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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/S!G COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Lioht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / 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 (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />ltleter Release <br />Rouqh <br />Service [\/eter <br />FINAL ,.-2C -702 / JLG dtv <br />Notes, Remarks, Etc. <br />OWNI]R BUII-DER DELCARATION <br />I hcrcby allirrl undcr pcnalty of pcrjury that I am cxcnlpl tioilr lhc Conlnckrrs' Liccnsc Law tor thc tbllowing rcuson (Scc.7031.5 <br />Business and Prolcssion Codc): Any City or County which rcquircs n rurillil lo conslrucl. allcr. improve. dcrnolish or rcpair uny <br />structurc. prior to its issuancc. also rcquircs lhc lpplicut for such Jrcrmit k) lilc n signcd slatctrEnt that hc or shc is liccnsed pursuanl <br />to thc provisiors of thc Conlracbr's Liccnscd Law (Chaplcr 9. Commcncirrg wilh ScclkD TUyJ of Division -3 of thc Busincss and <br />Prot-cssio[sCodclorth{lheorshciscxcmpllhcrcftomandthcbasislbrthcallcgcdcxempliotr. AnyviolationofScctionT0-ll.5byany <br />dpplicant[orapcfinilsubjcctslhc xppliclnlloacivilpcnahyofnotmorcthrnfivchundrcddollars($5(D). <br />_1. as owncr of thc profrcrty. or my cmployccs with wagcs as their solc coDrpcnsalion. will do thc work md lhc stmturc is not <br />intendcd oroflcrcdforsle(Sc.?(X4.BusincssandProlessionsCode:ThcConlractor'sLiccnsclawdoesnolapplyloanowncrof <br />thcpmtEf,y whobuildsorimprovcsthcmn.andwhod@ssuchworkhimsclforhcrsclforlhroughhisorhcrowncnrployccs. <br />providcd lhat such improvemnts N fiil intenfu or oflcrcd for sk. lf. howcvcr. tlE buiHing or irprovcmnl is sld wilhin onc led <br />ofcomplction. thc Owncr BuiHcr will havc lhc burden of proving that hc or shc did not buiH or improvc thc pmfLrty for llrc purfns of <br />salc). <br />_1. fls owncr ol'lhc propcny. am cxclu\ivcly conlracling with licensed conlractors h conslrucl lhc projccl (Scc. 7(M4. Busirc\\ <br />and PmfcssionCodc:'fheConlractor'sLiccnscLawdocsnolapplyloanowncrofprolxrlywhobuildsorimprovcslhcrcoD. <br />and who conlracls for such projccts with a Conlraclor(s) liccnscd pursuatrl lo lhc Conlr{chr's Liccorc Law). <br />-lrtncxcnrplurrdcrScctirrn-.l}.&P,C'follhisrcason' <br />Dnte:()wner: <br />W(IRKFRS' COMPENSATION <br />DECLARA'IIoN <br />I hcrcby allirm untlcr pcnalty of F-r.jury onc of thc folk)win8 dcclilationsl <br />_lhavcilndwill maintainaCcnific{tcofConscnttoScll:lnsureforlvorkcrr'conrpcnsation.as providcdlorhyScctt)n37(X)ofthc <br />Labor Codc. for lhc pcrformancc oflhc work lbr which thc pcrnrit is issucd. <br />_l havc and will maintain workers' conlpcnsation insurancc. ils rcquircd by Scclion 37(x) oflhc l-ahor Codc. for thc pcrlbrmncc of <br />lhc work for which this permit is issucd. My workcrs' conlpcnsation insurancc caricr and [x)licy nunrhcr trc: <br />Policy Nunlber: Expires: <br />_l ccnify that in thc pcrtbrmancc of thc work lbr which lhis pcrmit is issucd. I shall not cnrpk)y any pcrson in aly manncr <br />so as lo bccorrc subjcct lo thc workcrs' cornpcnsat ion laws of Californis. nnd xgrcc I hal if I shuld hccom subFct to th. <br />workcrs'compcnsationprcvisionsofScction3T0OofthclatnrCode.lshall.forthwithcomplywilhthosprovisions.. <br />WARNING: failurc to sccurc w(,rkcrs'compcnsxli()n c()vcrngc is unlawlul. rn(l shull snhjcct rn enlploycr kr crirnirral 1^-naltics antl <br />civil fincs up kr hundrcd lhousanrl &)llafs (Sl(X).(XX)). in cosl of conlpctrsiltion.li)r lhc <br />Scction .1076 of iillcrcsl nnd altorncy's li'cs. <br />I hcrcby illtlrill pcnalty oi pcr iury lhal I fltrr provision ofChrplcr 9 (conlnlcncing wilh Section ?(XD) of Divisiotr l <br />of lhc Bu\incs\ dnd Profcssions Codc. ond my lill li)rcc u(l cllcct <br />[-iccnsc Classl <br />I hercby affirm undcr frcnalty of pcrjlry lhat <br />issucd (Scc. -1097. (:iv. C.). <br />[rndcr's Nanrc: <br />ion lcnding ngcncy for the pcrlbrnuncc ofthc work lbr which lhis Frnril is <br />Lcndcr's Addrcss: <br />APPLIU^A NT NEC LA RATION <br />I hoeby affm undcr lEnalty of FErjury orc of lhe following delarations: <br />Dcmlition Pcrmits-Asbcstos Nolillcalion Fcderal Rcgulutions (Tillc 40. Pun6) <br />_Rcquircd htlcr of Notification <br />_l ccf,ily lhxt lhc lcdcralrcgulrlius rcgarding asaLslos rcrnovalarc n(il apl)licahlc lo lhis frojcct. <br />_l certify lhat I havc rcad lhis application ard slatc lhat the atx)ve infornution is agrm to conrply <br />ivcs ol rhis City <br />with rll Cily ilild Counly <br />ordinanccs lnd Slltc Llws rchting lhc <br />abovc rrcntioncd prcpcrty for <br />Applicant or Agenl <br />Ircnnile n{nr( <br />conslrucli(,n. arrd hcrcby <br />I <br />aDd <br />€