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ELECTR!CAL-INSPECTOR RECOR D <br />ev. 08-07-20 1 5 <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <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)7-lr. n *-(rs <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh)+-v -zt xl -t t\\ <br />ltleter Release V \-/ <br />I <br />?lc-z,r ,a-? totRouqh <br />llService [/leter <br />LTU AL 'o-/FINAL <br />lINotes, Remarks, Etc. <br />OWNIiR BU ILDIlR DI.ILCARATION <br />I hereby affrnr undcr penalty ofpcrjury tlrat I am etcmpl frcm the ContractoN' Liccns ljw for thc following rcaen (Sac.7031.5 <br />llusincss and Proltssion Codc)r Any City or County which rcquircs a Itrmit to conslruct, altcr, irnprove. dcmolish or rcpair my <br />slructure,priort)ils issuance.alsorequircstheapplicanlli)rsuchFrtrrilk)fileasignedstat€trEnl lhatlEorshcLslicetrsd pursuanl <br />lo th( pmvisions of thc Contractor's Liccnscd lf,w (Chaptcr 9. Commcncing wilh section 7Gi0 ol Division 3 o, thc Busincss and <br />PrcfessionsCodc)orthrthcorsheiscxempttherelionrandtl:ebasisfortleallegcdcienrption. fuiyviolatioilofsectionT03l.5byaDy <br />applicnntforapcnnitsubjcctslhe applicanttoacivilpcmltyofnot,mrethdnllvehundrcddollars($5UD. <br />_1, as owncr o,'thc polL..^(y. or nry ernployccs with wages as thcir solc compensation, will do the work md (he sttutuc is mt <br />irxerrlcd or offerc(l for slc (Se.7(X4. Business and Prufcssions Code: Thc Contraclot s Licensc bw r.lcs nol apply lo an owncr of <br />the proltny who builds or inl|)rovcs therdtrL dd wlF does such work himse]f or hersclf or tltrough his or lEr own enlployeeE, <br />providcd that such itnEovcmnts dc mt intcrxlcd oroltcrcd lor sb. ll. howcvcr, OE buiHing or ifprovcmnt is sh within onc yca <br />r>fconrplctiorr, tlrc Owrrer Builder will lurve the bunJcn of provirrtrr that lE or shc did nd buill or ir|Pove 0rc prcpery for thc purpo* of <br />salc). <br />_1. rs owner ofthc prr4rcrty. am erclusively contracting wilh liccnsd conlraclors to conslrucl tlE pNject (Sec. 7(X4. Business <br />arxl Pnrilssixr Code: Thc Col(ract(tr's License Law drrcs not apply b an owner of pro[tny who builds or improves lhereoil. <br />and who conuaclsforsuchpr(*'ctswilhoConlracklr(s)liccnscdpursumltothcContmctor'sLiccnsc[lw). <br />-l <br />anrexempt uiller Scctiotr-. B. & P.C. for llrs rcason. <br />Dete:- <br />}VORKI'IdS' COMPI'NSA'TION <br />DECLARATION <br />I hcrcby alllrm undcr pcnalty ol pcrjury rrnc ol'lhc li'llowinS dccltralions: <br />_l havc arx, will nuinrsil a Ctnilicarc of Consnl to Sclf-lNuc for work6s'compcNalion, as prcvidcd for bySction 3700 of thc <br />bbor Codc. for the pcrforrmcc of thc work for which thc pcrfiit ir issued. <br />_l have and will nraintnitr workers conrpeDralion insuratrce. as rcquired hy Section 3700 ofthe bbor Code. for the lErfortrErce of <br />rhc work lirr which this Frnlit is issucd. My urrrkcrs' conrpcnsation insurficc caf,icr {xl f(rlicy ilunlhkr uc:2..-i.-h <br />_l ccnity rhat in rhc lrrlbrnHrcc (,f lhc work for which tlis Pcrnit is issucd. I shall not cmploy my lrcrson in any mantur <br />No as to bccorrc suhjcct lo lhc workcrs' cotrrpensation laws o[ Cali fornia. and agrcc thal if I should bccom subject to the <br />workcrs' conrpenution provisions of Section l?00 of th. hbor C'ode, I slull, fonhwith coDlply with thos prcvisioN.. <br />WARNING: Frilure lo securc worlcrs' <br />civil tjnes up k) otrc hundred thousand <br />Scction :i076 of thc t2tnr Codc, inlcrcst <br />compensalion covcrage is unhwful, and shnll subject an cmploycr to diminal pcnal(iqs ild <br />dollars (S100.000t. itriadditito to Ihc cost of comJruulion, dmugcs a providcd for thc <br />l':::l'."b/ uuxt\I <br />t,l( t,iNst,]) ( r )N't t{,\( 1( )t{t <br />l)1.;( 1.,\RA'il()N <br />I lrcrcby affrtu under Fndlty of Frjury that I anr licensd undcr pruvision ofChnpler 9 (cornnEDcin8 with Section 7000) ofDivisiol 3 <br />of thc Busincsr and Itmfessions Code. ard rny licensc is in full forcc 0nd effect. <br />l-rcensc <br />,.1 <br />Dsr.,--jdJ:JO)l-)- <br />@ <br />I hcrcby allirm undcr F*naltyofpcrjury that thcre is a construction lcnding agcncy for thc pcrfoflnancc ofthc work lbr which thi$ pcrmit is <br />issued (Scc. 1097. Cn'. C.). <br />Lender's Nanle: <br />Lrn,lcr's A.l,.lre*., <br />@NroEe!484tr.!O! <br />I hqchy arlirm undcr Fnalty of pcrjury onc of the following deldalions: <br />Dcm,lition Pcrnits-Asbcsk)s Notification Fcdcral Rcgulatkrns (Title 40, Pd6) <br />-Rcquircd <br />trttcr of Nolificalion <br />with all City and County <br />and County to entd upon tha <br />dbove ntntioned propcny for inspect <br />Appli$trt or Agtnt <br />Prmitcc [anrc <br />-.Lo),o <br />/,^.\ <br />Poti"yNu^b.r, "pir"r, /J - q/rO.) f \