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ELECTRICAL.I NSPECTOR RECORD <br />Rev.08-07-2015 <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION <br />I hcreby aflinn undu pcnalty of pcrjury lhat I m erempt ,iom the Contracto6' Licse Law for thc following re6on (S€.?03 1.5 <br />Businws md Profesion Code): Any City or County which requirs a permit to coNtruct, allq, improvc, dmolish or rcpair my <br />strudue. prior to its issuilcc. also requirG thc applicel for such lmit to filc a signed stalmmt lhat he or she is licmed punumt <br />to thc prcvisions of the Contractor's Liccnsed Law (Chapts 9, Comencing with S@tion 7000 of Division I of the Busine$ md <br />Profsions Code) or lhat hc or she is exempt lhqefrom md lhe b6is for the allegcd cxmption. Any violation of Sstion 703 I .5 J)y any <br />applicantforapmnitsubj(tsthe applicanttoacivilpenaltyofnotmorelhefivehundreddollas($500). <br />_1, 6 ownq of the propeny. or my cmployeG with wag6 6 their $le compecation, will do Oc work md the structuc is not <br />inroded or offscd for sale (Se.7044. Buins md Prof*iom Code: The Contractor's Licmsc [rw do6 f,ol apply to u ownr of <br />th€ propeny who builds or improve thtron, md who do6 such work himself or hmelf or thrcugh his or ha om employes, <br />provided lhat such iffprovmmts de not intmdql or offqed for sle. lf, howqs, the building or improvmmt is sld within one )@ <br />ofcomplaior thc Oumq Buildq will have the hrdm ofproving tha hc or she did not build or improvc the prcpety for the purIrcs of <br />sle). <br />_1, o owner of the prop6ty, m exclusively contracting wilh licffied contracloB to conslruct the prcjsl (S@. 7044. Buins <br />md ftofsionCode:TheContraclor'sLicenseLawdosnotapplylodownerofprop€rtywhobuildsorimproveslhfi@n. <br />and who contracts for such prcjects with a Contracto(s) licmscd pursumt to the Contractor's Licmse Law). <br />I an cxernDt undtr Strtion-. B. & P.C. for this reoon. <br />Owner: <br />Y-AEXEBSTCAMIENSAII9N <br />DECI"ARATION <br />I haeby a{fim undo pmalty of pojury one of thc following drclaatiom: <br />_l have od will maintain a Certificate of Coruat to Self-lmure for workos' compercation. 6 prcvided for by Sslion 3700 of the <br />tabor Code for the pofomece of the wort for which the pmil is i$ued. <br />Vv1uu" <br />the work <br />and o rcquircd by Setion 3700 of the labor Code, for the perfommce of <br />imurmce cmio md policy oumber tre: <br />IPolicyL o <br />I cenify that in the psformance of the work for which this pqmit is issued, I shall not mploy any person in any mmno <br />m rtobccornesubjecttothcworkqs'compenstionlawsofCalifomia,odagrethatiftshouldbecomesubjsttotho <br />workm'compmationprcvisiomofSection3T00oflheLaborCode, Ishall.forthwithcomplywiththosprovisions.. <br />WARNINC: Failure to secure workm'compcnsation covwge is unlawful, and shall subjct m mploya to qiminal pemltiG md <br />civil fines up to one hundred thousd dollm ($100.000), in addition to the cost of comperoation, damages c providcd for thc <br />atomey's fm. <br />s <br />DECLARATION <br />I hoeby affm undo penalty ofptrjury that I m licosed undo provisioo ofChapta 9 (commscing with Se.tion 7000) of Division 3 <br />of the Businw md Prcfesioro Code, md my licmse is in full forcc ud cffet. <br />Liccnse t ltt <br />-Liceroe <br />Numbs:A)?)fQ <br />a <br />CONSTRUCTION LENDING AGENCY <br />I hseby amm undq penahy of pojury that th6c is a comtruction loding agmcy for thc pdfommce of the work for which this pcrmit is <br />issued (Se. 3097, Civ. C.). <br />t-md6 s Addr6s: <br />APPLICANT DECT,ARATION <br />I hotbyaffm unda penalty ofpajury one ofthe following daloations: <br />Dcmolition Psmits-Asbestos Notification Federal Regulations (Titlc 40, Pd6) <br />-Requfed <br />Idrtr of Notification <br />I cftiry that the fedqal rcgulatiore regading 6b6tos rqnoval tre nol applicable to this prcjel. <br />is cor(t. I agr€ to comply with all City and County <br />reprsmtativ6 of this City ed County to enta upon the <br />abovc mdtioned prcpeny for <br />2-- b 4-o? oApplicsnt or Agent <br />Pcrmile nrnre a <br />Site-Work <br />Underground <br />Pole Bases <br />Lisht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildins <br />Under Slab / Floor <br />Bonding / Grounding / UFER '?.124,/-o D knrl c <br />Transformers I il' <br />Torqueing <br />Sub-Panels <br />Air Conditioners ,l <br />Roof Top Equipment aJ z,t 20 Dknrta <br />Factory Wired Unit I rt <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilinqs (T-Bar Rough) <br />Meter Release ?)'?-rt ?d DKN,dl-fr bn, <br />I rl <br />Rough <br />Service Meter lr I <br />FINAL Al'?.t+1r'bh nh, <br />Notes Remarks Etc. <br />n*r <br />r.rt'[:],isuo Cofrlr,tclon <br />kndq's Nmc: