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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS ()\\'NFtR BtJIl.I)!tR Dl].( ARA.l l()N <br />I haeby aflim undo penalty of psjury lhat I an exempt fiom lhe ContracloE' Licmse lzrv for the follorving ree)n (Ss.]031.5 <br />llusincs ad Profeion Codc): Any Cily or County rvhich requirs a ponit lo coNlruct. allq. imdrove. dem,.lldr or rcp,,r any <br />slruclure. prior lo its isuance. also reauirG lhe applicanl for such pmit to file a si8ned stalmfit thal'he or shc is lilensed p. ;11 ,nt <br />to rhe provisions of the Conlraclor's l-icenscd ljw (Chapltr 9, Commencing wilh Section 7000 of Division 3 of thc Businefand <br />Profesions Code) or that he or she is exempl thseliom md th€ b6is for the allcged ermplion. Any violalion of Seclion 70-l 1.5 hy any <br />applicantforapmitsubjectsthe applicantloacivilpenallyofnotmorethanfivehundrcddollils($500). <br />I <br />_1, ru orvner of the prop€ny. or my employecs rvilh wage c their sole compensalion. will do the work md the strxclrlr is nol <br />intmdsl or of[sed for sale (Se.7M4. Business od Profesions Code: The Contraclor's l,icense Law does not apply to an owner of <br />thcprepqly whobuildsorirnp(rvslhqen.mdwhodo6suchrvorkhimselforhoselforthroughhisorherownemployed. <br />provtled that such improvqnols de not intmded or offqed for ele. If. howwq. the trrilding or improvment is old rvithin one )qrr <br />ofconrpletion. the (hvner Uuildo uill have the burdm ofpreving that he or she did not build or irnprove the propsty for the purB)se of <br />sle). <br />_.1, 6 os,nq of the propay. an exclusively contracting wfuh licmcd contradom lo comtrud lhe lrojed (S{. 7044. B6ins <br />md ProftsionCode:TheContractor'sLicenseLawdo6notapplytomownqoIpropcrlywhobuildsorirnproveslhermn. <br />and rvho contmcts for such projels with a Contrado(s) licfised puEuill lo lhe Contraclor's Licsse Las ). <br />_l en exempt unde 56lion B. & P.C. for this re6on. <br />O*ner:_ <br />WORKERS'COMPENSATION <br />DECLARA'I'ION <br />I haeby aflirm undo penalty ofpojury one ofthe following dalarations: <br />lhavemdwillmaintainaCerlificateofconsmltoSelfJNureforworkss'conrpensation.6 providedforbySslion3T00ofthc <br />Labor Code. for the pqfonnmce oflhe work for which the p6mit is isued. <br />. lhaveandwillmaintainwork6 cornp€nsationisura.ce.6 rcquircdbySdlion.lT00oftheLaborCode.forlhepofonnarlceof <br />the rork for rvhich this pemit is isucd. My works' compensdion iNurmce cmier md policy numbo ae: <br />Policy Numbq:- <br />-Expires:I ce(ily that in the pertrrnrancc oflhe work for $hich this pernrit is issucd. I shall not ernpk)y any person in an),manner <br />so ns b beconre subjecl k) the workq s' compcnsation las,s of Cali fornia. anrl agre that i f I should become subiel lo thc <br />workq's' compensalion provisions ofScclion 3700 ofthe Labor Codc. I shall. forthrvilh cornply wilh lhose provisions.. <br />WARNINC: Failure to wurc workers'compensation covemge is unlarvful. md shall subi(t an mployo to fitninal p6.llis and <br />civil finesuptoonehundredthousanddollars($100.000).inadditionlolhccoslofcompensation.damagesasprovidcdforthc <br />Setion 3076 of the Labor Code. inltrd md dlomey's fs. <br />o,,u,4i-2L2tl') <br />Dlt( 1.,\R.tiloN <br />I hoeby affirm unda porahy of perjury that I m licens€d undtr provision ofChapto 9 lcommmcinS with S(tion 7000) of l)ilisior l <br />of the Busines and Profcsions Codc. od my licmse is in full force ad effect. <br />Li."nr.Ctu"r, R/L <br />-License <br />Numbcr:14,2_ <br />I hreby affim undo petrahy of perjury that thse is a coNruclion lmding agmcy for lhe psfommcc of thc work for which lhis pqrnit b <br />issued (Se. 3097. Civ. C.). <br />Lendq's Nme: <br />l-ends's Addr*: <br />APPLICANT DECLARAl'ION <br />I heeby affnn unde pmalty of perjury one ofthe follorving declaations: <br />Dcmolition Pnnits-Asbestos Notillcation Fedqal Regulations (Title 40, PadO) <br />- <br />Required [,etter ofNotificalion <br />I cerlify thal lhe federal regulations regrding asbeslos renroval ac nol applicablc lo lhis prcjecl. <br />I cdiry lhat I hare read this application od slale that the above infonnalion is cor@t. I agre lo comply with all City and County <br />r reprsqlativB of this City ed Counly lo otq uB)n lheordinancs md State [aws relating lo comtruction. od hqeby autkrrize <br />above nrmtioned propeny for ircpecl <br />Applicsnl or Agcnt Signa(trrel Date: Cr(: J <br />r. I l.Permt(e nsme (prino, To \r t\)r*1glJ -2-L+%f <br />Site-Work <br />Underqround <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 />Buildinq <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouqh) <br />lvleter Release <br />Rouqh tolzt ll7 .,oq4/t D <br />Service ltleter I <br />FINAL I I - /{,17 m/<_/q .>^./ O,,itnj',ilV <br />Notes, Remarks, Etc.I <br />Cmiq: <br />o"", \ (I 2-L f 2.al} contractor: X <br />@