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ELECTRICAL.INSPECTOR RECORD
<br />08-07-201 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 Safetv /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />Rouqh
<br />t'l tService lvleter t,^ I5tr/lw &tz1/ t /1011 tI1\FINAL ttNotes, Remarks, Etc.
<br />J,
<br />oWNI]R BUII,DI'R DI;I,CARATION
<br />I hereby affrnr under penulty of perjury drilt I atrr cxenrpl fronl lhc CbntractoB' License liw for tha following rcasn (Sec.70Jl.5
<br />Busincss and Prol'cssion Codc): Any City or County which requires a fErmit to construct, altcr, irnprovc. dcrnolish or rcpair any
<br />structurc, prior () its issuance. dso requires lhe allplicaill tbr such p€nrit b fih a siBDed slatercnt tlEl lE or shc is licensd pursuanl
<br />to thc previsions of tlE Conlraclor's l,iccnscd law (Chapter 9, Commcncing wilh Scction 7000 of Division 3 ol thc Business and
<br />Professions Code) or thlt lE or she is cxcmpt tl)erclionr and llE b&sis fo, llE alle8ed €xemplion. Any violatiol ofSeclion 7031.5 by any
<br />applicanlforrpnnitsubjcclrthe nppticontlorci!ilpenillyofnotrmrethanfivchundrcddollars($5ui).
<br />_1. as owncr o,'lh. prolL..nv. or my ernployccs with wagcs as their Fle cornpcnsation, will do the work and (hc stM@ is mt
<br />iilerrled or offercd for ule (S6.7tX4. Busincss and Pn)fcssions Cq.le: The Conlractor's Licensc [:w rloes not spply to an owncr of
<br />the prcFny wk) builds ()r inwoves llErdnr and wlx) do4 such work himself or lErself or tfuough his or her own enrployees,
<br />providcd that such improvcrrcnts arc ffx inrcndcd or olltrcd for Mlc. ll. howcvcr. thc building or irprevcrrcnt is sld within onc ,til
<br />ofconrphliur. tlE owrcr Builder will lurve tlre burdcn of proviilg lhat lE or shc did ftn build or imprcvc tllc prupeny for the puqrcw of
<br />sle).
<br />_1. as owner of thc p()per1y, am exclusively contructing with liceNd conlracloB to construcl tha projcct (Scc. 7(N4, Busines
<br />ard PrDfe$ixl Code: The Contractor's LiceDse La* dcs not apply lo il ownet of proltny who builds or improves lhereon.
<br />and who conuacts for such projccls wilh a Contftb(s) licensd pursumt to thc Conuaclor's LiccN kw).
<br />-l
<br />&rexenrpt under Sectiur-, B. & P.C. fbr tlis reason.
<br />l)alc:_
<br />WORKE RS' COMPI.:NSATION
<br />pEslABAUgN
<br />I hcrcby aflirm undcr pcnalty ofperjuryonc ol lhc ti'lh)win8 dccleations:
<br />_lhareandwillnBinlsinaCenificaleofconscnltoSclf-l[surcf(rrworkers'eumFnsalion,as pmvidcdforbyScction3T0OoftlE
<br />hbor Codc, for thc tqforltffic of thc work for which lhc pqmit is issued.
<br />)11 lu"e aud wrll rnarntxln workers cotrrFErlsrtkD insurance. as rcqutre,l by s.ctx,n' thc work tirr whch this lErnrit rs issuc4. My srrrkcrs' cunrpcNalion i[3ulilrcc cuicr
<br />c,-ie., r H,ln6,-o1
<br />3700 of the hbor Code, for lhc pcrfom€ of
<br />{xi [blicy numbcr dc:
<br />Policy
<br />_l cenify rhat ir rlE Frlbrnuncc of tlt work for which this pcrnil is issucd, I shall not employ my pcrson in any mmner
<br />s as to becotre subjcct to thc worlers' conrpcnsation laws of Califomia, and agrcc thst if I slhuld becorrc subjcct lo lhe
<br />worliers'conrpcnsationprovisionsofSectionl?00oflhctiborC'ode,lstull,fonhwithconplywilhlho*prcvisioro..
<br />WARNING: Failure lo *cure workcrs'mrnpensation covcmge is unlawful, and shall subject an cmploycr to Fiminrl pcnaltics and
<br />civil tinesuDtoulchundredthousanddollars($100.{D0).inadditiootothecostofcompcrsalion,danHgesasprovidcdfortlrc
<br />Scction 3076 of Codc. intcrcst and ilk)ancy s ltcs.
<br />Z
<br />a 2
<br />, (-,-lo
<br />a
<br />DECLARATION
<br />I hcrcby affrm undcr pcnalry of pcrjury thar I am liccnsl undcr prcvision of Chrptd 9 (conmE-b8 whh SBlbn 7000) of
<br />of thc Busircss and Prcfcssions Codc, and my lkcnsc is in full fo.c iud cffccl.ro""
<br />Licelsc Nunrber:.'Tgzaii
<br />s"n","rn",Gur;,/aerA, -.-o/ ?e2^/cy'. r,,/. -oa,-
<br />CONSTRUCTION LENDING AGENCY
<br />I hcrcby altiln undcr pcnalty o[ pcrjury thd thcrc is a construction lcnding a8crcy for thc pcrfoflnarcc of thc *ork lt]r which this permit is
<br />issucrl (Scc. 1097. Cir. C.).
<br />kndcr's Nanrc:
<br />-
<br />[.nder's Address:
<br />APPI,ICANT DECI,ARATION
<br />I hrcby rfrirnr undcr pnalty of perjury onc of thc fi)llowing d@lilalions:
<br />Dcnrclition Pcrnrits-Ashcsbs Notification Fcdcral RcSulalions (Tillc 40, Pd(,
<br />-Rcquircd
<br />trltcr of Ndification
<br />-l
<br />ceaily thal thc lcdcral regulations rc8ilding ashcskrs rcrmval dc nol applicablc to this pmirt.
<br />-2-tQllfln\ lhdt I luv( rcil(l (tns apph(ntir'[ ilkl stiltc tlul tlrc rhrvc inli,rtrL[ir,tr .
<br />4lini6rnccs rmi Statc l,rqs rcl.ilinp I'r huildrnt c,,n\truclx,n. und hcrchy aulhdriz('
<br />is corrcct. I agrcc to conrply with all City and Coutrty
<br />rcprcscntatives ofthis City and County to cnts
<br />a Zd
<br />abovc rnentioncd prrpeny for
<br />Applicant or Agcnt
<br />Pcmlitcc nanrc
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