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COMMENTSDATE!D/SIG.APPROVALS <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Lile Safety /Low Voltage <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 (Rouqh) <br />Ceilinos (Hard & Soffit Rough <br />Ceilinqs (T-Bar Rough) <br />lVleter Release <br />--6r/./) <br />I t67/ 7 /VUL4.t a.).oRough <br />Itl nService Meter Dtha n-+fr4n DA:FINAL <br />Notes, Remarks, Etc I1 lv <br />ELECTRICAL-INSPECTOR RECORD <br />I hcrcby afiirm under pcnalty of pcrjury that I am cxempt tiom thc Contrrct)rs Licensc Law tbr thc tbllowing reason (Scc.70J l.5 <br />Busincss and Profbssion Codc): Any City or County which requfcs a fcrnit lo constnrct. altcr. inprove. denmlish or rcpair any <br />structure. prior k) its issudncc, also rcquircs thc alplicant tbr such pcrmit k) tilc a siSncd statcnrcnt that hc or she is liccnsed pursuant <br />k) the provisi(ms of thc Contractor's Liccnscd Law (Chaftcr 9. Cornmcilcing with Scction 7000 of Division 3 of thc Busincss and <br />proftss()ns Codc) or that hc or she is crcmpt lhcrcfi(,m and thc basis ti)r the allegcd cxcmption. Any violation of Scction 70.1 L5 by any <br />applicant li)r a pcrmit subjccts thc applicanl b a civil pcnally of not lnorc than fivc hundred dollars ($5txj). <br />_1. as owncr oI thc propcny. or my cnrployees with wrgcs as thcir solc compcnsalion. will do tlr work and lhc structw is not <br />intcndcd orolfcrcd fbr sale (Sre.7044, Business and Prottssions Codc: Thc Contractor's Liccnsc Law docs not apply k) an owner of <br />lhe pnlFny who builds or improves thcron, md who d(rcs such work himself or hcrsclf or through his or hcr own cmployces, <br />providcd that such improvcmn(s trc not intcndcd orollcrcd li)r sxlc. If: howcvcr, tlrc buildin8 or improvcrcnt is sold within onc ycd <br />ofcomplctrrn, thc Owner Buildcr will htvc thc burden ofproving that he or shc did not build or improvc thc proFfry fbr thc purfDs of <br />salc). <br />_1. as owncr ofthc property, am exclusivcly contracting wilh liccnsed contracloF to c()nstruct thc projcct (Sec. 7044, Bttsincss <br />anl pruti:ssinCode:ThcContracbr'sLiccnscLawdocsnolapplyk)anowncrofpr()pcrtywhohuildsorimprovcsthcrcon, <br />and who contracts lbr such prujects with a Conlraclor(s) liccnscd prrsurnt to the Conlracbr's License Law). <br />-l <br />am exctnpt undcr Section_-, B. & P.C li)r this rcason. <br />Date:- <br />TVORKERS' COI\IPENSATION <br />DECLARATION <br />I hcreby aflirm undcr pcnally of pcrjury onc ofthc fbllowing dcclaratioDs: <br />_l havc ard will maintain a Certiticate of Conscnt to Sclllnsurc trrr workcrs compcnsation, as provided lbr by Scction ]7(x) of thc <br />Labor CoIe, lirr thc pcrfbrmatrcc of lhe work lbr which thc pcrmit is issucd. <br />-l <br />havc and willnraiilaiD workcrs c()mpcnsation -17fi) of thc Irbor Codc, ti)r lhe pcrfi)rmancc ol' <br />thc work li)r which lhis pcrmit is issucd. My ard f)licy numbcr dc: <br />Policy <br />_l ccrtily thal in thc pcrli)rmrncc of the work tbr which this pcrmit is issucrl. I shall nol empk)y any person in any manncr <br />so astohccomcsuhjcctk)thcworkcrs'compensatiorhwsofCalilbrnia.andagrcethatiflshouldbccomesuhjccttothc <br />workers' comlrcnsation provisions ofScction J700 of thc LatDr Codc, I shall, li)rthwith comply with thosc provisions.. <br />WARNING: Failure h sccurc workcrs'c(,mpcnsat()n covcragc is unlawlil, and shall suhjccl an cmpl()ycr kr criminal pcnaltics and <br />civil tincs up k) one hundrcd thousand dollnrs ($100,000), in addition b thc compcnsation. damages as providcd ti)t <br />Section -1076 of.iDtcrcst and att)rncy's ftcs.q <br />I hcrcby atlirm undcr pcnalty oI pcrjury that I am liccnrctl under 9 (conmcncing with Scctin 7000) ofDivision l <br />of lhc Busincss and Pnrfcssiorrs Codc, md my licensc is in hrll ti)rcc Md cflcct. <br />Liccnsc Nnillbcr:tG <br />CONSTRUCTION I,ENDIN(} A(;ENCY <br />I hcrchy allirm undcr lrnalty ol pcrjury that thcre is a conrtmction lcndilg aeency fbr thc perli)rmancc of lhc work fbr which this pcrmi( is <br />issucd (Sec. -'1097, Civ. C.). <br />[andcr's Nanrc: <br />Lcn.lcr's Arldrcss: <br />- <br />APPLICANT DECLARATION <br />I lErcby afiim undcr pcnalty of pcrjury otrc of thc lilllowing dcclarations: <br />Dcmolition Permits-Asbcsk)s Ndification Fcdcral RcSulations ('I itlc 40. Part6) <br />-Rcquircd <br />[.ltcr of Notilication <br />-l <br />ccrtily that thc ttdcral rcgulations rcguding asbestr)s rcmoval arc n(n applicablc k) this pr)ject. <br />is corcct. I agrec to cr)mply with all Cily and County <br />rcprcscntativcs ofthis City and C(tunly k) <br />l),\, , rl* J 1; ')/i i ri <br />Pennitec namc <br />()5 <br />ufxnl lhc