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ELECTRICAL.! NSPECTOR RECORD <br />APPROVALS DATE rD/srG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Light 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 />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service lvleter <br />)-ea- t1I/FINAL YILC/'I- 1 )3)/ <br />Notes Remarks Etc. <br />OWNER BUILDER DEI,(]ARATION <br />I hoeby aflirrn undo pmalty of pcrjury that I m exempl frorn thc Contrado6 License Law for the following reen (Ss.70-11.5 <br />Busin6s and Profcsion Codc)r Any ('ity or County which requirs a pfinil to construct. alt6. improve, dmolish or repair any <br />struclure, prior to its issumce. also requirB the applicant for such pemit to file a signed statement that hc or she is licensed pmuant <br />to lhe provisions ofthe Conlractor's l,icensed [-aw (Chapler 9. Cornrnencing with Section 7000 ofDivision J ofthe Busincs and <br />ProfessionsCode)orthatheorsheisexemptthsefrommdthebasisforthcallcgederlqlign. AnyviolationofSmtionT0-ll.5byany <br />applicant for a pcnnit subjects lhe applicant to a civil pcnalty of not more thil live hun&ed doll{$500). <br />l. as owiler ofthe prolErly. or my employes with 1va8es as their sole compensation. rvill do the work md thc structue is not <br />intoded oroffqedforsle(56.7044,BusinesaldProfessionsCode:'fheContraclor'sLicemeLawdocnotapplytoanownerof <br />the trctEly who builds or improvG thaon. md who doe such work himself or herself or through his or ho om employee. <br />provided lhat such impro\,flrcnts trc not intmded or oflsed for sale. lf. how*f,. the building or improvemcnt is sld wilhin one y@ <br />ofcompldion. the Owner Builds will hare the burdor ofproving that he or she did not build or improve the prlperty for the purpos of <br />mle). <br />l, as owner oflhc propqty. am exchrsively conlracting with liccnsed conlraclom to construct lhe project (Sec. 7(M4, Buins <br />and I'rofesion Code: The Conlractor's Licensc Law does nol apply to an owncr ofproperty rvho builds or irnproves thereon. <br />and Nho contracts for such proiects with a Conlraclols) licensed pursumt to the Conhactor's Lictrse L-aw). <br />-l <br />an exempt under li. & I'(. l(n this rcason. <br />()Etrer: <br />WORKERS' COIIIPENSA'TION <br />DECLARA'IION <br />I haeby allirm unde penalty ofpajury one ofthe iollorving drluations: <br />__l have md will maintain a Ccrlificatc ofConsst to Self-lnsure frrr workos'cornpensation. o Srovided for by Setion 3700 ofthe <br />Labor Codc. for thc pafomanc€ ofthc work ior rvhich the pcnnit is issued. <br />llraveandrvillmainlainworkm compensationinsurance.m requiredbySection3T00oflheLaborCode.fortheperfomanceof <br />lhe rvork for rvhich this pcmit is i$uqi. My uorkos' compcnsation insurance caris md lnlicy numba ue: <br />Cmis:- <br />Policy Exoirs: <br />_l cgtiry that in th€ psfomancc of thc wo* for which this pcrftit is issued. I shall not mploy any peson in any mmner <br />m otobecomesubjrtlothework6s'composalionlawsofCaliirmia.aodagrcthatiflshouldbecomcsubjEttothe <br />rvorkm' cornpostion provisions of Setion .1700 of the lrh)r Code. I shall. fonhrvith cornply with those provisios.. <br />IVARNIN(i: l'ailure lo wure \\ork6s'compensalion covoagc is ancl an mployr to qirninal pmltie md <br />civil fine up to one hundred thousmd ($r thc ion. dmags c provided for the <br />Srtion -1076 of the tabor Code. <br />o,r", ll /11/fi. <br />irilcr!:t 3nd fes. <br />a-f--r <br />I hoeby aflinn unda poally ofpojury lhal I m ofChaptq 9 (commocin8 with 561ion 7000) ofDivision 3 <br />of thc []usirrcs and l)rofasions ('odc. md nry licqrsc is force and eff(t. <br />l.iccnse D <br />Date: I <br />I hdeby amrm under penahy ofpdjury that <br />issued (Se. -1097. Civ. C.). <br />Lendtr s Nailre: <br />tsa lmding agmcy for thc perfomilce of the work for which this p€mit is <br />Lends s Addrss: <br />APPLICAN'I DECLARATION <br />I lutby alfinn undo pmally of perjury one of the follorving daluations: <br />Demolition Psmits-Asbatos Notification federal Regulations ('l itlc 40. PM6) <br />Required Leltq of Notificalion <br />I colify that lhc re8ulalioN reliilding asbcshs rcnloval are not applicable to this project. <br />this application md state thal lhc is comect. I agre to cohply <br />ive ofthis City <br />with all City and County <br />and County to entq uFEn therclaling to <br />ahove nlenlioned <br />,\pplicoill or Agent <br />l'ernril$ trntrre <br />lor <br />rcprsenlal <br />@ ou",!flll4-