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ELECTRICAL.INSPECTOR RECORD <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 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 (Rouqh) <br />Ceilinss (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />lr/eter Release <br />Rough <br />Service Meter <br />FINAL q-/g -/g ,J/e{a*(h <br />Notes, Remarks, Etc. <br />OWN'R BUILDER DEI,CARATION <br />I hereby aflim undr pcnalty ofpdjury lhat I m exempl from lhe Conlraclo6 l-icmse hw for the following rc6on (Sec.70.ll 5 ' <br />Businss md Profsion Codc): Any Cily or County s,hich require a pmrit to conslrud. alta. irnprovc. dmolish or repair my. <br />slructure. prior to its issumce, also requires the applicant for such permit to file a signed statemmt that hc or she is licensed pursuant <br />to the provisiom of the Contractor's Licensed law (Chaplo 9. Commencing with Section 7000 of Division .l of thc Businss anrl r <br />ProfessionsCodelorthatheorsheisexemptthereliomandlhebasisfotlheallegcdcxemption. AnyviolationofsectionT03l.5byany <br />applicantforapermitsubj(tsthe applicanttoacivilpenaltyofnotmorethmfivehundreddollars($500). <br />I. o owncr of thc propeny, or my employe with wags o their rclc comprcation, will do the work ild the stnrctue is nol <br />intodel or of[ged for slc (S6.7M4. Busins md Profsiom Code: The Contraclor's Licose Lrw do6 not apply to m o$ner of <br />the preperly rvho tuilds or improvs thqon. md who doe such rvotk himself or hmelf or through his or ho orvn employc. <br />proridcd lhat such irnprovqnmts N not intmdel oroffsed for slc. l[ howws. the building or improvmot is wld rvithin one yrr <br />ofcornplaion. the Orrntr Buildg will have the burdm ofprcving tha he or she did not build or improve the pmpqty for lhc purfns of <br />sle). <br />l. o orvner ofthc ;ropdy. an erclusivcly contracting wilh lic6sed contraclors to construct lhc projet (S(. 7044. tJusin*s <br />and PrchsionCode:TheContractor'sLicenscl-awdo6notapplytoanorvnoofpropertywhobuildsorimproves(herNn. <br />and who conlracls for such projccts rvith a Contmclo(s) liceNcd pursudl lo the Contraclor's Licffse L!w). <br />I an cxempt undq Srclion- <br />r,,," - 'll -2.a7 <br />I hreby affirm under pmalty of pojury onc of the following <br />I havc dd N'ill maiilain a ('ertificate ofConsenl lo Self-lnsure rvorkm'cornproation, as provided for by Sslion .1700 of the <br />Labor Code. for the psfonnilcc ofthe work for which the permit is i$ued. <br />I have and will maintain workm' compemation insurmce. o required by Sction 3700 of thc Labor Code. for thc pcfomrmcc of <br />thc work for which this pemit is issued. My workm' compmation insurmcc cmiq ild policy numb6 ile: <br />( an ier: <br />Policy Nurnber:-Expircs: _ <br />I cef,iry that in lhc pqfonnance of the work for rvhich this pomit is issued. I shall not mphy any pe6on in any mannc <br />s 6 to becom. subjel to the $!rk6s'comp€nsation larvs ofCalifomia. md agre that ifl should become subject to the <br />worktrs' composalion provisions ofSection -1700 ofthe Lahrr Code. I shall. forthwith comply rvith thow provisions.. <br />WARNING: l;ailure to sccure workcB'cornpensation covcrage is unlawful. and shall subject an unployo kr oiminal penaltis and <br />civil fines up lo one hundred thousand dollare ($l ). in lo the of comperoation. darnages as providecl for the <br />Sslion 1076 ofthe l-ak)r Code. intq6t and Ies. <br />I hreby affirrn undcr poralty of perjury that I m licosed undq <br />of the Businss and Profsions Code. ud my liceroe is in full <br />9 Scction 7000) of Division -l <br />effst. <br />License Class:-- Licerec Nurnber: <br />lh(e:Contrsctor:__ _ <br />CONSTRUCTION LENDING ACONCY <br />I heeby affnn undo pen.lty of pgjury that thac is a consruction lending agocy for the Jn'fomoce of thc work for u'hich this pmnil is <br />issued (Sec. .1097. Civ. C.). <br />Lendq's Name: <br />Lfldq's Ad&s: <br />-APPLICANT DECLARATION <br />I hottry affinn undo psralty ofpcrjury one ofthe following dsldalions: <br />Demolition Pstnits-Asb6los Nolification Fedsal Regulations ('l ille 40. Pa16) <br />_.-Required Letter of Nolifi cation <br />I colify that thc fedcral rcgulations rcgtuding 6bcslos rcrnovnl are trot a|plicablc to lhis projecl. <br />I colily lhat I hare rcorl lhis applicalion i!il slalc that the ahrrc inforrnalion is conccl. I agre to cornply with all Cily and (\runty <br />f this City and County kr ml{ ufrn the <br />o,u,1ll-Z-tZ <br />ordinancG and State laws relating <br />abo\c nreillionc(l l)ropcllv for <br />Aplllicaill 0r Agcnt <br />l'ernrit$ trsnrc (print): <br />to building md hrcby reprsenlative o <br />D^r", /ll'z - 17