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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OWNERAUILDERDELCARATION B <br />I haeby affinn unrlo pmalty of perjury that I m ercmpt from thc Contraclos Licmsc Larv for the following ,"a}t Gql,Of '.tBusinss and Profession Code): Any City or County which rcquirs a pmit to construcl. altc. improvq dmolish or np"* my <br />struclue. prior to ils i$uilce. also requirG (he applicanl for such p€mit to file a signcd stalonot that h€ or she is licmed pmuilt <br />lo the provisions of the Contractor's Licensed Law (Chapto 9. Commencing $'ilh Sation 7000 of Division 3 of thc Businc$ md <br />ProfesionsCodelorthatheorsheisexemptthqefrQmandthcbruisfortheallegedcxmption. AnyviolationofsetionT03l.5byany <br />applicantforapcnnitsubjectsthe applicanttoacivilpenaltyofnotmorethmfivehundreddollils($500). <br />-1. <br />m orvner of the property, or my employees wilh wags as thcir sole cornpensalion. will do the wo* md lhe structue is not <br />intodql or offered for $le (Ss.7044. Businss md Prcfessions Code: The Conlractor's l,icmse Law do6 not apply to an ownq of <br />theproFErty rvhobuildsorimprovethssn,mdwhodo6such*nrkhimselforhqselforthreughhisorhaorvnemployec. <br />provided tlut such improvmmts ae not intaded oroffsed for sle. If. ho*'evq. the huilding or improvmot is mld within one yar <br />ofcompldion. the Ourer Buihc will hale the hurdo ofproving thal he or she did not tuild or imfrove the prcpqty for the purposof <br />sle). <br />-1. <br />c orwa of the propfiy. m erclusively conlracting with liccnsed contractoE to coNlrucl the projed (Se. 7M4, Buin&s <br />md ProfesionCodc:ThcContftctor'sLicenscLawdo6notapplytoeownsofpropcrtywhobuildsorimprovslhson. <br />md who contmcts for such prcjGts with a Contmcto(s) licsed pu6@t to the Contraclor's Licmse Law). <br />I an excmpt under Sslion . B. & P.C. for this reason. <br />Date:_Orvner: <br />WORKERS' COMPENSATION <br />I'ECLARATION <br />I hoeby allrm unda penally ofpgjury one oflhe following d{luatiom: <br />_l havc md will maintain a Cmificate of Co6ot to Sclflmure for workm' composalion. c providcd for by SEtion 1700 of thc <br />Lsbor Codc for lhe psfomece of the work for which thc pmil b isued. <br />-l <br />have and will maintain work6' compesation insurancc. 6 required by Setion -1700 of thc Labor Code, for the psfommcc of <br />the work for which this permit is ised. My workc compctetion itrurilce cmier ud policy numbo ae: <br />Ic <br />Policl /42 -/- 2az o <br />-l <br />certify thal in thc pofomance of the work for which this prinit is issued. I shall not mploy any petrcn in any mon. Js 6 to becomc subjct to thc works' comperstion laws of Califomia. md agre tha if I should bccome subjat to the <br />wort6' compeasation prcvisioro of Section 3700 of the tabor Code. I shall. fonhwith comply wirh rhos prcvisiom.. \ <br />J <br />WARNING: Failurc to wure workss'compssation covgage is unlawful. and shall subjel il qnployq to siminal poahics md <br />civil fines up to one hundred thomd dollm ($100,000). in addition to the cost of comperoation, damage o providcd for the <br />Setion 1076 of thc Labor Code. inttrBt md attomw's fe6. <br />l)ate: <br />LICENSED CONTRACTOR <br />DECI,ARATTON <br />I heeby aflirm undr penahy of psjury that I an licm$d under provision of Chapttr 9 (commmcing with SdioD 7000) of Division l <br />of the Busins md l'rofasiom Code. md my lictrse is in full force od efTet. <br />Li"r*"Cluu, B Nurnber: <br />g?7 <br />o*e, /o -32 -/?LD.C( onlractorl <br />CONSTRUCTION LENDTNC AGENCY <br />I hqeby aflirm unds penahy ofpqjury that thqc is a construction lflding agency for the pafonnmce ofthe work for which this permil is <br />issued (Se. -1097. Civ. C.). <br />kndtr's Narnc: <br />l-mde s Adtlrss' <br />APPLTCANT DECLARATION <br />I hotby alfinn undq penalty ofpajury one ofthc follorving dsluations: <br />Demolition Ptrmils-Asbeslos Nolification Fedsal ReSulations (Title 40, Pan6) <br />Rqluired Letlcr of Notifi cation <br />I certify thal lhe lederal regulations rcgilding mbestos rcmoval are not applicahlc to lhis project <br />-l <br />cerlify thal I hare read this application md slate that the atnve infonnation is corect. I alirre lo comply with all Cily and County <br />orditancB ild Stale l,arvs relating to building construction. od hereby authorize repreentati\'6 ofthis City md County lo oltr upon lhe <br />above motioned propefly for iropetion purpose. <br />Applicant or Agent <br />Pemi(ensme(prinrt, ,// 4/f G€-4 -f <br />/o -/? <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinss (Hard & Soffit Rouqh l-6- ze Y6 <br />Ceilings (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service Meter -t V --/t <br />FINAL 1 b u \XAAb1-w-l <br />Notes, Remarks, Etc.I \T <br />D^, , no {\"7 nin I