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ELECTRICAL.I NSPECTOR RECORD <br />Rev.0B-07-2015 <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARA ION <br />I hoeby afflrm undq poalty of ptrjury that I an cxempt from lhe Contractos Licrue tiw for thc followinS reen (Sa.7031.5 <br />Business md Profession Code): Any City or County which requira a pomit lo coNtrucl, a.lts. improvq dmolish or rqnir uy <br />structue, prior to its issuoce, also requir6 the applicilt for such pefinit to file a signed stammt that hc or she is lic$cd pmumt <br />to lhe provisions of the Contractor's Licensed taw (Chapttr 9, Commencing with Srction 7000 of Division 3 of the Bsincss md <br />ProfNions Code) or that he or she is excmpt thqefiom md the basis for the all€ged exmption. Any violalion of Section 70-11 .5 by any <br />applicantforapmnitsubjectsthe applicanttoacivilpenaltyofnotmorethafivehundrcddollas($500). <br />_1. s osn6 of the propeny. or my employe wilh wa86 6 their sle compcmation, will do the work md the struduc is nol <br />intfldql or ollered for ele (56.7044. Busins md hofsions Codc: Thc Contractor's Liccnse liw do6 not apply to il owns of <br />thc prepsty who builds or improve th6on. md who do6 such work himself or hwlf or thrcugh his or ho om employes. <br />providcd that such improvmls tre mt intmded or offsed for slc. I[ horvryq. the building or improvement is rcld within one ]s <br />ofcompletion. the O*ner Buildq will have the budo ofproving thd he or she did not build or improve the prcpaty for the purpo* of <br />sle). <br />_1, s owns of lhe propdy. an exclusively contracting with licfficd contractoE to coNlruct the prcjst (Sec. 7044. Bwins <br />md PrcfcssionCode:TheContractor'sLicenseLawdoesnotapplytoilown6ofpropertywhobuildsorimproveslhs@rL <br />and who contracts for such projGts with a Contrado(s) licmsed pumumt to the Contraclor's Licmsc Law). <br />I an exemDt unds Sslion-. B. & P.C. for this re6on. <br />O*ner <br />YABtrEBSIAMEENIAIIAN <br />DECLARATION <br />I h6cby amm undq pmalty of pojury one of thc following dslealioru: <br />_l have md will rnaintain a Cqtificatc of Coront to SelflNurc for workos' compmation. 6 pmvided for by Sction 3700 of the <br />Labor Codq for the pqfomucc of thc work for which thc permit is i$ued. <br />(have and will maintain work6' comp€roation imurece. a required by Setion 3700 of th€ Labor Codc, for thc fsfomancc of <br />the work for which this permit is issued. My imurmce cmie ad policy numbo ac: <br />D <br />l\rlicy Lo7 o La <br />I cefriry lhat in the psformance ofthe work for which this pornit is issucd, I shall not qnploy any poson in any manna <br />rc olobccomesutrjectlotheworktrs'compemationlawsofCalifomia,andagrcethatiflshouldbecomesubjtrttothe <br />work6' composation prcvisiore of Saion -1700 of the Labor Code, I stEll. fonhwith comply with thos prcvisioro.. <br />WARNING: Failure to suc worktrs'compeNation covcrage is unlawful. md shall subjet m onployer to qiminal pruhiq md <br />civil fines up to one hundred lhoused dollds ($100,000), in addition to thc co$ of compensation, danagcs o providcd for thc <br />Scrclron 3076 of the l,abor Codc, intercsl ild atomey's fe.-1-G-{-ytrrtz t <br />,n", l-Zl- Lo <br />DECT,ARATION <br />I hocby affmn undo penalty ofpsjury that I m licensed undo provision ofChapta 9 (comrnocing with Section 7000) of Division 3 <br />of the Bsins md Prcfqiom Code. md rny liceroe is in full force md effct. <br />License o3L2h <br />CONSTRUCTION LENDING ACENCY <br />I hqeby affrm unds penalty of ptrjury that th6e is a coNtruction lmding agmcy for the pqfonnmce of the work for which this pemit is <br />issucd (Sa. 3097, Civ. C.). <br />[,cnds's Name: <br />Ladq'sAd&B: <br />APPLICANT DECLARATION <br />I horby affinn unds paalty ofpqjury one ofthe following dclaations: <br />D€molition Pnnirs-Asb6tos Nolification Fcdsal Regulalions (Title 40. Pat6) <br />-Required <br />Lett6 of Notification <br />_l certify that the fedqal regulations regdding abetos rcmoval d c not applicable to this projecl. <br />4 "afi lratl have rcad thrs application od statc that thc with all City ud County <br />ed County to entq upon theordinance md State Laws relating to building ron. <br />abovc mfltioncd propcny for imp€rtion <br />Applicant or Ageilt <br />l'ortrrilcc name (print)l <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht 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 />Bondinq / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment Utq,/za ,fL< zl <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilings (Hard & Soffit Rough <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rouqh z?/zd 2/ 2, <br />Service Meter '1^7-ZA tZczT <br />FINAL q)-7a fl- e isru eA^ I Lrl <br />Notes, Remarks, Etc <br />B <br />,on rr"ror, <br />p,r". l'Zl *?<s