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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DEI,CARATION <br />I hreby aflim unda pendty of pojury that I m cxcmpt fiom th€ Contncror' Liccre lrw for thc folloying rcnlSc.703l.5 <br />Busin6s urd Profeion Codc): Any City or County which rcquirs a po'mit to @Etruct. altq. improvq rtrnolbh or rqair my <br />structuc. prior to its issuocc, also rcquirs thc spplicot for such pcrmit to filc a sigrcd $atmot thgt h€ or slrc b licq&d plN4t <br />to rhc provisioN of tlE Contractor's Licosd taw (C.hapt6 9. Comocing with Setion 7000 of Division 3 of thc Buins ud <br />Profsions Codc) or that he or shc is cxmpt thscfrom ild thc basis for thc alle?cd cxmption. Any violatiotr of Sstion 7031.5 by ey <br />applicantforapmitsubjctsthc applicmttoacivilpoaltyofnotmorethmfivchundrcddollus(3500). <br />,-l+\ u omc of the popaty, or my cmploye with wag6 6 thcir sle compcrEdion. will do thc wort &d thc stnrc1N is mt <br />intqdcd or ofiqed for slc (Sc.7O44. Buine md Prcfqiom Code Thc Contrrclor's Licre [8w do6 not apply to e oms of <br />th€ propcrty who builds or imprcrc th@n, dd who do6 such rcrt himsclf or hq*lf or thrcugh his or ho om cmploy€6, <br />providcd that such improvmts e mt intodcd or offqEd for slc. tf, howea, thc buikling or improvmt is sld within onc )ry <br />of complaion, thc Owno Buikk will harc the buda of prcving tha he or she did rct build or imprcw lh€ plopdy for thc pupos of <br />sD. <br />_1. re oms of thc propqty, m qclsive ly contracting with licased @ntracton to @nstruct thc projet (Se. 7044, B6ins <br />md Proftssion Code: Thc Contmctor's Liccnsc Law doc not apply to e own6 ofprcpqty who builds or imprcvG ths@n, <br />and who contncls for such projers with 8 Contmcto(s) licos€d puE@t to thc Contractor's Licffi taw). <br />-l <br />am exempt under B. & P.C. for this reason./\ttzn'DtuA 64L/(?- <br />I hereby alTirm under penalty of po'jury <br />_l have and will maintain a Certificate of Conse'nt to Self-lnsure for workers' compersation, as provided for by Section 3700 of the <br />Labor Code. for the performance of the work for which thc pennit is issued. <br />_l have and will maintain workers' compcnsation insurance. as required by Section 3700 of the Labor Code. for the performancc of <br />the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: <br />fu 4, certi$/ that in the performance of the work for which this permit is issued, I shall not ernploy any pcrson in any manner <br />so .ls to become subject to the workers' compe{sation laws of California. and agree that if I should bocome subject to thc <br />workers' compensation provisions of Section 3700 of the L:bor Code. I shall. forthwith comply with those provisions.. <br />a <br />WARNING: Failure to secure workers' compcnsation coverage is unlawful, and shall subject an onployer to criminal paulties and <br />civil fines up to onc hundred thousand dollars ($100.000). in addition to the cost of compensation, damages as provided for the <br />Section 3076 of the l-abor Code. interesl and attorney's fees. <br />oarcz fl '//- 2- O Appricant: <br />LICEI{ <br />DECI.,ARATTON <br />I hereby affrm under paralty of perjury that I am liccrsed under provision of Chapter 9 (cornmorcing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force and effect. <br />License Class: License Number: <br />W <br />I hcby affum unda pcnalty of pqjury that thqc is 8 coru(ruc{bn hnditrg agacy for thc pafor:rucc of lhc rcrk for which this pqmit b <br />isued (Se. 3097, Civ. C.). <br />Lender's Name: <br />knder's Address: <br />APPLICANT DECLARATION <br />I hereby aftirm under penalty of perjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) <br />_Required Letter of Notification <br />-l <br />cdiry thd thc ftdGal rcgulatioro rcgrdiag rbctos moval re mt eplicablc to thi! prcj6l. <br />, , I cqtiry thar I hrye ud this applicaion and st8tc that thc abovc iofomdion b cor€{. I agr to comply with 8ll city md Couty <br />ordimcB ud Ststc tts rcldiru to building con$rucriorl ad lEcby fltrhorirc rcpwrtatiE of thi! City ed Couty to atq rpotr thc <br />abovc mtioncd prcpsty fq ilspclion purpos6. <br />AppncnrorAsqrst,.*-,rl44RtP A G ALVeZ orr",Q - //- 20 <br />Pemlte mm. (prlol): <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards A <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm I Dampers <br />Communications Cable <br />/ <br />Building <br />Under Slab / Floor ,4 <br />Bondins I Groundins IUFER <br />Transformers U v <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilings (Hard & Soffit Rough n <br />Ceilinqs (T-Bar Rouqh)ln <br />J\Ieter Release 6'22-fu *Jq-1'6 IY <br />Rouqh 0.- <br />Service Meter 6,71 ^7A <br />FINAL \) <br />Notes, Remarks, Etc. <br />h <br />I <br />Rev. 08-07-2015 <br />,a <br />0^-zl-h hwl,l