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ELECTRICAL-INSPECTOR RECORD Rev. 08-07-201{ APPROVALS DATE ID/S!G.COMMENTS 0WNIIR B I.] I I,I)F,R T)I.;I,CA KA.I'I(,N I lrcreby affirru urrder penalty of pr.iury that I arn exenryt fmnr the C:ontracloni' License law for the following reason (Set'.7031.5 Busincss arxl Prol'cssion Crxlc): Any City or County which rcquircs a p-rrnit to construct, altcr. improve. dcrrxrlish or rcpair any struclure. prior to ils issuance. also requires tlre applicarrt tirr such pennil to fih a sigrrcd slatemenl that lr or she is liccnsed pursuanl to thc provisions ol'tht' Contractor's l,iccnsed l:w (Chaptcr 9. C'omrncncing with Section 7fi)0 of Division 3 ol'thc Business and Pnrl'essions Crxle ) or that lrc or she is exenrpl therefronr anrl tlrc basis ftrr the alleged exenption. Any violation of Section 703I .5 by any applicant ftrr u perrnit subjects tlre applicant to il civil penalty oI not rnore than five hundred dollars ($5tXtt. _1. as owncr ol'tlrc proli*rty. or rny crnplovccs with wagcs as thcir solc cornpcnsation, will do thc work and the structurc is not intendetl or olTeretl frrr sale (Sec.7O44. Business antl Professiorrs Ctxle: 'I'lrc Corrtractor's License Law tloes not apply lo an owner oI tlrc prlpefly wlxr builds or irt4rrovc's lhereon, and whr does suclr work hinrself rlr herself or tluough his or her owrt enrpkryees, prol'idcd that such irnprovr'rncnts arc mrt intcndcd or olfcrc'd lirr salc. ll. howcver. tlrc building or irnproverncnt is sold within onc yr'ar o[ conrpletion, tlrc Owrrcr Builder will have the burden o[ provirrg that he or she did not build or improve tlrc pruperty for the purprse of s"tle). _1. asownerof the pnrpeily, amexclusilelycontracting with licen.setl conlraclorstoconstruct tlrc project (Sec.7(X4. Business arxJ Prulc'ssiorr CorJe: Tlre Contructor's License Law drles not apply to an owrrcr of proJrerty who builds or inrproves lhereon. and who conlracts frrr such pr<r.ic'cts with a Contractor(s) liccn*-d pursuant to thc Contraclor's Licensc kw). -IantexemptultderSectitllt-,B.&P.C.lbrthisreason. WORKERS' C0Nt I'DNSA'rI0N DECLARATION I hcrcby afl'irnr unrlcr pcnalty of pcrjury onc of the tirllowing dccluations: _llraveantlwill rtnintainaCerlil'icateofCon.senttoSell-hrsurelirrworkers'conlpensation,as providedfirrbySection3T00oftlrc Labor Codc, for thc Jrcrlorrruncc of thc work lbr which thc pcrnrit is issucd. _l have and will nuintuin workers' conrpensation insurarrce. as required by Section 3700 of the Labor Code, frrr lhe Jrrfonrurrce of thc work for wlrich this prnrit is issucd. My workcrs' conrpcnsation insurancc carricr uxl Jxrlicy numbcr are: S r) I-(+Na(\ !c(d Policy L ltLl"t/ro, o _l ccrtify that in tlrc ;^.^rtornuncc of thc work f<rr which tlris pcrnrit is issucd, I shall mrt enrploy any pcrson in any nranncr s() as to bccomc subjcct to thc workers' cornpen.sation laws of California. and agrec that if I should bccomc subjcct to thc workers' corrrlrcnsatiorr provisiorrs of Section 3700 of the Labor Code, I slurll, forthwith conrply with those provisions.. WARNING: Failure lo secure workers'compensation coverage is unlaw[ul, and shal! subject an employer to crirninal penalties and Sectkrn 3076 of thc l,atxrr (ixlc, intt'rcst and atlorncv's l'ccs. o I hercby affirnr under pnalty of perjury that I anr licensctl under pruvision of Chapter 9 (conrnrncing with Section 7firu) of Division 3 of the Busine.ss and Pmfessions Code. anj mv license is in full forcc and effect. Licerxe lD Nunrber:o D CONSTRUCTION LENDING AGENCY I hcrcby al'lirrn undcr 1^-nalty of pcrjury that thcre is a construction lcnding agcncy for thc pcrlbrmance of the work ltrr which this pcrmit is issued (Sec. 3097. Civ. C.). lrnder's Nanre: l-cnder's Address: APPI,ICAN'T DECI,ARATION I lrrcby aflirnr unclcr pnalty of Jrcrjury onc of thc lirlkrwing dcclarations: Denxrlition Pcrnrits-Ash,t'stos Notification Fetlcral Rcgulations ('titlc 4O, Part6) _Rcquircd L,cttcr of Notification _l ccrtily that thc I'cdcralrcgulalions rcgarding a.sbestos rcrrrrval arc nol applicablc' to this project. ordinanccs and Statc l,aws rclatirrg to building construction. tnd hcrchy authorizc rcprcscntativcs of this City and County to cntcr up)n thc atxx'e rrrcntioned pr()t)c't'ty ft)r pur[x)ses. Applicant or Agurt Itcrnritec nonrc ( urirrt ):rtlrt hia-m Gc p( Ort", Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor -?- Bondins I Groundinq I UFER (\-?la D,ffi,-/ Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough)I [Meter Release t(1 I DWt 7 I , Rough ,I Service N/eter t t17 lz e trytF 7 FINAL L('17lz CI Dftq I Notgs, Bemarks, Etc.t I /x Oul DI -m I I J a D