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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS owNER BUil,t)ltR l)r!l.cARAtl()N <br />I hereby oflirnt under pe[illty ofperiury thtt I rnr exeDrpt fn)m the Contrilcktrs l-icc[\e l-xw frrr the frrlhru'ing rcasotr (Scr.7{).11.5 <br />Businesr anl Prrrfessirrn Crxlc): Any City or C()unly which requircs t ltrrrril lo cr)n\trucl. alcr. itrlfr(rle. dcnr)li\h (tr ttl,irir rny <br />strucrure.Iri)rtoits is\urrce.nl\orcquirestlfipplfrntlirr\uchFfnit!rflcr\igie(l\ltlcnrnl lhrllror\lEi\lic(D\c(l lur\uant <br />h rhe nrovisi)nr of the Contrnctor's l,icensed Lnw {Chafler 9. (iililnrencin8 wilh Seclir]tr 7()(x) of l)ivi\ir)n .1 ol lhe llrr\itre\q and <br />applicilnr for a pcnnit ruhjccts the npllicnnt to a civil penalty of nrt trrrc thrn [ive hun(lred ilrllrrs {$5{Il) <br />_1. as owner of the |)rol*rty. r,r nry emnli)yee\ with wcge\ n\ tlRir so[' c(xnFn\d i)n. will (h, llE c1trk rRl I lF strrkltlt i\ n( { <br />theFn)peny wlx)h{iklsorinprovesth€F)n.andsh)(liErsuchutrkhirn\elfrtrlErselfrrrthroughhisorlf,'rillvnenrll(iye('\. <br />mle). <br />_1. ns r)wner oI rhe property. iln exalusively contrrcting wilh licen{&l c0nlrrcl0rs lr) cotr\lnlcl llE pfl)iect (Sec. ?0 14. ltttsinr'is <br />and who contraclsfirr\uchDr)jccr\wilhr(1)ntrrcl()(\)liccn\erl|rur\urnllrlhe(i)nlrilclrir'sl.(cn\.'l-r\r'1. <br />I ilIrc\ernDt un{lcr Sccli(,tr ll & l, (. ti,r lhi\ rcr\,,tr <br />Date:- OHner:-- <br />lvoru(rRs' coluPl NsA l'toN <br />DECLARA'I'ION <br />I h€reby nffirm under Frn{lty of Frjury ore oflh€ fr)lk)wing dslrrationsl <br />_l havearxlwill nhintilinaCcnit^liltcofConsntt)Self-ln\urctirrworkers'crrrnpensrtion.nr pfi)vidcdforbySection.l?(xlilfthc <br />Llthr Gxle, f{rr I ha perfornmf,ce of the work for which lhe perfitil is issued. <br />_l have .nd will nlnintrin workers' compensation insurxnce. rs requirerl hy Scction .1711) oflhe t,xhor Co(le, irr the perlirrnlxnce of <br />the work for which this pcrmit is issucd. My workers' contpensntion insurnnca cxrrier iftl policy nuDlher ilre: <br />_l cenify thrl in thc perf(,rnuncc of tlt rir)rk for which thi\ |t rDlit i\ i\suc(|. | (hall o({ enlpl()y itry p.'r(rtr in rny rnirnncr <br />so as I' heconr suhiert to (hc wrrrker\'coillFnsiti()n hss of('xlifi)rtria. rfi(l tlrec lhrl if I \lx)ukl tx'corne \uhiccl l0 llB <br />*orkers'crrnrpensalionprovi\irxr\(,fSecti('n:]7l)()t)flheLrhtr(ixle.lqhrll.t!ilhwilhct)rDl)ly$ilhlh(tt'l)r(rti\i(rtr\. <br />IVARNIN(;: Failure lr rcure workers'cotr{En$ti()n cr)verilge i\ unlilwlil, an(l (hrll $hiect rn .rnphyer to (rirtrhnl |rnrllic\ and <br />Section -107fr rrf the l,rhtr C(xle. intere{ nnd alt)rrey s fees. <br />Datc: nppt,ant: -&' ' T7' <br />' - | lLdNSr p c0N'l RAC I(lR <br />DECI-ARAIlON <br />of the Business rnd Professirns Code. nnd rny license is in litll f(rrce rn(l efltct <br />Licenst:Nurilbcr: <br />Datei__ _ CoDtractot:(_,,t 7, <br />CONS'I'RUC'I'ION L}'NDING AGf, NCY <br />I hercby affirm under FEnolry of perjury rhrt th€rc is a conrtruoion bntling agency for tlt Jrrfrrnmrce of tlrc srxk lbr shicl thi\ lErni( k <br />issued (Sec. 1097. Civ. C.). <br />Lender'\ Nirnc: <br />kndcr's Addr.\\: <br />APPLICAN'I' DECl,ARA'IION <br />I hercb)'illfiflnun(ter |rrrlty rrf 6rluryone of the followins (leclilralir)[\: <br />Denx)lition Pernrits-A\heslr)\ Nrnificxtiotr t;ederfll Re8ulnti(,ils ('l ille 4{). I'rrl6) <br />Required [-elter of NrI illcnli()n <br />-l <br />cenify lhrl the federill refulxlilnr reSardinE n\tE\k)s renxr!rlrre nrl applicrhle trr lhis l)rt)iect. <br />_l ccnify rhat I hflvc reird this tpplic{tion rill \lillc thrt the uhrve infirrnrl hn i\ correct. I ngre lo (onrnly *ilh nll ('ity ilnd (iuflly <br />odinances nnd Sttre hwc rclilting t() huikling conilructir)n. ilfr| herehy rutlxrrize refresentilives of this Chy nnd Cr{rnly to enler uF)n llE <br />ahrve rmntioncd pnrFny fitr in\r(Jirr purFt\e\.FL'" t 1/' ,ste:Applkana or AEell Sl8mturc: <br />I'emlte mm (prlntl: <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor I ) <br />€6ndrtrq / Crr-oundins /(UFER Ah,trl*WWIlH <br />I ranslormers J'I <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soflit Rough <br />Ceilinqs (T-Bar Rouqh) <br />Itleter Release <br />I I <br />Rouqh {4Uhfl'-l tvtlt2 <br />Service Meter tiLlL lw wwr*,/ <br />FINAL ir:zi- it tunrt|y 37 <br />Notes, Remarks, Etc.( <br />Policy Numbcr: llxpircsl <br />-