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DATE ID/SIG.COMMENTSAPPROVALS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Itrleter Release <br />Rouqh <br />Service lvleter I/14MtFINAL/0/z ?/ 2d I <br />LNotes, Remarks, Etc. / <br />oWNER BIJII,I)ER DT.]I,CA RATION <br />I hereby afrirnr ufider penalty of perjury that I aDr exeDrpt from th. Contraclos Licensc law for the following rcasn (Scc.703 1.5 <br />Busincss and Prolssion Codc): Any Cily or Counly which rcquires a fEnnil lo construcl, altq, improvc. dcmlish or Rpair My <br />slructurc, prior k, ils issuarrc. also rcquins lhc app[cet for such Frcmil lo fih a sigkd slatcmf,t that hc or shc k liccred pur$il1 <br />to thc prcvisions of (hc Contractor's Liccnscd lrw (Chaptcr 9. Cornmcncing wilh Section 7000 of Division 3 of the Busincss and <br />ProfessiotrsCode)orthatheorsheisexempttherefiomandthebasisforthealle8edcxenlplioil. ADyviolalionofSectionT03l.5byany <br />opplicanl for a permit subjccts th. applicant to u civil pemlty of not more than five hundrcd dollars ($500). <br />_1. as osncr ol'llr prol--ny. or rny crnpbyecs with wages as thci, $le comltnstion, will do thc wtrk ard thc stMm is mt <br />intcrxlad oroffcrcdforulc(Sec.7(}l,l.BlsincssendProfcssionsCode:ThcContracrcr'sLiccnrLawdcsnotapplytomowncrof <br />the pmFny wlxr huilds or inproves llMdilL atxl wlD does such work himself or lEr*lf or throuSh his or her own enlployees, <br />provided lhat such improvcrrcnts trc not intcnded or olfcrcd for snlc. ll, howcvca, lhc building or improvemnt is sold within one yc4 <br />ofconrpleli)n, thc OwrEr Builler will lrave the burden ofpNvio8 th{t he or shc did Nt build or imptuvc th€ prcpqly for lhc purlx)s o[ <br />sk). <br />_1. as owncr of thc propeny, dm cxclusi!cly contracting wilh liccnsd contretoA to consNct th. prcjcct (Scc. 7014, Busincs <br />arx, hollsqiflCode:TheContracbr'sLicenseLawdoesDotapplytoanownerofpropcnywhobuildsoriDprovcsthereon. <br />and who con(racls for such prdccts with a Glnlmcto(s) liccnsed pursuml to lhc Conractor's Liccnse hw). <br />-IaneIemptundelSecti(nl-.B.&P'C'lbrtIrisrcayln,Datc:- <br />WORKERS' COMPI]NSATION <br />DECLARATION <br />I hcrcby aflirm undcr peralty ofpcrjuryom ofthc following decldatioN: <br />_[ have ard will nEintain a Cenil-rcalc of Conscn( to Sclf-lnsurc for workm' om1rcroation, as prcvidcd for by Setion 3700 of the <br />l2bor Code, tor thc psforlmc of the work lbr which the pelmit is issued. <br />[flur. "na <br />*ltt n)arntain wurk.rs conlpcnsation insuranc., as rcquircd by s.clion 3700 of lhc kbor Codc, for lhc pcrfomurc of <br />the_work for wlich lhis frcrnil i3 issucd. My sorkqs' @mpcMion imurmcc wicr ud policy numher re: <br />n <br />Policy <br />_l certify lhat iD thc lErli,rnuncc of lhc work for which this pcrmil is issucd, I shall not cmploy my Jrcrson in any mnncr <br />s as lo bccorrc subjcct to lhc workcrs' cornpcnsation laws of California, and aSrcc that if I should bccom subjcct to the <br />workels' conrpensation pruvisions of Section 1700 of the Labor Code, I slnll, fonhwith cornply with thos provisions.. <br />WARNING: Failurc to scur. workcrs'compcnsation covcnSc is unlawful, md shall subjcct an cmploycr lo oiminal p.mhics and <br />civil fircs up to orc hundrcd thousand dollars ($100.000). ir addition lo lhc co$ of cotrqrretion, deug.s u providcd for thc <br />atrorrcy s <br />I hercby affrnr undcr pnalty of pcrjury thal I an lic.nsd undct pmvision of Chsptcr 9 (comminS with Setion 7000) of Division 3 <br />of thc Busincss and Prcfessions Codc. arxl my liccnsc is in full fore and cffcct. <br />Liccnse Nunrb€r: <br />CONSTRUCTION LENDING AGENCY <br />I hcreby allirm undcr pcmhy of pcrjury thd thcrc is a construction hnding a8crcy for the pcrformarcc ofthc worl lor which this t6mit is <br />issucd (Scc. 3097, Civ. C.). <br />Lcrder's NanE. <br />[.ndcr's Addrcss: <br />APPI,ICAN'T DECLARATION <br />I hrcby dllrnrundcr ltnalty of prrjury ooc ofthe folk)wing dcclurtions; <br />DcnDlition Pcrn)its-Asbcstos N({ificati(xr Fcdcral RcSulati()ns ('l itlc 40, Pm(, <br />_Rcquircd [rttcr of Noti6calion <br />_l ccnily thd thc fcdcralrcgulations rcgdding asbcstos rcmlal dc not applicablc to rhis project. <br />,fi,{t .cnlty rt,nr I luvc rcad tlus applcation drd statc lhal thc atxrve informlion is co[cct. I agrcc to conrply qith all City od County <br />'oldinances ild Slatc l2ws rclating to building constructio[ anl hcrcby aulhorire rcprcrcntativcs of this City ild County to enter upon thc <br />ah)vc rrenlioncd pmpcny for purposs. <br />Applicant or Agrnt <br />I'crnrilcc nflnrc <br />^*,[$lJ4!L2- <br />ELECTRICAL.INSPECTOR RECOR D <br />\, <br />08-07-201 5 <br />I