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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Lioht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor <br />Bondinq I Groundinq 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 (Rouoh) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rouqh) <br />lVleter Release <br />Rouqh ,/i 4 <br />+{&/AService Meter ,//Zr/zD // <br />FINAL ' i/.'lo -2e /Lc'/{r.teflos 72t7 <br />Notes, Rgmarks, Etc.t <br />-lD <br />OWNI.:,R BUILDI'R DF:I,CA RATTON <br />I lrcreby affirru untler penalty of prjury that I anr exenlpt fronr the Cbntractors' License Law for the firllowilrg reav)n (Sec.7031.5 <br />Busincss and Prol'cssion Code): Any City or County which rcquircs a Jrcrmit to conslruct, allcr. irnprovc. dcmolish or rcpair any <br />structure, prior to its issuance. also requircs the applicarrt lbr suclr Jrcnrit to lile a sigrrcd stalenrenl that lr or she is licenscd pursuant <br />to tlrc provisions of thc' Contractor's l,iccnscd law (Chaptcr 9. Comrncncing with Scction 70fi) of Division 3 of the Busincss and <br />Professions Code) or that lrc or slr is exentpt tlrerefronr and the [rasis tbr the alleged exenrption. Any violation of Seclion 7031.5 by any <br />applicantforuperrnitsuhjectsthe npplicanttotcivilpenaltyofnotmorethuttfivehundreddollars($500). <br />_1, as owncr ol'thr. propcrty. or tny r.rnpkryccs with wages as thcir solc colnJrcnsation, will do the work and thc structure is not <br />interxhd or offered for sale (Sec.70l4. Business antl Prufessions Ctxle: The Contractor's License Law docs not apply lo an owner of <br />the pn)perty wlru builds or irrqrrrves thrurn, and wlto tltns such work himself or lrcrself or througlt his or lrcr own entployees, <br />providcd that such irnpnrverncnts :uc ft)t intendcd or ollcrcd for sak'. Il. howcvcr. thc building or impnrvcrrrcnt is sold within onc )car <br />of completion, tlrc Owner Builtler will have the burden of proving that he or she tlid not buikJ or impnrve thc properry for the puqxrse of <br />s:rle). <br />_1. as owner of the propetly, am exclusively contracting with licensctl conlractors to construct thc project (Sec. 7(X4. Busirrcss <br />arxl Protcssion Code: The Contractor's License Law dtrs not apply to an owner of progrcrty who builds or intproves thereon. <br />and who contract.s for such prnjc'cts with a Contracto(s) liccnscd pu]suant to the Contraclor's Liccnsc l-aw). <br />-l <br />anr exenrpt under Sectiott-, B. & P.C. tirr lltis reasott. <br />W O RKE,IIS' COT}T PT]IISATT ON <br />Ihcrcbyaffirmun<lcrpenatryofpcrjuryoneoftlrc,o,,o,",ffi <br />_l lmve arxt will nraintafur a Certificate of Consent to Self-ln.sure for workers'contgrcnsation, as pnlvided for by Section 3700 of the <br />Labor Codc, for the perf<rrrnance of the work lbr which thc pcrnrit is issued. <br />Uth have arrrl will nrainrairr workers' conrpensation insurarrce, as required by Section 3700 of the Lahor Ctxle, for the Jrcrfonnance of <br />lhc work for which this pcrnrit is issucd. My workcrs' compcnsation insurance carricr arxt plicy nuntber are: <br />,rrr,r, ' AEG fi:;uf^n< <br />poricy *"^*,, ' 1L - oo1 186 -o I -l { Expires: ' 6 -( -bzo <br />_l certity that in thc ;xrfornunce of tlrc work for which this pernrit is issucd, I shall not cnploy any pcrson in any manncr <br />so as to become subject to the workers' corrrpcn.sation laws of California. and agrce that if I stnuld become subject to the <br />workers' conrlrnsation provisinns of Section 3700 of tlte labor Cotle, I slull, forthwith conrply with those provisions.. <br />WARNfNG: Failure to secure worket's' comperrsation coverdge i.s unlawful, and shall subject nn cmployer to critninul penalties and <br />civil tines up to one hurrdred tlurusund dollars ($100.000t. in additiott lo llte cost of danuges as provided for lhe <br />.Scction 1076 of thc Lalxrr Ctde. intcrest and attornc'y's <br />0 $L <br />I hereby affirrn under pnalty of perjury tltal I attt licerrseil <br />of the Busincss and Professiorrs Code. arxl mv license is in full ftrrce and effect. <br />9 (corrrrrrcncing with Section 7firu) of Divisior;I <br />. -7/q3C -(oLicerrsea t <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby al'lirrn undc.r p^*nalty of pcrjury that thcrc is a construction lcnding age'ncy l'or thc grcrlorrnancc of thc work lbr which thi.s pcrrnit is <br />issucrl (Sec. 30t)7. Civ. C.t. <br />Lender's Nanre: <br />lrnder's Address: <br />APPI,ICA NT DECI,ARATION <br />I hxchy affrnr undcr pnalty of pcrjury onc of the lirllowing dcclarations: <br />Denrolition Pcrnrits-Ashcslos Notification Fctlcral Rcgulations (Title 40. Pan6) <br />-Rcquircd <br />Lcttcr of Notification <br />_l ccrtily that the l'cdcralrcgulations rcgarding ast)cstos rcrnovaltuc not applicablc to this proi'ct. <br />N, ccrtily rtut I havc rcad rtris application and statc ltrat thc ahrvc infornulion is corrcct. I agroc to conrply wittr all City and County <br />ordinanccs and Statc l^aws rclating to building construction, and hercby authorize reprcscntativcs o[ this City and County to cntcr upon thc <br />above rnentioned pro;xrty for <br />Allplicant or Agenl <br />l'crntilcc <br />r,it", t *;L 5-ZC'2o <br />ev. 0B-0 201 5 <br />7