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ELECTRICAL.INSPECTOR RECORD <br />Bev.08-07-2015 <br />\- <br />APPROVALS DATE ID/SIG COMMENTS oWNllR IIUILDER Dl),CARATION <br />I hereby affrnl utrder pcnalty of per.iury thal I ur cienrpt from lhc Contraclos' Liccn* law for thc following rcason (Scc.7031.5 <br />Busincss ard Prolcssion Codc): Any City or County which rcquircs a [*rmil to construct, altcr, improvc, demlish or rcpair any <br />struclurc, prior b its issuance. also rcquircs the applicuil for such [Emrit lo fih a sigrcd slatemnt that lE or slE is lice[Ed pur$il1 <br />to the provisions of thc Conractor's l,iccnscd lrw (Chapter 9, Commcncin8 with Scction 70UJ of Division 3 of thc Business and <br />ProtessiorsC(xje)orlhathcorsheisexempttheretionlandtlEb6isfortlEallcgedexenrption. AnyviolarbnofSecrionT0Sl.5byany <br />applicant for d pcrnrit subjecls thc applicant to a civil penalty of not mre lhdn fivc hundrcd dollars ($500). <br />_1. as owncr ol lhc prolrc[v. or rny crnployccs with wagcs as lhcir solc comlEnsation, will do the wffk ard thc stMlm is mt <br />intended or ofcred for srle (Se.7(X4, Busincss and Profcssions Cqlc: Thc CoDtractor's License Law docs nol apply lo u owncr o[ <br />thelt)ltlly wk,buildsorinp()vesthcr5n\andwhodoessuchworkhin[elforlErselforthroughhisorfurowtrenployees, <br />providcd that such improvqrcnts ilc frn inlcilcd or ollcrcd I'or slc. Il. howevcr. thc building or ifiprovcrftnt is sold within one yetr <br />ofcon\rlcli[ thc Owner Builder will havc the bordcn ofprovirS lhat he or shc ditl ml build or irprcve tlE pmfE(y for th€ plrpore of <br />sde). <br />_1. as owft. of th. prcpcny, am.xclusivcly conuactinS with liccn$ri coMetoB to (lnshcl lh. poFct (Se. 7(N4, Busircs <br />ard holessinCode:TheContmctor'sLicctrsellwdcsrctapplytodowftrofpropcnywhobuildsorimprovesthd@n. <br />atrd who contrrcts for such projects wilh a ContEcto(s) liccnsd pursuul to the Conudor's Licc6c kw). <br />_l an)exempt under ScctioD , B. & P.C. lbr this rcasoil. <br />WORKERS' COMPU,NSA'IION <br />DECLARATION <br />I hcreby aflirm undcr pcnalty ofpqjury onc ofthc Ibllowing decldatioG: <br />_lhavcanlwill trEinlainaCenillcalcofConscnttoSelf-lNurcforworkcrs'snr[ENdion,as pmvidedforbySetior3Tmofthc <br />l2bor Code, for thc Frcrfornme of thc worl for which the psmil is issucd. <br />_l have and will nnintriil workes c(lnlpcnsatirD insurance, as requircd hy Scction 3700 ofthe tibor Clode, for thc lErfonronce of <br />thc work llr wlich this Itrnit is issucd. My wrrrlcrs' compcnsation insurucc cm'iq axl grlicy nunrter uc: <br />Policy Numbcr: Expircs: <br />_l ccnify lhat in thc Frfornuncc of thc work for which this pcrmit is issucd, I shall not erploy my [rcrson in dy mMmr <br />s s to bcsrc subjccl lo the wo.kers' compcngion laws of Califomia. and agrce lhat if I slFuld bccorrc subjcct to thc <br />worlicrs' $nrpcnsation prolisioN of Scction l70U of lhc tibor Code, I slull, fonhwith conrply with rhos prcvjsions.. <br />WARNING: Failurc b secure wokers'r.rnlEnsrlion covcrage is unlnwful, and shall subject an crnployer to cyiminal penaltics nnd <br />civil finesuDlo(xrehundredthousrilddollars($100.000).inaddilionk)llrccostofcompensalion,danugcsasprovidedlbrthc <br />Scction 3076 ofthc tihor Cfrlc. i.l.'rcst and atbrncv's lces. <br />Datc:_ <br />UEEN4SNIBACTI}B <br />DECI-A,RATION <br />I hcrcby afftrnl undcr pcnally ofpcrjury that I anr liccrud under prcvision ofChaplcr 9 (conmrncing with Scction 7000) ofDivision 3 <br />of lhe Busincss and Pmfcssions Codc. arxl nrv liccnsc is in full fore and cffcct. <br />Lic€use Nurrrbcr: <br />W <br />I hercby aflirm und.'r pcnahy of pcrjury lhd therc is a construction lendinS a8ercy for thc pqfomrce of lhe work lt r which rhis pqmit b <br />issucd (Scc. 3097, Civ. C.). <br />knder's Nanrc, <br />trnder's Address: <br />APPI,ICANT DECI,ARA'I'ION <br />I tmjty afllnr undcr I--nrlly of pcrjury onc of thc following d(luations: <br />Dcnx,lilioo Pcrnits-AstE'sbs Notificali()n Fcdcral Rcgulalions (Titlc 40, Pd(, <br />_Rcquircd bttcr of N(xificalion <br />_l cdily lhat thc fcdcral rcgulations rcgudinE asbcstos remval ilc nol applicable to this proj6t. <br />_l cenily llul I luvc rcad this applicalidl rtrd stalc llral the abovc infornulion is colrcct. I agre to @nlply with all Cily od County <br />ordinanccs and Stalc Laws rclating to buildinS conshction, and hercby authorizc rcprcscntativcs ofthis Ci(y and County to entcr upon thc <br />above lrentioncd pmpcny for inspection puqx)*s. <br />Appli€nt or Ag6l <br />Pmits Mme {prinl)r <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safetv /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <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 />Ceilinos (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar Rouqh) <br />lvleter Release <br />Rouqh <br />Service lMeter t <br />FINAL \/7.1/ zutnt -?M.al) <br />Notes, Remarks, Etc.t