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ELECTRICAL.INSPECTOR RECORD 1 <br />APPROVALS DATE ID/SIG.COMMENTS owNER BUII.DER DELCARATTON .. <br />I hcrcby rfllrnr undcr pcnrlty of perjury thtrl I ilr cxcnrpl froN thc Conlrnctn's Liccnsc [-aw for thc l'olk)wing rcdson (Scc.7o]l.5 <br />Busincss and Prolcssion Codc): Any City or Coully which rcquircs a Jrrmit to construct. altcr. improvc. dcfr)lish (* rcpnir a[y <br />stnrclurc. pri()r lo its issunncc. also rcquircs thc applicont lbr such Frnlil lo lilc a signcd stiltcnrcnl lhill hc or shc is licenscd pursuanl - <br />to thc f,rovisbns of thc Contractor's l-iccnscrl bw (Clapler 9. Conrncncing wilh Scclion 7fiI) of Division J ol thc Busincss ar:J <br />PrJissiois Codc) or lhat hc or shc is excnrpl lhcrcliom an(l lhc husis lbr thc utlcScd cxctrptt)n. Any vi()lation ol scctkrn 70.i1.5 hy any ' <br />npplicantforapcrnlilsubjcctsthc applicanlhacivilpcnallyo,trotmorclhnnllvchundrcddollars(S5(X)). <br />_1. as owncr of lhc prolLny. or nly employccs wilh wngcs as lhcir colc conlncnsalidl. will<ftr thc work and thc slmtrrrc is fr)t <br />intcndcd orollilcdlorsdlc(Scc.7(M.1.[]usincssandProtcssionsCodc:'fhcConlractor'sLiccnschwdocsnolapplyloanownerol <br />thcpnrl--ny whobuildsorirnprovcslhcrff,n.nftlwhod(res{chwo*hirnsclforhcrscllorthroughhisorhcrowncntpk)yccs. <br />frovidcdthalsuch inlprovcrrcnls{rcnotirilendcdoroffcrcdtbrsnlc.lt.howcvcr.tlrcbuildingorimprolerrcntissoldwilhinrrrcvcur <br />ofcoinplcti{nl. thc Ou'ncr Buildcr will halc lhc hurdcn of proving thal lrc or shc did tril huild or impmvc lhe pmfEny for llrc purlms of <br />salc). <br />_1. a\ owncr of lhc l)ropcily. anl crclusivcly conlrilclinS wilh liccnsc(l conlftrckn s lo constnrcl lhc l)r()jccl (Sec. 7(144. Ilusircss <br />arrd Pnrfcssirn Codc: l hc Contraclor's Liccnsc Law (locs nol al)ply to an ou'ncr ofpropcrly who builds or imprcr'cs lhercon. <br />and who conlracls ti)r such pro.jccts with a Cornraclols) liccnscd pursunnl to lhe Conlractor's l-iccnsc Lilw). <br />-l <br />am cxcmpl undcr Seclion-. Il. & P.C. for this rcason. <br />Daler- owtrer:--- <br />-WORKERS' COIlIPENSATI(IN <br />DECLARATION <br />I hcrchy affirm under frcnalty of Frcrjury one of the [ollowing declarations: <br />_lharcandwillnuintainaCcnificatco[Conscntk)Scll:lnsurcforsorkcrs'coilrpensiltion.as providcdforbyScclion]7(X)ofthc <br />Labor Codc. for thc pcrfornunce of thc work lirr which lhc pcrrril is issued. <br />thc urrrk lirr which this pcrrrrit is i\sucd. M), workcrs' coilrlrcnsathn insurancc caricr .rxl policy numtrcr arc:L VIA C <br />Policy Nunrbcr z1-tq <br />_l ccnili lhrl in lhc lrcrlornuncc ol lhc Nork lin shich lhis Frmit is issucd. I shall not cnulov any pcrson in rDy nrlnrcr <br />so ilsl()hcoDlcsrhjcclblhcworkcrs'corrpcnsalionlawsofCnlilbrnir.an(lngrcclhalillshouldbcconrsubiccllolhc <br />workcrs' comlED\ation prolisions oIScctir)n .]7U) ol thc [ntx[ (ixlc. I shrll. li)rthsith coilrply u'itl] tho\c prorisi(ilrs. <br />\YARNING: Frilurc k) scurc trorkcrs'conrpcnsali()n colcrigc is lrnluu'lul. and ihall \rbjccl an cnrpkrltr tr crirninrl lrnahicr and <br />civil flncs ip to onc hundrcd lhou\and dollrrs (Sl(X).(Xx)). in iddili{)0 to lhc cost (,1-conlpcisnlion. danragcs as providcd li)r the <br />Section 1076 of thc lilnr Code. iilcrcst rnd axorrcv's fccs. <br />o",", r !'l-P ,tpplicrrrt: f <br />DECI ARATION <br />I hcrcby allirnr undcr pcnalty of pcrjury lhal I rnr licen*d undcr provision ol Chnpler 9 (cornmcnciIg wilh Seclion 7UX)) of Divisiotr 3 <br />of lhc Busincss and Profcssions Codc. and nry liicnsc is h full li)rcc and elTccl. <br />I-iccn\c Nttrnher' <br />qrBqBr <br />Dnrr. )jlt-Lo conrrec(ori 11 Gtot."^lgl 11fa<1:1l <br />CONS'TRUCTI(IN LENDIN(; A(;ENCY <br />I hcrchy alfirm undcr Frcnally of pcrjury lhat thcrc is ! con{mclion lcnrling agcncy firr lhc performancc of thc w(rk for which this ptrrnit is <br />issued (Scc. 3097. Civ. C.). <br />l.cn(lcr'\ Nrnrc: <br />I-crxlcr's A(kkcss: <br />APPLICANT DECLARATION <br />I hocby aliinn undcr penalty of perjury onc of the following dechrations: <br />Demolilion Pcrmits-Ashcstos Notificatk)n Fedcral Rcgulations (Title 4(). Pnn6) <br />-Rcquircd <br />[-cller of Notilicalion <br />_l ccrtify that thc lcdcral rcgulations rcgtrding asbcstos removal ilrc nol npplicahlc ft) lhis proFct. <br />($l ccnify rhar I havc rcad this application dd st&te lhat thc atnvc inforrnation is corccl. I agre lo comply wilh ull City and Counly <br />-ordinailces ilnd Slitc hws rcloting to building construction. ud hcrehy aulhorizc rcprcscnlalivcs oI this City and County to entcr upon thc <br />rhovc trrcntiotrcd propcfly fbr inspcclion <br />Appli(iltr| or Agctrl Siguntu." I <br />I'cmiree nunrerprin,,, ( (11'f ^J lia <br />r)r,e 5 +l118 <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 />Building <br />Under Slab / Floor <br />Bondino / Groundino / 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 />lMeter Release <br />Rough <br />Service Meter <br />F!NAL <br />Notes, Remarks, Etc. <br />Carricr