury lhrl <br />issucd (Sec. 3097. Civ. C.). <br />l-ender's Name <br />agency the pcrfomance ofthc work for Nhich lhis perniil is <br />l.ender's Address <br />APPLICANl'S DECI,ARATION <br />I)emoliti<rn Pernrils'Asbestos Nolification federal Rcgulatiof,s ('fille 40. Parl 6) <br />Rcquired Lcttcr oI Nolifi cal ion <br />I cerlilv that lhc lideral rcgulations regarding asbcslos nol applicablc lo lhis n()icct. <br />is coftcct. I altrce to comlly wilh all City and County <br />atrthorize reprcsenlali\es ofthis ( ily and CoInly to enler upof, lhe <br />l)ale:- <br />S'*'-t.u h tr{@- <br />orf>rfs <br />M:\WP5 1 \Permit-lnspeclion For lnspection 31 06 <br />uN-7 I