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DATE ID/SIG.COMMENTSAPPROVALS <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 />Bonding / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Condltioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilinqs (T-Bar Rough) <br />Meter Release <br />Rouqh <br />Service Meter Avw)FINAL c-10-20 <br />Notes, Remarks, Etc. <br />ELECTRICAL-INSPECTOR RECORD <br />I hcrcby aflrm uuler pcnalty of perjury thal I dtr cxcmpt frcnl lhc CbntracloN' Lic.Nc bw for thc following rcasn (So:.7031.5 <br />Business and Prolesrion Code): Any City or County which rcquircs a [Ermil lo construct, alter, improve. dcmlish or rcpair any <br />struclurc, prilr to its issuance. rlso rcquiEs thc applicail for such lEmit b fih s si8rcd slatcmnt lhal hc or strc is liccMd pulsanl <br />to thc pmvisions of thc Contractor's l,iccnscd law (Chaptcr 9. Commencing with Scction 7000 of Division 3 o[ the Busincss od <br />Prof€ssions Cqre) or that lE or she is excnrpt therefiom and tlE b6is for tlE alle8ed exenption. Ary violalion of S4lion 7031.5 by any <br />applicant for a pcf,nit subj(t$ lhc applicant lo a civil pcmlty oI not mre than fivc hundred doll.m ($5uJ). <br />_1. es ownca ol lhc prelEny. or my crnployces wilh wages as thcir solc compcnsdion, will do the wtrk and tha stm@ is mt <br />intcrxlcd or offercd for salc (Se.7044. Busincss and Prclessions Codc: Thc Conlraclor's Liccns Law docs not apply lo ah ownc! of <br />thepNtEny wlnhuil&orimJtroveslhiamuardwlDd(BsrchwotkhimelforlEr*lforlhrcughhisorherowlemployes, <br />providcd that such imptr)vcrrcnts [c mt iilcndcd or olTcred for eb. Il. howcvq, 0E building or itrprovcrEnt is sld wilhin orc ycd <br />ofconpblk)n, $c Owrcr Builtr will have thc bqrden of prcving that he or shc did mt boill or irpmvc thc pmp<ry for thc purpow of <br />sb). <br />_1. as owncr of the pmpefly. um cxclusilcly contracting with liccn*d conlaaclors to construcl lha prcFct (Ss. 7{X4. Busirc$ <br />aill P[)tessimCode:TheContmchr'sLicenseLawdoesnotapplytoanownerofprope(ywhobuildsorimproveslhereon. <br />and who cootracls for such projccts with a G)nlretor(s) IiccGEd pursutut to (hc Conuactor's Lice[se Law). <br />-l <br />urexempt under Sectiul-, B. & P.C. for this reason. <br />WOI{XI.lRS' COM PI)NsATl0N <br />DECLARATION <br />I hcrchy alfirm undcr pcnally of pcrjury onc of lhc l'ollowing dccluatiotrs: <br />_lhavcanlwill nuintairaCcnilicatcofconsenttoSclllnsurcforworkcts'compemation,as prcvidcdforbyScction3T00ofthc <br />l.rhor Codc. for the pcrfoflMrce ofthc work lbr which lhc pctrnit is issucd. <br />_lhavearrdwillnraintainworkcrs'collpcrNati()ninsurancc,as rcquiredbySetion3T00ofthehborCodc,forlhcpcrfomH[eof <br />thc work for wlich lhis Frnlit is issucd. My workcrs' compcNation insurecc cmicr a&l F)lky number oc:it c d <br />l'olicy 2 <br />_l ccnify that iu thc lErli)rnuncc ol'thc work for whicll this permit is issucd, I shall not cmploy ury pcr$n in a[y nranncr <br />$ aslobccoDrcsubjccttolhcworkcrs'coillpcnsdionlawsofcalifomia.andagrccthatiflslnuldbccoresuhjecttothc <br />workers' conrpensalior provisiotrs of Sectiotr 37U) of thc Labor Code, I slull, fonhwilh cornply wilh lho* provisions.. <br />WARNING: Failure 1o rccure workers'compensation covcBgc is unlawful. and shall an emploler to oiminal panaltiqs and <br />rivil t'ucs up lo orc lundrcd thousand dollars ($100.000). ir additi(nr n) thc danugcs as provided fi)r lhe';:'{5rryr**dd iltorrcy's fek <br />LICENSED CONTRACTOR <br />I'I]CLARATION <br />I hcrcby affrm under lEnalr), of pcrjury rlut I anr licen*d under pruvision of Chapter I (comnEn(in8 with Scction 7000) <br />ol' the Buriness and l'rofessions Code. nnd rnv liccnsc is ir lull force und effect. <br />Liccnsc NuDrbcr:6"b <br />CONSTRUCTION LENDINC AGENCY <br />I hcrcby al llrm undcr Fnalty of pcrjury that thcrc is a construction hnding agcrcy for thc perlormarce o[thc work lbr which lhis ltrmit is <br />issued (Scc. 3097, Civ. C.). <br />Lcndcr's Nanle. _ <br />Irtrdc) s A,l,lre.': <br />@NpEc!.AB .UAN <br />I lucby aftirnr undcr 1*-naly of pc{ury onc of thc li)llowing dccluations: <br />Dcnx)lition Pcrnrits-Asbcskls Notification l'tdcral RcSulrtions ('I itlc 40, Pm6) <br />_Rcquircd Lcttcr of Notificati)n <br />_l cenili thal thc fcdcral rcgulAtions regilding asbcsbs rcmrval uc nol applicablc lo this projcct. <br />@l ccnify rtrot I havc rtad tlus apphcation ild state tlut llE atrvc informatiou is co[ecl. t e8lce to comply <br />ordinmccs dd Stalc Laws rclatinS k) huildinS constructhn, and hcrcby authorire rcprc$nutivcs ofthis City <br />with all City and County <br />and County h cnlcr <br />above nEntioned propcny for inspcction <br />ADpli(strl or Agol <br />Hev.08-07-2015 <br />Pcmrilcc ndnlc <br />5 <br />dr