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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER I)I]I,CARATIoN <br />IhcrchyatlirmundcrpenallyofpcrjurythdtIamcxcmllliontheConlrrckxs l-iccnscl-awli)rllEli)llowillgrcason(Scc.70.11.5 <br />Busincss and Profcssion Cu.lc): Any Cily or CouDly which requirc's r Frnrit lo eonslnlcl. allcr. inlfrovc. dcnx)lish or rcplir anyt' <br />stnlcturc. plior to its issuancc. also rcquires lhc apllicant li)r such Frnil k) filc r signcd slalcnrcnl lhal hc or shc is liccnscd pursuant <br />k) thc lrovisions of the Contractor's Liccnscd Lrw (Chxplcr 9. Conrnrcncin8 wilh Sccli{)n 7fiI) of Division -l of thc Busincss and ' <br />ProltssionsCodc)orthathcorshciscxcnlptthcrcliomandlhcblsisli)rlhcallcgcdcxcnrpti(m. AnyviolalionolScctionT().ll.5byany <br />apflicanlli,rapcmitsuhjcctsthc apnlicanlloacivilpcnallyr)fnotrxlrcthatrl'ivchundrcddollars($5(n). <br />_[. as owncr of thc prolEfly. or my cmployccs with wagcs as thcir s(rlc conllcnsali()n. willdo llrc work and lhc strutrrc is not <br />irilcndcd orofltredforsalc(Sa.?(X4,BusincssandP()lcssionsC(xlc:'l_hcC()ntrack)r'sl-iccnscljwd()csnotafplyk]anowncrol' <br />thcpmFily whobuildsorimprcvcslhcmn.erlwhod{rcssuchwo*hinscllorhcrsclforthn)uShhisorhcrowncmpl(}yccs, <br />provided that such inrpruvemnls rc ilil intendcd orolLrcd lor elc. Il, howcvcr, thc huilijing or impn)vcmnl ir sold wilhin onc ycil <br />ofcunplcti)n, the Owner Buillcr will havc tlE burdcn oiproving llut hc or she dil nol huild ()r in{rrovc thc pn}FErty for thc lurfx}* ot <br />salc). <br />_1. as owncr of the propcdy. am cxclusivcly contraclirS wilh liccnscd conlrxck)rs k) conslnrcl lhc projcct (Scc. 7044, Busincss <br />anl PmfissitnColc:TheContrack)r'sLiccnscLawdoesnotapplyloanowncr()fprolErlywh()buildsorimproveslhcreon, <br />and who conlracts lbr such pn8cls wilh a Contractd(s) liccnscd pursuant lo lhc Contrack)r's Liccnsc lnw). <br />I anr crcmDl uodcr Scction . B. & P.C. Ii)r lhis rcason. <br />lVORKERS', Col\IPENSA',ilON <br />I)I:CI,ARA'TIoN <br />I hcrchy allirm under penalty of Frjury ()nc of lhe li,lh)wing dcclarati{nrs: <br />_l havc ax.l will maintam a Ceflillcatc of Conscnl k) Sclf:lnsurc tor workcrs eonrpcnsalirln. as p()vidcd ti)r by Scction .1700 of lhc <br />ktrcr C(xlc. Ibr thc pcrlbrmncc of thc work lbr which lhc pcriltit is issucd. <br />x hevc and will maintain workcrs' compensation insurance, as rcquircd by Scction -l?00 ol thc Lahor Codc, lif thc pcrformance of <br />work li)r pcrnlit is issucd. My workcrs conrpcn$xtion instrancc cafticr iurd F)licy rilnrbcr:uc: <br />t'olicy Nu <br />_l ccrtif y that in thc perl()rmance of Ihc work l()r which lhis pcrnril ir issucd, I shall n()l cmpl()y nny pcrson in any manncr <br />so as to bccorc suhject k) thc workcrs' cotrlpcnsrt ion hws of Calili)rnir, rDd {grcc lhal if I sh)uld bcc()nlc suhjcct k) thc <br />wu'kcrs'compcnsationp()visionsofSection.l?0Oofthcl-rtxrrCrxlc.lshrll.l'orlhwithcomplywilhthoscfll)visions.. <br />WARNING: Failurc to securc workcrs'conrpcnsali()il covcragc is ntrlnwlirl. rld shall suhjccl an ctrrpk)ycr lo crinrinal Fnrltics and <br />Scction -1076 of C(xlc, iilcrcst and atk)mcy s lacs. <br />I hcrchy allirm undcr penalty ol pcrjury thal I anr liccnsed Chrptcr I (ronrmcnciilg wilh Scction 7000) ol Divisi()n -1 <br />of thc Busircss and Prol'cssirns Codc. md my liccnse is m lill li)rcc an(lcllcct. <br />[-lecnsc a Nrrrlhcr:GG7?<-= <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby aillrm under penally of Frjury that lhere i\ a construction lcnding agcncy fi)r thc pcrli)mMcc of lhc work t(rr which this frcmit is <br />issued (Sec. 1097, Civ. C.). <br />lxnder's Namc: <br />landcr's Address: <br />APPLICANT DECLARATION <br />I trcrcby alim under pcnalty of frcrjury onc of lhe fi)llowing dcclarali{)ns: <br />Dem)lition Pcrndts-Asbeslos Notificalion Fcdcral Rcgulalt)ns ('l itlc 40. Pan6) <br />-Required <br />ktter of Nolification <br />_l ccnily that thc ladcral regulalions rcgtrdin8 astrcsk,s rcrnovtl iuc ilot applicuhlc k) this proicct. <br />I ccnily that I havc rcrd this applicdtion imd sldte that thc atr)vc ilrlbrnul!)n rs corrccl. I agr(r k) c(nlply wilh all City and County <br />ordinanccs and Statc Laws rchting b buildinS construclion. ilil hcrehy aulhorizc rcprescnlalivcs ofthis City and County to <br />ahovc nrcntioncd p()pcny lbr inspccti(tr1 <br />Applicant or <br />Itennilcc nrnre <br />qupirr.r urxln thc <br />Site-Work <br />Underoround <br />Pole Bases <br />Lioht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / 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 (Rouoh) <br />Ceilinqs (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rouqh <br />Service Meter It <br />FINAL 4lt4 71),/r A/taF*ry <br />Notes, Remarks, Etc I rl <br />I