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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light 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 />Bonding I Grounding I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilinss (Hard & Soffit Rouqh <br />Ceilinss (T-Bar Rouqh) <br />N/eter Release <br />Rouqh 9,/r,/z t,R<-ts,V' =' /"t' <br />Service Meter , <br />7/*/e)FINAL ruS,;te4.eS Af) <br />7aNotes, Remarks, Etc., <br />OWNIiR BUILDER DEI,CARATION <br />I hereby affirnt under penalty of perjury that I am exempt from the Contractors' License law for the following rcason (Sec.7031.5 <br />Business and Profcssion Codc): Any City or County which requircs a pcrmit to construcl, alter, irnprovc, dennlish or repair any <br />strucrure, prior to its issuance. also requires the applicant for such perntt to file a signed staternenl that hc or she is liccnscd pursuant <br />to the pmvisions of thc Contractor's l,icenscd Law (Chapter 9. Commencing with Section 700O of Division 3 of the Business and <br />Professions Code) or that lle or she is exempt therefrom and tlre basis for tlre alleged exenrption. Any violation of Seclion 7031.5 by any <br />applicant for a pennit subjects thc applicant to o civil penalty of not morc than live hundrcd dollars ($5tttt). <br />_1. a.s owner ol'the propcrty, or my clnployccs with wages as their sole compensalion, will do thc work and thc structure is not <br />intenlal or offercd for sale (Sec'.704+. Busircss and hofessions Cqlc: The Contractor's Licensc l-aw docs not apPly to an owner of <br />the properry who builds or improves tlrreon" and wlp does .suclr work himself or lrerself or through his or her own employees, <br />provided that such irnprovenrcnts arc rnt intcndcd oroffered for sale. Il. howcver, tlrc building or irprovcrmnt is sold within one )aar <br />of complctiorL thc Owncr BuiIJer will havc thc burden of pnoving ttrat hc or shc did mt buill or inrpmvc thc propaty for thc purposc of <br />K8-:'ff Tii"JJ;?lffi ]il"Jl,:"ffr':x,;:iff [*;Tff :"J:ffiilfr lff If,,';::i'tr;lHl,[tril <br />and who contracts for such projccts with a Contractor(s) licenscd pursuant to the Conuactor's License [.aw). <br />_l anr exempt <br />f <br />I hcrcby affirnr undcr pcnalty of pcrjury onc of the tbllowing <br />_l have and will nraintain a Certilicate of C<lnsent to Self-lnsure for workers'conqrcnsation, as provided fior by Section 3700 of thc <br />Lahor Code, for the performarrcc of thc work for which the Srrmit is issued. <br />_l have and will nraintain workers' conrpen.sation insurarr:e, as required by <br />thc work for which this pcrmit is issucd. My workcrs' comlrcnsation insurancc <br />Seclion 3700 of thc l-abor Code, for the perfornunce of <br />carricr uxl policy number arc: <br />Policy <br />_l ccrtify that in thc prtbrnuncc of thc work for which this grcrmit is issucd, I shall not enrploy eny pcrson in any manncr <br />so as to bccorne subjcct to thc workcrs' conrpcnsation laws of Califomia, and agrec that if I should beconrc subjcct to the <br />workers' com;rnsation provisiorrs of Section 3700 of the Labor Code, I shall, forrhwith comply with those provisi<lns.. <br />WARNING: Failure to secure workers'compensation coverdge i.s unlawful, and shatl subject an employer to criminul penalriesrand <br />civil fines to oue hundred lhousand dollars (S in addition to the cost of comSrcnsation, danrages as provided for thc <br />Scction Codc, intercst and <br />>o <br />I hereby affinn under ;rcnalty of perjury tlrat I ant licensed 9 (corunrencing with Section 7m0) of Division 3 <br />of the Business and Professions Code. arxl my license is in full forcc arxl elTect. <br />Licensc Numbcr: <br />Contrector: <br />CONSTRUCTION LE}IDING AGENCY <br />I hcreby al'lirm undcr pcnalty of pcrjury that thcre is a conslruction hnding agerrcy for the Jrcrformance of the work for which this permit is <br />issued (Sec. 3097. Civ. C.). <br />[.cnder's Name: <br />A PPI,ICANT DECLARATION <br />I hrcby aflirnr undcr pcnalty of perjury one of thc folklwing declarations: <br />Dcnxrlition Pernrits-Ashestos Notification Fedcral Rcgulations (Titlc 40, Pan6) <br />-Rcquired <br />lrtter of Notifrcation <br />,Z certity that rhc fcdcral rcgularions regarding asbcstos rcmoval ile not applicable to this prolxt. <br />{rcertify tlrat I luve rcad this appticarion arl state rlrat thc ahrve informalion is corrcct. I agree to conrply with all City an<l County <br />ordinances and Statc Laws rclating to construction.auttnrize reprcsentatives of this City and eotcr upoll ure <br />ahrve rrrcntioned property for <br />Applicant or Agent <br />Pcrnritec nonrc <br />u) <br />-201 <br />I <br />t