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APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor -1. t A <br />ll4:'b.ulflBonding I Grounding I UFER Hfilfu (0\t' <br />Transformers ,' , <br />Torqueing <br />Sub-Panels <br />Air Conditioners / <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Igilings (Hard & Soffit Roush <br />Ceilings (T-Bar Rough)lt , <br />N/eter Release )llb/h)6'L{ZLi@t tlx <br />ll <br />Rough II al f! <br />Service lVleter ilM',A lWrin $/Y <br />FINAL '2/2 elart Dba.lh ,fatr[ <br />Noles, Remarks, Etc.r <br />c7( <br />ArV <br />I <br />}IT]II,DIiR <br />I hereby affirnr under penalty of perjury that I arn exempt fronr the Cbntractoni' License [:w for the following reason (Sec.7031.5 <br />Iiusinc.ss and Prol'cssion Codc): Any City or County which requircs a pcrrnit to construct, atter. irnprove, demolish or rcpair any <br />slructure, prior to ils issuance. also requires the appliczutt for such grnnit to file a signed slaternent that lr or she is liccnscd pursuant <br />to the provisions of the Contractor's l,icenscd law (Chapter 9. Commcncing with Section 7fi)0 of Division 3 of thc Bu.siness and <br />Professiotts Codel or tltat lrc or slrc is exempl therefrom arxJ tlre basis for tlr alleged exenrption. fuiy violation of Section 7031.5 by any <br />applicunt for a pennit subjects the applicant to a civil pcnalty of not nrore than [ive hundred dottars ($500). <br />-1. <br />as owncr ol'the propcrty. or my crnployees with wages as their sole compcnsation, will do the work and the stnrcture is not <br />intentled or offered for sale (Sec'.7044. Business and Prufcssions Code: The Contractor's Licensc Law does not apply to an owncr of <br />the properly wlro builds or ilrtprrves thereon, and wlm does such work himself or lrerself or through his or her own enrployees, <br />providcd that such imprrrvctrcnts arc rnt intcnded or olTcrcd for sah. Il. howcvcr, rhc building or furprovcnrcnt is sold within orc )car <br />of complctitrru thc Owrrcr Buikler will have the burden of pnrving that hc or she did not buikl or inrprove thc propcrty for rhc purposc of <br />sale). <br />-1. <br />as ownet of the propcrty, um exclusively contracting with licenscd conlractors to construct thc project (Sec. 7044, Busincss <br />and hofession Code: The Contractor's License Law does not apply to an owner of property who buil<Js or improves thereon,and who contracts for such projccts with a Contractor(s) licensed pursuant to thc Contractor's License l-aw). <br />-IantexemptunderSectiott-,B.&P.C.lbrthlsreason. <br />WORKERS' COMPI'NSATION <br />DECLARATION <br />I hcrcby affirm undcr pcnalty of pcrjury one of thc tbllowing dcclarations: <br />-l <br />have and will nnintaitt a Certilicate of Consent to Self-lnsure for workers' conrlrcrxation, as pruvided for by Section 3700 of the <br />4ffi; <br />for the grcrformancc of thc work lbr which thc perrnit is issued. <br />will nraintain workers'insurarrce, as required by Section 3700 of the labor Code, for the Jrerfonrnnc'e of <br />is compcnsation insurancc carricr and policy numhcr are: <br />D <br />-l <br />ccrlify that in thc lrcrfornuncc of thc work for which this pcrmit is issucd, I shall not cmploy any pcrson in any manncr <br />so as to bccomc subjcct to thc work!'rs' compensation laws of California, and agrec that if I stnuld becomc subject to the <br />worliers' contpensation pruvisions of Section 3700 of the Labor Code, I shall, furthwith comply with those provisions.. <br />WARNING: Failure to secure workers' compensation coverelge is untawful, and shall subject an cmployer to criminal pcnaltics und <br />compensalion, damages as provitled for thecivil lines up to one tlxrusand dollars ($100.000). in addition to tlrc of <br />Scction 307(r intcrcst and attorncy's l'ccs. <br />I.I (]T]NSI'D CONTRA C'I'()R <br />DECII\RATION <br />I hereby affirm under penalty of perjury that I anr liccnsred under provision of Chapter 9 (comnrencing with Section 7000) of Division 3 <br />of the Business and Professions Code. and my licensc is in full force and effect. <br />Numbcr: /o3 73/C <br />CONSTRUCTTON LENDING AGENCY <br />I hcrcby allirrn under pcnalty of pcrjury that thcre is a construction lending agcncy for the pcrlbrmancc of thc work lbr which this pcrrnit is <br />issued (Sec. 3097. Civ. C.). <br />bnder's Name: <br />lrnder's Address: <br />APPI,ICA NT DECI,ARATION <br />I lucby allirm undcr pnalty of pcrjury onc of thc f<rlkrwing dcclarations: <br />Dcnrolition Pcrnrits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40, Parr6) <br />_Rcquircd l,etter of NotiFrcatkrn <br />Sl, ccflily that thc federal rcgulations regarding asbcstos removal are nor applicable to this project. <br />I(btt tlral I have read this appticatiorr and state thar the above intbrmarion is corect. I agree to conply wirh all City and County <br />ordinanccs and Statc Laws rclating Io building construction,City <br />rrrcntioned purposes. <br />or <br />abovc <br />nanlc <br />property [or inspection <br />and hcrcby authorizc rcprescntativcs ol'this and to cntcr <br />l/t <br />ELECTRICAL-INSPECTOR RECORD <br />a) <br />I <br />1 <br />Rev.15 <br />tlb 1,, <br />1