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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safetv /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under SIab / Floor /, t nl .- a, Bondins I Groundins I UFER L, l/&/)@4t#â‚¬,t6w Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush) Ceilinss (Hard & Soffit Rouqh Ceilinss (T-Bar Rouqh) [\4eter Felease lt AI ft Zil{CYPLT 'd/1,ru UrrDOa Rouoh Service N/eter t l-tl r1 FINAL l/t^tr/,/4lJ -n0 Notes, Remarks, Etc. --b> OWNI',R BUILDER DIILCARATION I hereby affrnr under penalty of prjury that I anr exenpt frorn the Cbntractom' License law for the following rcason (Sec.7031.5 Busincss and Profcs.sion Codc): Any City or County which requircs a permit to construct, altcr, irnprovc, demolish or rcpair any structure, prior to its issuance. also requires the applicant for such Srcrnrit to file a signed staterncnt that lre or she is licerrscd pursuant to thc provisions of thc Contraclor's Licenscd law (Chapter 9, Comrncncing with Section 7fiX) of Division 3 ol'thc Business and Professions Code) or that he or she is exempt therefronr and tlrc basis for tlrc alleged exenption. Any violation of Section 7031.5 by any applicant for a 1rcnnit subjects thc applicant to a civil pcnalty of not more than five hundred dollars ($5tttl). _1. as owncr ol'ttrc propcrt),. or nry crnployccs with wages as thcir solc compensalion, will do thc work and the structure is not intcrxled or offeretl for sale (Sec.704a. Business anrl Prufessions Codc: The Contractor's Licensc Law does not apply to an owner of the prcgrerly wlxr builds or improves llrre<rn, and wlto does such work himself or lrerself or tluough his or her own entployees, providcd that such irnprovernnts arc not intendcd or ollbrcd for sale. Il. howevcr, the buikling or improvcrncnt is sold within one year of conpletioq the Owrrcr Buikl,er will have thc burdcn of proving ttrat hc or she did not buikl or improve thc proputy for tlre purpose of salc). -1, as owner of the property, am exclusively contracting with licenncd contracloni to conslruct tlrc projcct (Sec. 7(X4, Business and Profession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who conlracts for such projects with a Contracto(s) licenscd pursuant to thc Conuactor's Licensc l.aw). -l anr exempt under Section-, B. & P.C. tbr this reason. I 1...,.. WORKIiRS' COM PENSATION DECLARATION I hcrcby affirm undcr Jrcnalty of pcrjury one of thc lirlkrwing dcclarations: _l have arxl will nnintain a Certilicate of Consent to Self-lnsure for workers' conrlrcrusation, as provided for by Section 3700 of the Labor Codc, for thc perforrnancc of the work lbr which thc pernrit is issucd. -Ithe have and will nraintain by Section 3700 of the l-abor Code, for thc performance of uxt plicy numhcr are:work for which carricr a T {u^q Policy a q 2oz-o -\+- )o - Ll _l ccrrify that in thc lrcrfornuncc o[thc work for which this grcrmit is issucd, I shall not cmploy any pcrson in any menncr so as lo beconrc subjcct to the workcrs'compen.sation laws of California. and agrce that if I should become subject to thc workers' conrpensation provisions of Section 37fi) of the Labor Code, I shall, forthwith comply wilh thosc provisiorts.. WARNING: Failure to secure workers'compcnsation coverdge is unlawful, and shall and civil fines up to one hundred tlrousand dollars ($100.000). and attorney's [ces. ilt addition to llte cost ol'for lhe .Scction 3076 of thc (,o a, I hereby affirnr under penalty of perjury that I anr licenscd under 9 (conurpncing with Section 7firc) of Division 3 of the Business and Professions Code. and my license is in full force aml effect. License o c-lo c- 7a Nurnber: e ,fo I hcrcby al'lirm undc'r pcnalty of pcrjury that thcrc issued (Sec. 3097. Cir'. C.). a construction for thc pcrlbrmancc ol'thc work l'or which this pcrrnit is l-ender's Nanrc: Lrnder's Address: A PPI,ICANT DECI,ARATION I hrcby affrnr undcr pnalty of pcrjury onc of the folklwing doclarations: Dcnxrlition Permits-Asbcstos Notification Federal Rcgulations (Title 40, Part6) _Rcquircd l,cttcr of Notification _l certily that thc fedcral rcgulation.s rcgarding asbcstos rcmoval are to this projc',ct. _l ccrtily tlral I havc rcad this application and stalc thal thc is corrcct. I agrcrc to conply with all City antl County ordinanccs and Statc Laws relating to building of this City and County to cnter upon thc above rncntioned properly for inspection purposes. Applicant or Agent Pcrnrilec ur".t (a- q -Zo Rev. 08-07-201 t [d/ryru I /t