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ELECTRICAL.INSPECTOR RECORD <br />DATE ID/S!G.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <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 (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />unlawlirl. <br />t(, lhc(x).{xx)). in <br />lccs. <br />Ceilinos (T-Bar Rouqh) <br />N/eter Release <br />Rough <br />Service Meter rlu t <br />mnur: <br />F!NAL <br />Remarks Etc <br />t <br />o\\'NItR IrtIt,Dt]R l)ut.( ARA t'roN <br />I hcrcby allirm under pclally ol pcrjury thnl I am cxcrnpl lionr lhc Conlracn)rs' Liccnsc L{w tor lhc f'olk,wing rcnson (Scc.7o.ll.5 <br />Busincss arrd Prolcssk)n Codc): Any City or Counly which rcquircs a Jrrmil lo con\tnrct. rllcr. iil{rrove. dcnmli\h or rcpair nny . <br />slructurc. prior to ils issuancc. also rcquircs thc apflicanl for such pcrillil l() lilc n signcd stalcntcnt that hc or shc is liccnscd pur\uxnt _ <br />k) thc provisiotrs of thc Contrilctor's l-iccnscrl Iaw (Chaplcr 9. Coillmcnciilg with Scction 7(XX) of l)ivision .l of thc Busincss and ' <br />ProlcssionsCodc)orlhillhcorshciscxcmpllhcrclromdndthcbasisfbrthcallc8cdcxctrlption. AlyviolationofScctimT0ll.5hyrny <br />dpplicanllbrapcrmilsubjcctslhc applicanlloacivilpenallyofnotnDrcthanfivchundrcd&)lhrs($5(X)). <br />_1, xs owner of lhc proFrly. or my cnrployccs with wagcs a\ thcir sole conrpcnsalion. will do lhc work md thc struclurc is nol <br />inlcnded oroiltrcdforsalc(Scr.7(Il,l.BusincssandPnrfcssionsCrdcrJhcC()nlracbr'sLicensclrwdocsnotalfrlykranowilcrol' <br />thc propcny who builds or improvcs thcrmn. anil who (locs such sr)rk himscll ()r hcrselfor lhrough his or hcr own crtpkryccs. <br />providcdlhctsuch imfrovcnEtrtstrcnolirlcndcdorolltredf()r$lc.lf.howcvcr.thchuildingorinlprovcmntissoklsilhtnonc)rar <br />ofcompblion. thr Owner Buiklcr will havc thc burden ol proving lhd hc or shc did nol build or improvc the prcfrcrty for lhc purfns of <br />salc ). <br />-1. <br />as owncr of thc propcny. ntrl cxclusively conirncting wilh liccnscd conlrack)rs b conslrucl lhc nrojccl (Scc. 7044. Busitrcss <br />aml PnrlcsshnCqle:ThcConlrrctor'sLicensclawdocsnolapplyloanowncrofpropcrlywhohuildsorinrproveslhcreon. <br />and who conlmcts f()r such projecls wilh a Conlrdchr(s) liccnsed pursra[t lo lhc Conlractor's l-iccnsc Law). <br />_l am cxctrlpl u&ler Sccl B. & P.C. for this rcason. <br />Dste:_,_Owner: <br />WORKFRS' COIIIPENSA'IION <br />DECLARATION <br />Ihcrchyallirntunrlcrpcnaltyofpcrjuryoncofthclblk)u'ing(lcclarttions: <br />-l <br />havc rutd will mairlain a Ccf,ificatc of Conscnt lo Sclf'lnsure li)r workcrs conrlEnsation. as providcd for hy Scction .i7(X) of thc <br />htnr Codc. for lhc Frcrformancc ofthc work for which the pcrnrit is issucd. <br />_l havc ard will uainlilin workcrs'ItrSUTaDCC. AS hy Sccl i0fl .17(x)ol thc l.nhor (irdc.lir thc pcrfbrnuncc ol' <br />lhc uork h,r whi(h thi\ pcrilrit i\ issuc{1.cxrricr u(!policy rttnrbcr nrc: <br />_l ccrlili thal in thc pcrfbrDuncc of tbr which lhis pcrnrit is issucd. I shall n(il uny pcrson in any nranncr <br />so xs b bcconE suhjecl b thc workers'cotrrpc[sdtion luws ol'Calili)min. and rgrcc rhat if I should bccomc lo Iltr <br />workcrs conrprr)satior prrvisions ol Scctir)n JT0l0 ol thc Lahrr Codc. l shall. lbnhwith coiltply <br />IVARNIN(l: traihrrc to workcrs'to ffiilrinnl frmltics arxl <br />civil fincs up k)thousand do {)l daNngcs as providc(l li)r thc <br />Scctbn .1076 of Lulxrr anrl <br />I hcrchy allirmun(lcr pcnaltyol pcrjury thal (c(,nrmcncing with Scclion 7UX)) of t)ivi\k)n l <br />of lhc Busincss and Profcssir)ns Codc. ard my is in lirll l'orcc md <br />-?- ,*'\ <br />I hr:rchy al'lirnr untlcr 1)cnxlly ol lcrilrry lhal thcrc is i lcnding rgcncy lirr lhc f$iinlnililcc ol the work lbr s'hich this |rlnit is <br />issucd (Scc. 3097. Civ. C.). <br />[-cntlcr's Nrnrc: <br />Lcndcr's Addrcss: <br />APPLICANT DECLARATION <br />I hcrc+ry aflim uMcr pcnalty of Jrcrjury onc of the following dccltrotions: <br />Dcnxrlilion Pennits-Ashcstos N(ilificalion Fcdcral Rcgulations (Title 40. Pnn6) <br />_Rcquircd kltcr of Notificatkln <br />I ccnify thrt lhc li\loral rcguldtions rcgrrding a\hc\k)s lo lhis pr+ct. <br />I ccrlily lhal I hnvc rcx(l lhis ion is corrccl. I xgrcc lo conrl)ly wilh nll Ciry <br />ordinarces and Slalc Lnws rclat <br />ahovc nlcnli0ncd l()pcf,y lirr <br />Applicsnt or Agenl <br />trxnte <br />lhc <br />rcprcscnlalivcs oflhis Cily and County cnlcr thc <br />APPROVALS <br />).rn\I\a/ll-,r4 <br />7 4)z-z-* 4{tz