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ELECTRICAL.INSPECTOR RECORD 1- <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildins <br />Under Slab / Floo.n- <br />Bond i ng / {ror.indi nlV U FER ['/4-rq ll-L2, <br />Transformbns/- <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rough ?-9-L9 /),t-,?7 <br />Service Meter <br />FINAL t -'ZY'Zn AC ts <br />^)€ fut e2, <br />Notes, Remarks, Etc <br />I heeby affrm unda poralty of pqjury thd I m exempt from the Contracto6' Lictre Law for thc following r@n (Ss.7oll <br />Buines and Profsiof, Code): Any City or County which require a pomit to conslruct. alta. improvc, dorclish or repair <br />strucluq prior to its isuace, also rcquiro thc applicmt for such pefinit lo filc 8 signed slamot that he or shc is licmcd <br />to thc provisioro of thc Conlractor's Lico*d taw (Chapto 9, Commeocing with Section 7000 of Division 3 of lhc Bsins <br />PrefessionsCode)orthathcorshcisexcmptthoefiomildlhcb6isfortheallegedcxmption. AnyviolationofsectionT0ll.5br <br />applicantforapmitsubjetsthe applicanttoacivilpenaltyofnotmorethanfivehundreddollils($500). <br />l. s own6 of lhc prcpeny. or my emplo)6 with rvags o thcir wle comperuation. will do the work md thc strudue b not <br />intoded or oflscd for sle (Sc.7044. Buins md Prcf*iom Code: The Contrador's Licse lrw do6 nol apply to e o\\'ntr of <br />rhe prepqly who buil& or imprcvs thmn. md who doc such wort himsclf or hdslf or thrcugh his or ho om employeo. <br />providcd that such improvmmts e not intqdcd orolTqed for slc. If, howqq. the building or imJnovmmt is $ld within one )@ <br />ofcornplaion the Owns Buildq will have the hudo ofproving tha he or she did not build or improve the prcpsty for the purposof <br />ule). <br />I, 6 o*rd oflhe propdly. m exclusively contracling with licsed contractomlo construcl lhe p{ojd (56. 7044. Bsins <br />md Profsion Code: The Conlractor's License Law do6 not apply lo m owns ofpropcrty who builds or improves lhs@n. <br />and who contmcts for such prcjds with a Contmcto(s) licfised puEumt lo lhe Contrador's Licfisc [aw). <br />_l an exempt unds <br />-ivonr6{s' <-<rn-rpex.sn t tffi---Zffi- <br />I hseby amm unds poralty of pcjury one of thc following deluatiom: <br />_l have md will maintain a Certificate of CoNot to Self-l6ure for workss' compssation. a prcvidcd for by Sstion 3700 of lhe <br />kbor Code. for thc psfomucc of thc work for which the pamh is isued. <br />I havc and will maintain work6' compcNation insurancc. r required by Sction 3700 of the hbor Codc, for thc pqfommce of <br />lhc work for which this pmit is isued. My workm' compmption imurmcc cmim md policy nurnbo re: <br />,*,., €-p-rt34. r)o*tr,nol T.r.<ora^z o Qo. <br />Policy <br />I cflify that in lhc psfonnance of thc work for which this pomit is issued, I shall not mploy any pqsn in my mens <br />so 6 to become subjsl to the workm'compcmation larvs of Califomia. ild agrcc that if I should berome subjEt to the <br />workss'compmstionprovisiomofSction-1700oftheLaborCode. Ishall,fonhwithcomplywiththowprovisions.. <br />WARNING: Failure to sue work6'comp€o$tion cov@ge is unlawful. md shall subjet an mploy6 to oimioal pqultis and <br />civil fins up to onc hundred thownd dollm ($100,000), in addition to the cost of compemation, damages m provided for the <br />S(tion 3076 of the Labor Code, intE6t ud attomcy's fe6. <br />",,", <br />-?lLt l11, <br />I hmby affm unda penally of perjury thal I m licoscd unda povision o Chapl6 9 (comocing with Secrion 7000) of Division I <br />of lhe Busins od Prcfmiom Code. md my licme is in full force md effat. <br />Licemc Liceroc Numbq:1tL13z <br />I hmby aflim undo pcnalty of psjury that thse is a corctrudion loding agmcy for <br />issucd (Se. 3097, Civ. C.). <br />Lcnda's Name: <br />pgfomance of the work for which this p6mit is <br />Lodo's Ad&e: <br />APPLICANT DECLARATION <br />I hu*y aflirn undo penalty ofperjury one ofthc following dcluations: <br />Dmolilion Pmits-Asb6tos Notification Feddal Regulations (Title 40. Pd6) <br />_Required trtts of Notificstion <br />-l <br />cqtiry that the fedoal rcgulatiom regrding cbetos ronoval ue not applicablc to this prcjcct. <br />-l <br />cglify that I havc red this application and slate that the above infomatioo is corqt. I agre to comply with all City ed County <br />ordinancG md State laws relating to building conslruction. md hoeby authorizc rcprGatativG of this City md County to at6 upon thc <br />above mmtioned propcrty <br />Applicrnt or Ageila <br />for irepe<tion purposs. <br />o"",7lzu/t1 <br />",,",1lLt-ll1 <br />I)trtc ' llzr'lll <br />Permite name (print):