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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough EXPIF tED <br />Service Meter <br />FINAL MAR IU 207 <br />Notes, Remarks, Etc. <br />Owocr-BuildqDcclar&tion rr7 - <br />I hereby affirm under pemlty of perjury that I am exempl form the Coilmdors' License Law for the following rson (sff.7Ol L5 BNin6s <br />and Profession Code): Any City or County which rcquirc a pemit to comtruct. alter. improvc. dcmolish or rcpair any structue. prior to ils <br />issuance. also rcquircs thc applicant for such pcrmit to file a signcd statcmcnt that h€ or shc is liccnscd pursuant to thc provisions ofthc <br />Contractor's [,icensed Law (Chapter 9. Commencing with Section 7000 of Division 3 ofthe Business and Profesions Code) o, that he or <br />shc is cxempt thcrcfrom and lhc bsis for thc alleged cxemption .Any violation of Section 7031.5 by my applicant for a pmil subjects thc <br />applicant to a civil penalty ofnot morc thm fivc hundred dollars ($500). <br />_1. s owncr of thc propcny. or my cmployets with wages as thcir sole compcnsation, will do thc work and thc structuc is not inlmded <br />or offcred for slc ( Sec.7044. Busines rnd Professions Codc: Th€ Contraclor's Liccre Law dos not apply to an owncr ofthe prcpcny <br />who builds or imp.o\'6 Ih6con. and who dos such work himsclfor h6clfor through his or hr own cmploycd. providcd lhal such <br />improvcmcnts arc not intcndcd or offcrcd for salc. If. howcvcr, thc building or improvcmcnt is sold within one ycs of complction. thc <br />Owncr-Buildcr will havc lhc burdcn ofproving that hc or she nol build or improvc for thc purposc ofsalc). <br />_1. 8s own( of the propdy. am cxclusivcly conlracting wilh liccNed conlracloB to constnlcl thc prcjcct ( 56. 7044. B6in6s and <br />Profession Codc: The ContrSclor's License law docs not apply to an owner ofpropedy who builds or improves thereon , and who <br />conlracts for slch projocts with a Conlractor(s) licensed pursuant lo the Contractor's License Law.). <br />_l m cxcmpt utrds S€tion <br />Datc: <br />& P.C. for this rcason. <br />Owner: <br />WORKERS COMPENSATION DECLARATION <br />I hocby affim under penalty ofpcrjury onc ofthc following dcclarstioB: <br />_l have and will maintain s Certificatc of CoNcnl to Sclf-lnsure for workers' compenetion, as provtded for by Section 37oO of the <br />lrbor Codc, for thc pcrfomancc of thc work for which the pmit is issucd. <br />ll|ave and will maintain workers' compensation insurance, as rcquired by Section 3700 of the [abor Code, for th€ performncc of the <br />work for which this pemit is issued. My workers' compensation insurance orrier and policy number are <br />Caricr: <br />Policy <br />('Ihis scction nced irot complcted if thc pemit is for One hundred dollaG l$lo0l or lcss) <br />)4 "".tlry <br />rrut <br />became sub.lect <br />in lhe pcrformance ofthe work is issucd. I shall nol cmploy any pcrson in eny manner so as to <br />to the workers' compensalion and agree that ifl should become subJEt to the workers' <br />compcnsation pro!isions ofS(tion 3700 ofthc I fonhwilh cornply rvilh <br />,^r,, lO- 13. <br />x":T1i:,li*:J ;"#;fi 'ffi:compensatron is unlawful. and shall cubj.ct an employer to oiminal pcnallics and civil <br />($10o.000).in addition to thc cost ofcompcnsation. &mgcs u providcd for thc Sstion j076 of <br />thc Lrbor Codc. intcrot md anorney's fe6. <br />LICENSED CONTRACTORS DECLARATION <br />I hcrcby aflim undr pcmlty ofprjury that I m liccNcd undo prcvision ofChapto 9 (commcncing wilh Scction 7000) ofDivision 3 of <br />lhc Bsincss and Profssiom Codc. md my liccmc is in full forcc and cffft1. <br />t-icensectass' CIO Number _ <br />""", /O- A- H <br />I hcrcby affim undcr pcMhy ofperjury that <br />issucd (S(. 3097. Civ. C.). <br />Lender's Nsme: <br />tsa ion lcnding agcncy lhc pcrfomancc of lhc work for which this pemit is <br />l-ender's Address <br />APPLICANT'S DECLARATION <br />Dcmolition P.rnrits-Asbestos Notification Federal ReSulations (Title 40. Pan 6) <br />Rcquircd lrlter of Nolifi cation <br />I fedcral rcgulations rcgarding asbcstos removal arc not applicsble to this project <br />I I have rcad this application and slalc lhat the above infomalion is corcct. I agree to comply wilh all City and Counry <br />Slatc ltws rclating to building construction. and hocby authorizc rcprccntatives ofthis City and County to cntcr u[pn thc <br />( <br />abovc <br />of <br />prop€(y inspection <br />03.31 .06 <br />I