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l <br />ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE !D/S!G.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <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 />lMeter Release <br />Rouqh <br />Service lvleter I '.1 \r n) <br />FINAL l.to\Uo J.{\,0 t\\t\flttllij Vb <br />Notes, Remarks, Etc. <br />OWNIiR BUIT-DER DEI,CARATION <br />t hcrcby affmr undcr pcnalty of Frjury that I m.i.nrpl frcm lhc C:onmctoN' Licensc kw fo. thc following Een (S.c.7031.5 <br />Businqs ard Profcssion Codc): Any City or County which rcquircs a pemt to con$ruct, alts, irnprovc, demlish or rcpat my , <br />strucmrc, prior to ils issuancc. alqr rcquins the appli(ail for such [Emtt lo fik a sigEd statcEnt lhst h. or shc it liccned pusul <br />lo the pmvisions of thc Con(retor's Lkensd t2* (Chaptcr 9, Comrrcrcing wilh Section ?U)0 of Divirion 3 of thc Busines md <br />Professions Codc) or that h€ or she is exempt thereliom snd llE bak for tlE allcged exenption. Any violalion of S(lion 7031.5 by atry <br />applic,dtforapcnnitsubjectsthc applicanttoncivilpen!ltyoInotmrcthnnfivchundrcddollars($5LU). <br />1(. *t n*nc, nt tt c pror*ny, or my crnployees with wagcs as thcir sole compensation, will do thc work md the strctm is mt <br />inrenLd or off.!.d for slc (Se.7Ut4. Busincss and Prcfcssions Codc: The Contraclor's Liccns ljw docs nol apply to m owncr of <br />theFopeny wlbbuil&orin{,rovestheNtradwlDd@3suchwor*himselforlEtselforthrcu8hhisorherownenrployees, <br />providcd that such impmrclrcnts ec rer inlcided o. ollcrcd for elc. ll, however 0rc building or itrprorcmnt is sH within orc )rd <br />ofcompldiorr lhc Owrrcr Builder will havc tlE burden ofpmvinS thd h. or shc did rct buill or irpDE 0E prcpdty for lh. porpos of <br />sle). <br />_1. s owncr of rh. propdy, am crclusivcly contractinS wilh licc[Ed contraclor to construct ttE pmFct (S.c. 7044, Busircs <br />arxi fto(t$ionCode:ThrCotrtractor'sLicens€Lawdcsnotapplytodowrerofpropcnywhobuildsorimprovesthereon. <br />and who conuacts for such projccts with a ContBcb(s) liccnsd pursumt to the Conractor's Licetuc [lw). <br />-Imrexemptuildersecti(,l-,B.&P.C.lbftlrisreason-<,/s ,/er) <br />I lrcrcby aflirm undcr pcnahy ofpcrjury onc ofthc lblhwing <br />_l havc arxl will nuiilain a Ccnificate of CorEnt b Sclf-lnsuE for workds' conrltnsation, as Jrevided for by Scction 3700 of lhc <br />bbor Codc, fo, thc lErforrmc of thc *ork for which thc pcrmit is issucd. <br />_l have and will nraintain workcrs' conrJrcnsalion insuranca, as Gquircd by Section 3700 of lhc ljbor Codc, for the pcrfomrec of <br />the woak for which this Nrnit is issucd. My workcrs' onrlrcnsation irourmce cdier iud F)licy nunrtrr ue: <br />lral"9 <br />Policy Numbcr: Expitcs: <br />kndcr's Addrcss: <br />Pcmitcc nanrc <br />_l ccniry that iD lhc Frlin'nuncc of lhe work for which this F(mil is issucd. I shall nol employ any lrcrson itr uy mmncr <br />s as to becoDE suhjccl lo thc workcrs' conlpcnstion llws of Califomia, and agrcc lhat it I stnuld bccorrc subjecl to thc <br />*orkers' conDcnsalion protisions of Section l?00 of llE tibor C'ode, I dull, fonhwith colrply with tho* prcvisions.. <br />WARNING: Failurc to scurc workcrs'mmpcnsalion covcroSe is unlawful, and shall subjet an cmploycr to oiminal pcmhics snd <br />civil lmcs up b orc hutrdrcd thousaud dollars ($100.000). in addilion lo lhc cosl of compctrtalion, danugcs a provided for thc <br />Scction 1076 of lhc tihor Code, intcrcst ed dbrrey's [ccs. <br />I hereby affrDr under trDnlr], of |rrjury lhat I atrr licenrd under provision ofChapter 9 (corurEncin8 with Sstion 7000) of Division 3 <br />o[ the Business and Prcfessions Code. nnd my liccnsc is in lull fore and effect. <br />W <br />I hcreby allirm undcr prnalty o[ pcrjury that thcrc is a construction lcnding agency for thc pcrlbrmancc of thc work lbr which this pcrmit is <br />issued (Sec. 3097, Civ. C.). <br />[rnder's Name: <br />APPI.ICANT DECLARATION <br />I hoEbyaffmlundcr [Enalty of pcrjury ore of lhc following dehatiotrs: <br />Demlition Pcrmits-Ashcslos Notificstion Fedcral Rcgulations (Tille 40. Pd6) <br />-Rcquired <br />lrlcr of Notification <br />-....*t ccrtify that rhc fcderal rcgulations rcgdding &sbcstos rcrnoval [c not applicablc to this pmj$t. <br />I "*ify l^tl luvc rcarl this application imd statc thal lhe atmvc information is cor.cl. I s8re to comply with all City and County <br />ordinarccs md State kws rclatitrg (o b{ilding consmcdotr ald hcrcby suthoria represntatives ofthis City and County to cnts uponthe <br />above rEnlioned prcpeny for <br />Applicant or ASmt <br />ev. 08-0 2015 <br />LiccNc Class:-Liccnsc Number: <br />- <br />Datc:- Cotrlnclor: <br />**, e/3/<D