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ELECTRICAL.INSPECTOR RECORD <br />DATE ID/SIG COMMENTSAPPROVALS <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 / Grounding / 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 Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter /^\ <br />FINAL \a-\\-11 K \L{UJ <br />Notes, Remarks, Etc.U\J <br />OWNER BUILDER DELCARATION <br />I hereby affinn undq p€nalty of p€rjury thal I an exernpt fiom lhe Conlractos Licmse larv for thc follow'ing reen (5(.70.11.5 <br />Businas md Profasion Code): Any City or Countl rvhich requira a penrrit lo conslrucl, alltr. improve, donolish or rqtair any <br />structue. prior to its issuance. also requirB the applicant for such pmrit to file a signed stalment lhat he or shc is licssed pursuant <br />to the provisioru of the Contraclor's Licensed law (Chaptcr 9. Cornmencing with Strtion 7000 of Division 3 of the Business od <br />PrefessionsCode)orthatheorsheisexcrnptthqefrornMdthebasisfortheallegedexonfnion. Anl.violationofsectionT0.ll.5byany <br />applicant for a pmit subjsts the applicant lo a civil penalty of nol rnore lhan five hundred dollars ($500). <br />_1. re owns of the prope(y. or my employB with wag6 6 (heir slc compsBtion. r'ill do the work md the strudue is not <br />intoded oroffqedforsle(S{.T044.BusinesmdProfasionsCode:TheConlractor'sLicoseLawdo6notapplyloanownsof <br />the fmpsty who builds or imprcvG thson. od who doc such wo* himse lf or hmelf or through his or hr o*r employec. <br />provided lhat such improlsnmts oe not intodcd orolTqql fur sle. lf. howflc. the building or improvsnot is rcld rvhhin one ya <br />ofcompletion. thc O1t'ns Builds rvill have the turdm ofprnving tha he or she did not build or imgove the prcJrty for the purpor of <br />sle ). <br />l. o owner ofthe property. run exclusively contractinS with licensed conlnclos to constnrct the lroject (Sec- 7044. BNins <br />md PrcfesionCodc:TheContractor'sLicenseLawdoenotapplytoilownerofpropertyrvhobuildsorimproveslhq'eon. <br />and \\'ho contractsforsuchprojectsuithaContraclor(s)licensedpursuiltlotheContractor'sLicrueLaw). <br />--.1 m excmpt under S6tion--+. B. & P.C. for lhis remon. <br />o^,"-\z-to -17 .# h,,\*ffi-* <br />I hereby aflirm undo pmalty ofpajury one ofthe following drclrations: <br />_lhareodrvillmaintainaCqli6catcofconsmttoSelf-lNureforworkqs compmsation,a prolidedforbySection3T00ofthe <br />Labor Code. for the psfomance of the work for which lhe pmnit is issued. <br />lhaveandrvillrnaintainrvorkm'compensalt)niNurance.6 requiredbySection3T00ofthel-aborCode.forthepsfomanceof <br />the work for rvhich this pmit is issual. My rvorkos' composation insurilce caris md policy numbe ue: <br />Cuier: <br />Policy Numbs:-Expires: <br />I cenify that in the pqfonnance ofthe *ork for rvhich this permit is issued. I shall not mrploy any pmon in any rnanntr <br />so as to become subi$t to lhe work6s'compflulion la\s ofCalifomia. and agree that ifl should beonre subject to the <br />workqs'conpensalionprovisionsofSction.lT00oflheLat rCode.lshall.forthrvithcornplyrvithlhoseprovisions.. <br />WARNINC: Failure lo scue workffi'compemation coverage is unlarvful. and shall subjcct an mployer to oiminsl FEnalli6 and <br />civil fines up to one hundred thousand dollas in addition lo lhe cosl of compeNation. dmages as providcd for the <br />sillion 1076 of thc t-atnr Code. intsGl ild <br />,..,-.\2- lO - /1 <br />I hereby amnn unds pcnalty of pqjury thal I an licensed under provision ofchapts 9 (commencing rvith Smion 7000) of Division 3 <br />of the Busines md Profixsions Code. md my licose is in full force md effet. <br />Liccnse Cla$: <br />Datel <br />-l-icense <br />Numbe: .- <br />(l)nl rficlor: <br />CONSTRUC'TION LENDINC AGENCY <br />I hreby aflirm undo penahy of psjury that thse is a construclion lcnding agency for the pofonnuce of lhc rvork for rvhich this pornit is <br />issued (Ss. -1097. Civ. C.). <br />Lcndq's Name: <br />-- <br />APPLICAN'I DDCLARA'I'ION <br />I hqrby affmn under psalty of pejury one ofthe follorving dwlarations: <br />Dcmolition Pnnits-Asb6tos Notification l'edqal Regulalioos (-fille 40, Pdt6) <br />-Required <br />t*tter of Notification <br />*ith all City and ('ounty <br />dd County to mtq upon thc <br />2-to-l <br />I celify that the federal regulations regdding mbslos renoval ae not applicable to this prejet. <br />Ltrds s Addrs: <br />I Zc/ r/q?/1