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ELECTRICAL.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hereby atfirm undq penalty ofperjury that I m excmpt fiom lhe Conlractore' l.icense LaN for thc following rea.gon (Se.70-]1.5 <br />Busines ad Profsion Codc): Any Cily or County which requirs a pmnit lo construct, alto, improve, donolish or repair my <br />slructue. prior to its issumce, also requir$ the applicanl for such pmit to file a signed statemmt that he or she is lictrsed pusumt <br />lo thc prcvisioN of the Contractor's Licensed larv (Chapts 9. Cormencing rvilh Setion 7000 of Division 3 of the BusinN ild <br />Profe$ions Code) or that he or she is exempt thsefrom and the basis for the alleged ermption. Any violalion oisdion 70-11.5 by any <br />applicantforapf,nitsubjststhc applicanttoacivilpenaltyofnotmorethmfivehuodreddollus($500). <br />_1. a omo of the prcp€ny. or my employc with wag6 s their sle compenstion, will do lhc wo* dd the structuc is nol <br />intqded or olTered for sle (Sa.7044, Businos md ProfmioN Code: The Contraclor's Licflse lnw do6 not apply to d oMs of <br />lhe prcpdy who builds or irnprove th@tr od who do6 such wrk hirnself or htrself or lfuough his or ho om employca. <br />provided lhat such improvmots ffi not inlodcd or off6cd for sle. If. howoo. the building or improvemdt is rcld within one ]q <br />ofcompletion. the Ownq Builds rvill have thc budm ofproving thd he or shc did not build or imFrovc the prcpsty for the puposof <br />sle). <br />_1. a owno of the propqty. m cxclusively contraclin8 with licmed contractoE lo connruct thc projecl (Se. 7044, B6ins <br />and ftofsionCode:ThcContraclor'sLiccnscLawdoqnotapplytoaownoofpropenywhobuildsorimproveslhq@n, <br />and who contracts for such prcjecls wilh a Contmcto(s) liceacd pureumt to the Contractor's t,icse Law). <br />I m exempt ud6 Sstion-. B. & P.C. for this r6of,. <br />Owner:_ <br />WORKERS' COIIIPENSATION <br />DECLARATION <br />I hercby affirm unde pcnslty ofpsjury onc ofthe folkrwing dcclrralions: <br />_l have and will maintain a Ccrtificate of Comol to Self-lmure for workers' compensalion, 6 provided for by Setion 3700 of lhe <br />Labor Codc, for the psfonnace of the work for which thc tmit is isued. <br />_l have and will maintain workers' comp€nsalion imurmce 6 required by Sstion -3700 of lhe Labor Code. for the psfonnilcc of <br />the u'ork for which this pmit is isued My workos' compruation insurilcc cmio and policy numbe re: <br />\-. o^^(a <br />Itlicy 0t{?a3 2- t-ll <br />_l ce(ify lhat in the perfonnance of the rvork for rvhich this permit is issued. I shall not enploy any person in any moner <br />m clobecomesubjattolheu'ork6s'compeflsationla*sofCalifomia.ilda8rethalifIshouldbecomesubjettothc <br />workqs' compeNation provisions ofStrtion 3700 ofthc Labor Code. I shall, fonhwilh cornply with thos provisions.. <br />WARNINCT Failure to wue work6'cornpenslion covqage is unlarvful. md shall subj4t m onployo to siminal tEEltics md <br />civil lines up to one hundred thousmd dollm ($100,000), in addition lo the cost of compemation, dmages 6 provided for the <br />Section 3076 ofthe Labor Code. intset dd altorney's [ee. <br />-1- <br />I h6eby afftrm undfr poalty of perjury that I m licosed undo provision of Chaptq 9 (comqcing wilh S(tion 7000) of Division 3 <br />of the Busine md Profmions Code. md my licmc is in full force ad effat. <br />l-iccnse Numtrcr:413 ( 8r <br />n"r", 1-3 \ - L0 con,""",.., J- 50.-ralcd <br />CONSTRUCTION LENDINC ACENCY <br />I hoeby affirm under poalty of pedury that th6e is a construction loding agency for thc pofonnilce ofthe work for which this permit is <br />issucd (Sa. .1097, Civ. C.). <br />Lender's Name <br />Lender's Addrs: <br />APPLICANT DFCI,ARATION <br />I hslby affim undq pqa lt y o f pcrjury one o f the follow ing dr luat ions: <br />Dcmolition Pmits-Asb6tos Notification Fcdqal Rcgulations (Tille 40. Pafl6) <br />-Required <br />Lats of Notificaliof, <br />-l <br />cstify that the fedaal regulatiom rcgrding abetos rmoval ae not applicable to this prcject. <br />l4!cqti& rhat I havc rad lhis application ild state that the above infomalion is conecl. I sgrc lo comply with all City and County <br />ordinancc ad State laws rclating to building constructioo, md hseby authorizc reprGotative of this City ud County to mtq upon th€ <br />abovc mmtioned property for <br />Applican( or Agent <br />Permitee n6me (print):t4 <br />_-Lr( -l al <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Grounding / 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 />Meter Release <br />Rouqh <br />Service Meter <br />FINAL ?-LO-?,0 fr< ln <br />Notes, Remarks, Etc. <br />(