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ELECTRICAL.INSPECTOR RECORD <br />Rev.08-07-2015 <br />APPROVALS DATE ID/SIG.COMMENTS oWNER BI.JII,DI.:R 1)I.),CARATION <br />I hcrcby affrnr undcr pemlty of pcrjury rhat I dI exenrpl frcnr thc ContractoE' Licen* [:w for thc following Easo (5(.7031.5 <br />lrusincss and Proltssion Codc): Any City or Counly which rcquircs a pcrmi( k] construct, altcr, irnprovc, dermlish or rcpair my <br />structurc,priork)its issuance.alsorequir.stheapplicanforsuchpcrntttofilcasiBncdstatenEnl thatlEorshcislicc[Ed pursuant <br />ro rhc previsions of thc Contractor's l,icenscd liw (Chapte. 9, Commencing wilh Scction TUXJ ol Division 3 of thc Busincss and <br />Prolessions Code, or that lE or she is erenlrt therefronr and tlE basis for t|r alleged eiemptior. Any violatiotr ofsection 7031.5 by any <br />.pplicantforopcrmitsubjcctsthe ilpplicanttoncivilpennltyofnolmore(hanfivchundreddollars($500). <br />_1. as owncr ol'lhc proFny, or rny ernplorcs with waScs as thcir srlc compcnsation, will do thc work aid thc sfuw is mt <br />intdr.lal or offcrcd for sle (Se.7()44. BusiDess and Prcfcssions Codc: Thc Conlraclor's LiccN [jw d@s not apply lo m owner of <br />the prcperly wlru huilds or imgrows tlEru$n, and who dcs such work himself or lrcrself or thrcugh his or her own enrployees, <br />providcd that such improvcrmnts @ mt intcrdcd or offce\d for salc. If, howcw. 0E huiHing or itrprorcmil is sld within ore )ra <br />ofcomplctiorl thc Owrrcr Buiklcr will have the burden otpnrving lhat hc or shc did rct buill or imptuve thc pNpqty for lh. purposc o[ <br />sh). <br />_1, as owncr ofthe propefly, am cxclusivcly conractinS with licen*d conlractors to construcl th. prcject (Sec. 7044, Busincss <br />and Prultssiil Code: The Contrack)r's Liceilse Law does not apply to an owner of prolrdy who builds or improvcs thereon. <br />and who contEcls for such proiccts with a Contmclo(s) liccnsd pu,suut to the Conu&tor's Lice[se Lrw). <br />_l anr exen4n under Sectitrr-, B. & P.C. lir this reason. <br />Dale:- <br />WORKEKS'COMPENSATION <br />DECLARATION <br />I hcrcby affiim under pcnaltyofperjuryonc ofthc following dccldations: <br />_lhaveuxlwill nuinlaiDaCenilicalcofCofl*ntloSelFlNurcforworkqs'comlrcnsatiotr,6 prcvidcdforbySetion3T00ofth€ <br />libor Code, for lhc pcrlornucc ofthc work tbr which thc permit is issued. <br />_l have and will trHi!ilain workers co[rpensati{)n insurance, as requted by Seclion 3700 ofihc titx)r Codc, for lhc [rcrfof,rEEe of <br />thc work for wlich this lrrmit ir issucd. My workcrs' coD{Ensation insurmcc cmier axl lrclicy nunrbcr uc: <br />a V N3 uil-4n6 co <br />I_tripircs:- <br />_l ccnify lhat io thc FrfornHncc of lhc work for which this pcrmit is issucd. I shall not cmploy any pcrson in any manner <br />s as to bccom subjccl lo thc workcrs' compcnsation laws of Calilbmie. aM a8rce that if I stmuld becorre subject to thc <br />workds' con{*nsatioD provisions of Section 3?00 of the tnbor Code, I slull, fonhpith conrply with lho* prcvisions.. <br />WARNING: Failure lo rccurc workers'compensation coverage is unlawlul, and shall subjcct an employcr to oi,ninal pcnahts and <br />;r'-l':;Ef6yi1"'T'::it dollas ($100,000). <br />dd dlorrcy's lccs. <br />in additi([ lo of comltrelion, duugcs as rovidcfbr thc <br />I hcEby affrm under Fnalty of pcrjury (hat I am lic.nsl undcr poviiion of Chaptcr 9 (comEncing with Setbn 7000) of Division 3 <br />of thc Busincss and Prcfcssions Code. ard my liccnE is in full fore ard cffcct. <br />Licens.a b Number: <br />Ll -/7 <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby af,irm undcr Fnalty o[pcrju]y that thcre is a consrruction lcnding agcncy for thc perlormarcc ofthc work lor which this pcrmit is <br />issucd (Scc. 1097, Civ. C.). <br />kndcr's Nanrc'- <br />kndcr's Address: <br />APPLICANT DECI,ARATION <br />I hocby armundcr ptmlty of perjury one of thc following d4l[alions: <br />DenDlition Pcrnlils-Ashcslos Notificati()n Fcderal ReSulations (Title 40, Pd6) <br />_Rcquircd t ttcr0f Notifietion <br />_l ccdily thal thc fcdcral rcgula(ions regtrding sbeslos rcrreval uc mt applicablc to this pmj€t. <br />Sl ."nlfy rtrur I luvc rcad this applicatio[ inil statc thal lhe ahovc informlion is corer. I agre to conply with all City and County <br />ordinanccs ild Stalc hws rclatiog to boilding conshction. ard autk)rize rcprcscnlativcs oflhis City and <br />6bovc trEntioncd propcny f<rr inspection purpors. <br />Applicatrt or Agml <br />I'cmrilcc nanrc <br />1..J <br />upon tlrc <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Groundino / 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 />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />lrleter Release <br />Rouqh <br />Service fr/eter A. <br />FINAL 6-E n H{t+\il\ <br />Notes, Remarks, Etc. <br />-+ <br />,^,r*,^*,,' 1 bO o o t ! b OQ. )Ql