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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS oWNER BtJII,I)I]R I)l]I,CAR 'TION <br />IherehyaflirnruntlcrpenahyofFriurythrtIailrexenrilfromtlrcConlraclos Liccnselrtwforthcfollowingrcaen(Sec.70]1.5 <br />llusincss and l,rol'cssi1)n C'!dc): Any City or Counly which rcquircs a ltrmil kr construct, altcr. irnproyc. dcrnolish or rcnat any <br />structrrre.pri(,rt(!irs issurncc.ahorequircstheal)l)licaDtk)rsuchltrnilk)rihusig[cdslateiltil lhalleorsheislicct*d pursuanl <br />to thc provisions ol'llrc Contrnctor's Liccnscd l,aw (Chrl)fcr L Cornrncncing wilh Scction 7000 ol l)ivision 3 ol'thc iJusincss an<l <br />ProlessiotsCode)orthatlwrrrheiserenr|ltherelronrandtlEbasistbrtlEalleS!'dexenrpti(nl. Atyri()laliolofSecliulT0ll.5hy6ny <br />ilpplicxn(forapennitsubjcclsrhe npplicxn(torcivilpennltyolnoltruethilnfivchundrcddollurs($5()l)). <br />_1. as owncr ol-lhc protl-ny. or n)y crnpl()yces wilh wagcs as thcir sle cornpcnsation, will do thc work ard thc stMlwc is il)l <br />itiletxlcd orofferedforsalc(Sec.?(]t4.BusiilcssardPrcfcsstilNCode:TheCoDx'aclor'sLiccnscLawdoesnotapplytoanownerof <br />thepn)IEdy wlx)larildsorinprovcstlErdnLarxlwlx)d(tssuchworkhinrselforlErselforlhrcughhisorlErownenpl()yes. <br />providr'd that such itnprovctrcnts uc iltr inlcndcd or oll'crcd for salc. I1. howcver, lh! building or improverrcnt is srrld within onc yt'ar <br />ofconpleliur, tlE OwNr Builtler will have thc burdcn ofpn)virrg llu( lE or she did eil build or inrp()vc lhc pmpef,y for llE purposc of <br />sdc). <br />_1. fls owncr ofthc propeny, ah cxclusi!cly contrrctinS wilh licen*d conlr.cloA to conslrucl lhc preject (Sec. 7(X4. Busincss <br />and PnrtLssirlrCorle:'IheContracrcr'sLicenseLawdoesnotapplytoanownerofpropenywhobuildsoriNprovesthereou. <br />and who contrac(s for such p()jccls wilh a Conlrack)r(s) licensd pursuml to thc G)ntractor's Liccnsc Law). <br />-l <br />ilur exetrrpt undcr Scctioil-, Il. & P.C. lirr this rcasrrr. <br />Dstc:- <br />WORKI'RS' COMPTiNSA'TION <br />DECLARATION <br />I lrcrehy affirnr undcr pcnalty ofpcrjury onc oftlrc li)llowing dccltrations: <br />_lhaveandwill nuintairrCenilicaleofC()nscntk)Self-lnsureforworkcrs'cotrrlEnsalion,as prcvidedforbyScct()n3700ofthe <br />LatDr Codc. Ior (he pcrforruncc ol lhc work li)r which thc pcrinil is isslcd. <br />4fivcarulwrll nrrrntuinworkers coD)pensalioninsuftncc,as requiredhySeclion3?00oflhetnk)rCode,forthcperfonnatrceof <br />- the wtrk for which this lErnlit is issucd. My workqs' courFnsaliul irNurilcc cmicr axl 1rclicy nunrbcr uc: <br />lrrli!y \ <br />_l colitylhatiIthclErli,rnraDcc(,flhcworkforwhichtlispcrilrilisissucd, Ishall notcnrpkryanylErrcniranynunncr <br />so as k) bcconr subjcct to lhc workcrs' coililrc[saliil] laws ofcalilornia. aDd agrcc lhat il l should becoDN subjcct to lhc <br />*orkers conrpcnsarion proyi\idN ofSectiotr 3TLU ofthe Latrur Code, I $hll, fonhwith cornply with tlD* proviriotrs.. <br />WARNING: l;ailurc lo scura worlicrs'compensation covcragc is unlawful, nnd shall subjcct nn ernployer lo rirninol pcnaltics and <br />civil itres up tr) o,lc ltrrtrdrcd thousand rhllars (S irr additior to lhe cosl of competrsatioil, danug.s as providcd for thc <br />Scction:1076 hlxrr Codc, inLcrcst Itcs. <br />7/rt <br />I hercby affirrn undcr lxtrally of perjury lhnt I arn licenser.l under pn)vision of Chdptcr 9 (conmEncitrg with Section 7000) of Division 3 <br />of lhe tlusines\ rnd l'mfessions Code. ilrxl rrv license is in full l'orce aril elfecl. <br />I-ic!'0sc 4V3/ o <br />I hcrcby allirnr unds Ff, naltyol pcrjury thrl <br />issucd (Sec. 1097. ('iY. C.). <br />isr lcnding agcncy lilr thc pcrli)flnnnce ofthc work lt r which lhis pcflnit is <br />Lendcr's Nanrc: <br />[.ndcr's Addrcs\: <br />APPI-ICANT DECLARATION <br />I lFrcby afiimrundcr pcnnlty of perjury one of thc i)lbwing del{ations: <br />Dcnx,lili()n Pcrilrits-Asbcsk)s Notificarion Fcdcral Rcgulati()ns (Tillc 40. Pd6) <br />-Rcquircd <br />lxtlcr ol Notificalion <br />_l ectrily lhat thc lcdcralrctuhri,)ns rcgffdin8 ilsbcslos rcrnovalrrc il{ al)pli(ablc () lhis pr()jcct. <br />{:ttrityrtut llu\ ilpl)h(rti(nr rxl slillc thal llE irlx)\'c rtrlinrrilrnr i\ c(xrccl I agrcc lr conrplv with all City antl Crrunty <br />and (i)unly lo ('nlcr ulx)n Llrordinanccs and rclaling h buildinS conslruction. and hcrchy auth)rizc rcprc*ntatircs of this City <br />ilboYe [EntioEd <br />Appli(sDt 0r <br />Itrrnril(c ilunrc <br />lor inspcction <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 />Buildinq <br />Under Slab / Floor <br />Bondinq / Gf6ilnEinb / UFER Z/ta/to Pc,r^le,o $2, <br />. -v <br />lranslormers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />lVeter Release <br />Rouqh 4c/zo PL Zrl <br />Service l\Ieter <br />FINAL VrA/zo lCr?U€..aS Zry <br />Notes, Remarks, Etc. <br />.u*i"r, *r^A<-.E^c(. A <br />l)atr:*/,./.-