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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION <br />I hftby affm undq paalty of psjury that I m q@pt &om thc ContractoE' LicoE trw for th€ following lwn (Sc.7031.5 <br />Businas 8trd Profasion Code): Any City or County which rcquim a pamit to coEtruct, alt6, improvc, &molish or rtpair my <br />structw, prior to its isuucc. also rcquire thc applicmt for such pcrmit to filc a signcd stat@6t thd hc or shc is licq&d plllswt <br />to thc Fovisio6 of thc Contnctor's Liccnscd law (Chaptq 9, Commcing with Setion 7000 of Division 3 of thc BEitB ud <br />Prcfeioro Codc) or that hc or shc is qcmpt thqetom md thc bssis for thc allcjcd umption. Any violstio! of Setion 703 I .5 by uy <br />app[cmtforaparnitsubjetsthc applicmttoacivilpcultyofootmorcthdfivchundrctdollm($500). <br />lff * o*o of ,tc propsty, or my mplo)6 with w8g6 s their $le ompcreation, will do the wod< ad tIrc $ruc{rc is not <br />ffiilrdcd or offred for salc (Se.7044. BGins md Prcfsioro Code: Thc Cortraclor's LiccN L8w do6 not apply to m oM6 of <br />'thcpnpory whohuildsorimproqthqon.mdwhodo6srchwrlhimselforhmlforthrcughhisorhaomcmploye, <br />providcd that such imFowmtts e rct irtqrdod or of&rcd for slc. lf, howrc. thc huiHing or improvmt is eU withio onc )s <br />ofcomptiio& th€ o\rn6 Buil.h will harc thc hrda ofprcviry thd hc or she did not build or itrprow thc pmpqty for thc Brpo& of <br />slc). <br />-1, <br />r owno of thc prcpcty. m acluive ly contrsc{ing with licqts€d contrctoG to consEuct tlrc prcjct (Se. 7(x4, &sins <br />srd Profusim Code : Thc ContEctor's Liccnsc Law do6 not apply to e oms of properry who builds or improvG th6@n, <br />ad who ontncts for such Fojels with I ContBcto(s) lictrcd p6ualt to thc Cotrtractor's Licffi ttw). <br />I am exemot B. & P.C. for this reason. <br />rD <br />I hereby affrrm under penalty of perjury one of the following <br />-l <br />have and will maintain a Certificate of Consent to SelGlnsure for workers' compensation, as provided for by Section 3700 of the <br />Labor Code, for the psformance of the work for which the pennit is issued. <br />-l <br />have and will maintain workers' comperu;ation insurance. as required by Section 3700 of the Labor Code. for thc performance of <br />the work for which this p,ermit is issued. My workers' compcnsation insurance ciurier and policy numhr are: <br />in the pcrformance of the work for which this permit is issued. I shall not employ any person in any manner <br />subject to the workers' compensation laws of California. and agree that if I should become subject to the <br />workef,s' compensation provisions of Section 3700 of the Labor Code, I shall, fcrrthwith comply with those provisions.. <br />WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an onployer to oiminal pmalties and <br />civil fines up to one hundred thousand dollars ($100.000), in addition to the cost of damagcs as provided for the <br />ISection 3076 of the interest and attorney's fees. <br />,2 <br />I hereby afl'irm under penalty of perjury that I arn licensed under 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Codc, and my license is in full force and effect. <br />Number: <br />Date:_ Contractor: <br />CONSTRUCTION LENDING AGENCY <br />I hwby aflim undo pcnslty of pajury that th@ b 8 snstruction lcnding agocy for the pafomuce of thc rcrk for which this panit b <br />issucd (Sc. 3097, Civ. C.). <br />Lendcr's Name: <br />I-cnder's Address: <br />APPLICAI\T DECII\RATION <br />I hcr*,y affirm under penalty of perjury one of thc following dcclarations: <br />Demolition Permits-Asbcstos Notification Federal Regulations (Title 40, Part6) <br />-Required <br />[rtter of Notificaion <br />-l <br />certi& that the fcdcral regulations regarding asbestos removal are not applicable to this project. <br />f%iry tha I havc read thb application and state that the abovc infonnation is correct. I agre to comply with all City and County <br />ordinanccs and State laws relating to building and hereby authorizc reprcseilatives of this City and to cnter upon the <br />above merltioncd property for inspection <br />Applicnnt or Agent <br />Permitee name <br />( <br />Zoz+> <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Poo!, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm I Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Groundinq / 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 />Ceilings (Hard & Soffit Roush <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rouqh I <br />Service Meter Pr I rL c2- <br />FINAL I <br />)t1 l'10 yr++f o/ <br />Noles, Remarks, Etc.I <br />I <br />)r ( lAISI <br />I I <br />+ <br />Rev. 08-07 -201 5 <br />Carrier: