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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 Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq / 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 />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />lt/eter Release <br />Rouqh <br />Service Jvleter r\ <br />F!NAL G-10-).0 )Y-Uplt) <br />Notes, Remarks, Etc. <br />I)I],I,CARA'I'I()N <br />I hcrcby a{ftrm undcr penalty of pcrjury thal I m) .xcmpt ftom thc Conmctos' LhcNc llw for rhc following ca$n (Ss.703t.5 <br />Busincss and Prolcssion Codc): Any City or Couily which rcqutcs a pcnnit to construct, altcr, improve, demlish or rcpair dy <br />structurc, prior to its issuance. also rcquircs tha applicel for such pcmit to fih a siBncd stalcrcnl lhat [E or shc is liccnsd pur$ant <br />lo tlE pmvisions of thc Contretor's l,iccnsed law (Chaprct 9. Commrcing with Section ?fiD of Division 3 of lhc Business ild <br />Professions Code) or that hc or she is exemft therefrom ed tlE b6is for tlE alleged exemptior. Any violation of Section 703 I .5 by any <br />applicantforap.nnitsubj.ctsthc rpplicanttoacivilpcnflltyofmttrcrcthanfivchundrcddollars($500). <br />_1. as owncr ol thc propcny. or my cmployccs with wages as thcir solc compcnsation, willdo the work and thc stMuc is not <br />inlcilal or ollercd for sle (Sd.7041. Business and Prcfcssions Cqlc: Thc Conlractot's Lic€n* kw d@s nol apply lo an owncr o[ <br />lhcpropcny wlmhuildsorirnprovr'stherer!odwlx)d@ssuchworkhimselforherselforlhrou8hhisorlErownenrployees, <br />providcd that such improv.lrcnts tre il)t inlcndcd or o,Icnd for &Lh. Il. howcver 0E boihing o, irrprovcrrcnl is $ld within onc yca <br />ofconplctiur the OwrEr Buil-ler will have the buden ofprovir{r thd hc or she did mt buikl or inrprcvc thc prcp.iy for thc purlo* of <br />$ilc). <br />_1, as owncr ofthe p,opcfly, am cxclusiv.ly coilracting with liccn*d conlraclors to coo$trucl lhc pojd (S.c. 7044, Businc$ <br />anl Profusirr Code: The Contractor'i Liccnse Law dcs rct apply to d owrct of ptopcny who builds or improvcs Iher@[ <br />and who conuacls for such projects with a Contractor(s) Iiccnsd pursumt to the Conuac(or's Liccmc Law). <br />-l <br />Mrexempt undcr Sectiur-, B. & P.C. lbr lhis reason. <br />EQBSIESSA!4IENSAIIQN <br />DECLARATION <br />I hcrcby affirnr under pcnaltyofperjury onc ofthc tbllowin8 dcclffatioN: <br />_lhaveadwillnuintairaCef,ificatcofCoosctrtbSelf:lnsuEforworkers'con{Ero&tion,as pmvidcdforbyScction3T00ofth. <br />kbor Code, for thc lrcrfofllffic of lhc work for which lhc pcrmit is issucd. <br />_l havc and will nraintain workers' conlpcusation insurancc, as requiftd by Scction 3700 of thc ljbor Codc, for lhe perfonrmc of <br />thc work for which lhis Frcrnit ii issuct. My workffs' cotr{ENtion isuruce cuier {d plicy numher de: <br />D.l.r- <br />Scction <br />,r <br />Policy o o <br />civil llDcs ul k) onc lrundred thousand dollars ($100.000). in <br />rntctcst <br />_l ccrily tlut iI thc lrrli,rnutrcc o[thc work for which this pcrmil is issucd, I shall not cnrploy any lrcrson rn ary <br />$ as to bccorrc subjcct lo thc workers' compensrlion laws of Califof,lia. and agrec that if I shuld bccorrc subjcct to the <br />workers' conrpensation proviriors of Sectiotr 3700 of the Labor Code, I slull, fonhwith comply wilh tho* pruvisions.. <br />WARNING: Failure to *cure *orkcrs' ompcnution covcmgc ;;x,:::':1h*&wfii:;*1H1fi :lr: <br />co <br />z / r /Z(t <br />and <br />lhe <br />K <br />and dtormy's ttcs.(. <br />I hcrcby affrnr under trnalty ofFrjury that <br />o[ th. Business and Professions Codc. afil <br />LICENSED CONTRACTOR <br />I)ECI,ARATTON <br />I anr liceilsd undcr prcvision ofChaptcr 9 (conilrEncing wi(h Secton ?000) of <br />rny license is in lull fore rRl cffcct.7 z o7aLiceilse <br />W <br />I hcreby aflirm undcr lEnalty of pcrjury that thcrc is a construction lcndin8 agcrcy for the pqlbrrec of the work lbr whkh lhis pcrmit is <br />issucd (Scc. 3097, Civ. C.). <br />Lndcr's Nanr: <br />Irndcr's Address: <br />ASPIISNDE9!A8AI!9N <br />I hcEby affmlundcr lEnalty oIpcrjury onc of thc folk)ping decldations: <br />Dcnblilion Pcrmits-Asbcstos Notification Fedcral RcSulati(,ns (Titlc 40, Pd6) <br />_Requircd Lcttcr of Ndificalion <br />cdili that thc l'cdcralrc8ulations rcgddinS asbcstos rcmval sc nol applicablc to this pmlrt. <br />ccnili that I lhvc rcrd this applicalion ud stalc tl[l lltc atx)vc inlirrmali(ilr is corcct. I agre to conuly <br />I rcprc*nutives ofthis City <br />with all Chy and County <br />ordinmccs and Statc kws rclaling lo building conshctioe ard hcrcbyauthoria <br />abovc Ncntioncd propefly for inspcction purynscs. <br />and to cntcr upon tlE <br />Applicant or Agot <br />l'cmritcc nanrc <br />>o <br />Rev. 08-07-201