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ELECTRICAL.INSPECTOR RECORD <br />I <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underoround <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 />Bondinq / Groundinq / UFER l.al- t9 J J zJ*l o(.tb <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 />N/eter Release u <br />I <br />Rouqh <br />Service Meter ?t t,\l - t9-D.E*?t?/ <br />F!NAL 3*o/ztzo -D-Glo(?n) <br />Notes, Remarks, Etc <br />OWNER BUILDER DELCARA'I]ON <br />I hcrcby affirrn under pcnalty of pcrjury lhal I am cxcmil frenr thc Conlraclors' l-icensc law for lhc lolk)wing rcason (Scc.7l)J1.5 <br />Busincss arxl ProLssion Codc): Any Cily or Counly which rcquircs 0 lErmil lo construcl. altcr. improvc. dcnrclish or rcpair ary <br />slruclurc.pri)rk)ils issuancc.ilsorcquireslhcapplicantforsuchFErmillolilcasigncdstatcrmnl thsthcorshcislicenscd pursuant <br />kr the provisions of thc Conlmctor's Lice[scd liw (Challcr 9. Commcncing wilh Scction 7(Xn of Division -3 of the Busincss and <br />ProfcssionsCodc)orlhathcorshcisexcmplthcrcfromandthcbasisforthcollcgcdcxcmption. Anyvk)lnlionofScctionT0.ll.5byrny <br />applicant for a pcrmit suhjccts thc applicant to a civil penuhy of not nmre thun l'ivc hundrcd dollars (S5(X)). <br />_l,as owneroflhcpropcny.ormycmployccswilhwagesastheirsolcconlpcnsutiur.willdolhcworkandlhcslructurcisnot <br />irlcndcd oroflcrcdlirr*rlc(Src.7044.BusincssandPmt'cssionsCode:'lhcCuilraclor'sLiccnscl-awdocsnolrpplytoanowncrol' <br />thc pn)fEny who huilds or improves thcd)n. snd who d(rcs such work himsclfor hcrsclfor threugh hi\ or hcr own cmployees, <br />providcdthatsuch irnprovetrrntsmnoliilcndcdorofltrc{forsle.ll.howcvcr.thcbuildtigoririlprovcrrcnlisy)klwithinoncytru <br />of completion. thc Owncr Buildcr will havc thc burden ofproving lhd hc or shc did Dot build or improrc lhc pmFny tbr lhe purJb* of <br />slc). <br />_1. {s owncr of lhc propcrly. anr cxclusivcly coillrtcl in8 wilh liccilsed coillrilclors lo conslruct thc proiccl (Scc. 70"14. Business <br />and Pnrfcssir:nCodc:'lhcConlrrctor'sLiccnsc[-rwd(,csnotapplyk)anowncrolpropcrt]whohuildsorimprovcsthcrco[. <br />and who conlracts lbr such projccls with u Corilrrclo(s) liccnscd pursuanl lo lhc Contraclor's l,iccnsc lrw). <br />-lantcxcntplunJcrsccli()n-'B,&P'C.lbrlhjsrcnson,D!te:_ Oen€r- <br />WORKFRS' CONTPENSA'TION <br />DECI.AEAIIAN <br />I hcrcby affirm undcr lcnllly ofperjury onc ofthc [ollowing dcclarations: <br />_l hlve and will nulillailr u Ccrtiticatc ol-Conscnl k) SelHnsure tor wrrkcrs' corrrpcnsalion. as I&vidud lirr hy Scction -j7(X) of lhc <br />l-ahor Code. ttrr thc pcrlirrnrancc ofllrc work for which thc pcril]it is issucd. <br />_l havc and will maintain workcrs' comlrcnsnlii)n insurancc. as rcquircd hy Scction 37tn oflhc lih(rr Codc. [br thc perfonnancc ol' <br />lhc work for which lhis pcrriit is issued.insurancc curicr and nunrhcr uc: <br />Policy 3.3\. \q <br />_l ccrlity lhal in lhc pcrlormflncc of lhc work li,r which lhis pcrnril is issucd. I shrll nol cnrploy any pcrson in any illanncr <br />so as lo bcconrc subjccl k) lhc workcrs'cotrrpcDsrltm laws ofcalilbrnir. and agrcc lhrl if I should bcconrc suhjccl to thc <br />workcrs'coillpcnsationp()visionsofScctioD3T(X)oIlhct-iltnrCodc,lshrll.li)flhwilhcomplywiththoscproviskxrs.. <br />WARNING: Irilurc k) r'curc worlcr\'coverage is unhwful. rnd shall subject an cmploycr lo friminal FEnaltics and <br />civil fincs up to onc hundrcd thousand dollars in additioil to lhc c()st of conrpcnsrli{)n. drnilgcs as providcd li)r thc <br />Scct )n 1076 of thc l.rlx)r ( odc.xrtrl SP.u,,t", ? . Zl-' <br />I hcrchy affirtn undcr pcnalty of I rnr liccn\od utrdcr provision ol ( hnflcr I (cotrnncn(iilB u'ilh Sc(l ion 7(XX)) ol Di\ ision .1 <br />of lhc Business and Profcssions Codc- illd mv liccnse is in full forcc uxl cfltct <br />[,icensc Nutrrhcr: <br />a <br />I hcrcby affirm undcr Jrcnahy ofpcrjury lhal <br />issrcd (Se. 3097. Civ. C.). <br />bndcr's Namc: <br />construction lcnding agcncy for thc Jrerformancc ofrhc work for which this fErnlit is <br />hndcr's Addrcssi <br />APPLICANT DECLARATION <br />I Mry afllm undcr penalty of perjury one of lhc following declarations: <br />Dcmlilion Pcrmits-Ashcstos Notification Fcdcral Rcgulalions (Titlc 40. Pan6) <br />_Requircd lIl(cr r)f Nolifrcalion <br />_t lhc Icdcrill rcgulalions rcgnkling il\tErk)s rcrnovnl arc nol applicilblc lo this projccl. <br />I hnvc rcrrl this iln(l slnlc lhil lhc ntx)vc inli)r nilli()il wilh illl City and (i)rnly <br />Slntc l.a\\s an(l (bunly to cnlcr uF)r Ilrc <br />rbovc <br />or Agenl <br />l'crnr i 1(\{I nr c <br />lo huilding conslrucl <br />,,^^1 'ZU'18 <br />tc n7 an{ ( <br />1