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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNER BUII,DER DELCARATION <br />I heeby aflirm undo pmalty of perjury that I m ercmpt from the Contracton' Licme Law for thc following re6on (Ss.7031.5 <br />Businas md Profesion Code): Any Cily or County which require a pomit to coNtruct. alt6. improve, dmolis! or repair ay <br />slrucluc. prior to ils issumce. also rcquirs thc applicmt for such p€nnit to ,ile a signed statmot thd he0r she is licmcd pumuat <br />to the provisioB of the Cootractor's Liccnscd law (Chapt6 9, Comencing with Seclion 7000 of Division 3 of thc Bwins and <br />ProfmionsCode)orthathe orsheiscxmptthtrefromadlhcbasisfortheallcgcdcxmptioo. AnyviolationofS6lionT0Sl.5byany <br />applicant for a pmit subjcts thc applicant to a civilpenalty of not more the ftvc hun&ed dolles ($500). <br />-1. <br />o omq of the propeny. or my cmploye with wage m thcir ple composalion. will do the work ed the struclue is not <br />intadcd or offqed for sle (56.7044. B6ine md hofsiom Code: The Contrador's Licse law do6 not apply to il o\\rq of <br />lhc prcpeny who tuilds or improvs ths@q od who do6 such work himelf or h6slf or thrcugh his or ha om mployc. <br />providcd that such improvmots @ not intqdcd or offsed for gle. If, howd6. lhc building or impovmmt is mld within one )sr <br />ofcomplaion. the Owmo Buildq will havc lhc hrd@ ofprcving thrd hc or she did no( build or improvc thc plopsty for thc purpos of <br />sle). <br />-1. <br />6 ownq ofthc prop6ty. m exclusively contrading with lic$ed contractoE lo coNrud lhc projcct (S(. 7044, Bsins <br />and ProfasionCode:ThcContractor'sLicetrseLawdo6notapplytomownaofpropertyrvhobuildsorimprovGthd6n. <br />md who contmcts for such prcjms with a Contmdo(s) licsscd puBumt lo thc Contractor's Licmc Law). <br />-l <br />m exempt und6 S(tion-, B. & P.C. for this <br />I heeby affim undo p€nalty of pqjury onc of thc following dalaatiom: <br />lhaveodwillmaintainaCertificateofCons$ttoSelf-lnsurcforworkm'compmsalion,o providcdforbySection-3700ofthe <br />Iabor Code, for the pqfomsce of the wort for which thc pmit is issued. <br />-l <br />have and will maintain workm' compeNalion isurancc. 6 required by Sstion 3700 of the trbor Code, for the pofomece of <br />thc work for which this psmit is issucd. My rvork6' comp@sation ireurdce cffii6 ad policy nurnbe re: <br />c-*,, 2tares| A-bliorv\ T-*.o r** C-o . <br />e.ri"rN".r.. ?bOoolS-lO3l6l Eei*, \lt(11 <br />-l <br />cfiity that in the pqformance of thc work for which this pemit is issucd. I shall not mploy any person in my mmno <br />e 6tob€comesubjettothework6s'compffationlawsofCalifomia,udagrcthatiflshouldbecome subjettothc <br />workss' composation provisiom ofSection 3700 ofthe Labor Code, I shall. fonhwith comply with thow prcvisiom.. <br />WARNING: Failure to wue wortqs' compcnsslion coveagc is unlawful. md shall subjct I mploys to sininal pqahies od <br />civil fina up to orc hundrcd thosnd dollm ($100.000), in additiotr to thc cost of compcmtion, damag* r providcd for thc <br />Sction .1076 of the Labor Code intqcsi md altonEy's f6. <br />o,tu, jll2Jol 11'a T' <br />I hwby afl'im undo penahyof perjury that I m licosed unda provision of Chapts 9 (commmcing with Sation 7000) of Division l <br />of thc Busins ed Profsiorc Code, ed my licme is in full force md cffet. <br />Licef,se [,icense Number: <br />I hmby affim mda pcnahy of pojury that lhrc is I corutruction loding agocy for thc pqforrrucc of the work for which this pnnit is <br />issucd (Se. 3097. Civ. C.). <br />Lmdq's Nme: <br />Lendq's Addrs: <br />APPLICANT DECLARATION <br />I bar$affrm undo pcnalty of pcjury onc of thc following dckatiom: <br />Dmolitioo Pmit*Asbetos Notification Fcdaal Regulatio6 (Tillc 40, Pan6) <br />-Rcquircd <br />Lctt6 of Notificarion <br />-l <br />ccniry that thc fcdoal rcgulatioro rcgrding cbctos moval oe not applicablc to this prcjer. <br />-l <br />cdiry that I have rad thb appli€tion and statc thd thc abovc infomalion is corEl. I aglc to comply with all City ud County <br />ordimcB ed Statc tis Ehtitrg lo building con$ucrion, and h6cby authorizc rcp.Batativ6 of this Chy md Coutrty to mtG upon thc <br />above mmtioncd propcrty for itrpccrion pupoc. <br />Applicsnt or Agent <br />PermilN name T>4!H+ <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / F_loor <br />Bonding / Flroundilfs / UFER lr -r719 [Lcz)7 <br />Transformhrc-/ <br />Torqueing <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 Roush) <br />Meter Release <br />Rough <br />Service Meter tktv4t ft-La o <br />FINAL 6-at-n (LQ9 t't e no> 4Lr7 <br />Notes, Remarks, Etc. <br />n9 n7 an, a <br />""",1lzvl 11 - <br />o,,",'ltlal!-7 <br />o"",1fzt ,lFl