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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BTIII,DER DEI-CARATI()N <br />I hcrcby affi[n undcr pcnalty of perjury that I nnr cxempt trcnr lhe Conlractors' l,icensc [-aw lbr lhc lblhwing rcnson (Scc.70.11.5 <br />Busincss arrd Proltssidl Codc): Any Cily or Counly which rcqilircs x Jrrmit lo coilstrucl. nllcr. inurove. dcrnolish or repnir any <br />structrrrc.priortoils issuancc.nlsorcquircsthcilpplicaollbrsuchlErnlilkrfilcn{igncdsttrlcnrcnl lhnlhcorshei\liccnscd pursucnt <br />h lhc p()visions of lhc Conlr{cbr's l,iccnscd Law (Chaptcr 9. Conrmcncing with Seclion 7(XX) of Divisbn -3 ol lhc Busincss and <br />ProttssiotrsCodc)orthnlhcorshciscxctrrftthcrclromflndthchusislbrlhcflllcgcdcrcmpti(n. AnyviolalionofScctionT0-ll.5hyany <br />applicilnl li)r a fcrmit suhjccls lhc applic{nt lo a civil pcnalty ol not trxtrc lhfln ,lvc hundrcd dollars (S5(X)). <br />_1. as owncr of thc propcfly. or my ctrrployccs wilh wrges xs lheir solc conrpensalion. willdo thc work and thc sttucturc is nol <br />intcndcd oro,Icrc(lli,r$lc(Ss.7Gl,l.llusiilcssandl'rofessi<rnrCrrdc:'l-hc(-ontractor's[.iccn{cl-nwdoc\notapplykrnnowncrol' <br />Ihc proltfly u'h() huikh or inurolcs tlrcreu. and sho docs such rork hinr\cll-()r hcr\clfor lhrough his or hcr own cntphyccs. <br />providc(llhalsuch irnprovcnrnlsarenotiicndedoroubrc<llirrsalc.ll.howcvcr.thcbuildingorinlprovenritissoldwithiloncyc:rr <br />ofcoilrdcti(nr. lhc Owncr Buildcr will hrlr lhc burdcn of provirrg tlul hc or shc did ilot huild or inrprovc thc pmpcrly lor lhc purF)sc ol' <br />salc). <br />_1. ns owncr of lhc propcrly. rnr cxclusivcly conlr0cling with licensed conlraclors t) coostruct thc projccl (Scc. 7044. Ilusi[css <br />and PnrltsshnCrxlc:ThcConlraclor'sl,iccrlscLnwdocsnotnpplyk)ailownerofnropcrtywhobuildsorinrprovcslhcreon. <br />xnd u'ho conttucts lbr such projccls wilh n C()rnrrck)r(s) liccnscd pur\uanl to ihc Conlraclor's l-iccnsc [.aw). <br />I rnr cxcmnl undcr Scction . B. & P.C. lbr this rcason. <br />Drte: __ Otner: <br />UQ8EE8LCAIIEEIIIAIION <br />DECLAMIION <br />I hcrchy aflirrn undcr pcnalty of pcrjury onc oflhc loll()wing dcclaralions: <br />_l havc and will nuintai[ il ('crlifcxlc of Conscnt k) SclLlnsrrc lor workcrs' conrl)cisali()n. {s providcd lirr hy Scctk)n -37(X) ol lhe <br />I-abor Codc. fbr thc pcrlbrililncc ofthc work lbr which lhc Frnrit is issucrl. <br />lhc work li)r which lhis pcrnril issucd.workcrs' cort)cnsnti()n insurrtrcc carricr iln(l policy nunrbcr arc: <br />l\rlicy <br />_l ccrtily thal in thc perlbrnurncc ofthc work for which this pcrnrit is issucd. I shall nol enlpkry nny pcrs(,n in aDy rrrnncr <br />so ask)trccomcsuh.icctblhcworkers'conrpcnsrti(,nlnwsofCrlili)rnia.rndilSrcclhrtiflshouldhcconrcsuhjccttolhc <br />workcrs' compcnsalioil p()visions ofScclion 37(X) ol lhc Latxtr Codc. I shall. lifihwilh comply with thosc provisions.. <br />WARNIN(;: Fnilurc k) securc s'orkcrs conrpcilsrli(nr is unhwlirl- rnd nn cmpkrycr b criillinal pcnilltics rnd <br />(.11 rdditiorl k) lhc cosl damagcs as provided for thc <br />, <br />I hcrcby alfirm undcr pcnally ol pcrjury thrl I am liccn\cd undcr pn)vision ol Chrptcr 9 (comtrrncing sith Scction 7{XX)) of Divisi(n .l <br />of thc lrusirlcss rild Proltssions Codc. and nry liccnsc is iD llll lbrcc nnd clltcl. <br />1LlL|t11t <br />l,iccosc <br />Conl <br />CONSTRUCI'ION LENDING ACENCY <br />I herchy lltrm undcr frcnahy of pcrjury lhat lhcrc is a constructi()n lcnding ugcncy for lhe lxrfornuncc of lhc work for which this fErnril is <br />issued (Scc. 309?. Civ. C.). <br />kndcr's Nrmc: <br />Lcndcr's Addrcssl <br />APPLICANT DECLARATION <br />I hqeby trmml undcr pcnahy ol lErjury oilc of thc folk)wing dcclarationsi <br />Dem)lirion Permils-Asbeshs Noliflcalk)n Fcderal RcSulalions (Tille,t0, Pan6) <br />_Rcquircd lf,llcr of Nolilicution <br />_l ccrlily th{l lhc lcdcral rcgulalions rcgarding ashcslos rctrx)valare n(n applicahlc k) this projcct. <br />_l ccrtil,v lhot I harc rcrd this rnd statc lhilt thc atx)lc ion is corcct. I agre lo conrply with all Cily nnd Counly <br />ordinanccs and Stale [trlws tcprcscnlalivcs to enler uF)n lhe <br />atxlvc ntillioncd pft)pcrly fi)r <br />Applicanl 'rr Agent <br />/)u <br />l'rrnril$ nanrc (prinl ): <br />ard hcrcby <br />4 <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht 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 />Bondino / Groundinq / UFER 8-t-l?2r (/.{6fu .5 <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Sotfit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />lr/eter Release ,/I <br />Rouqh a 7l-k l/, {*.&?) <br />Service lt/eter I <br />FINAL JaleC*A ,67) <br />Notes, Remarks, Etc. <br />I <br />Caricr <br />civil <br />l)alr