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ELECTRICAL.INSPECTOR RECORD <br />Rev. 08"07-20 1 5 <br />APPROVALS DATE ID/SIG.COMMENTS OWNIER B I'II,DIiR DIiI,CA RATION <br />t hereby affinn under penulty of perjury that I anr exerrryt fronr the Contractoru' License [-aw for the following, reav)n (Sec.7031.5 <br />Busincss and Prol'cssion Codc): Any City or County which rcquircs a pcrrnit to conslruct, altcr. itnprovc. dcrntrlish or rcpair any <br />structure. prior to its issuance. llso requires the applicant fbr such Jrernilt to file a sigrred slatemenl that lte or slte is licensed pursuanl <br />to thc provisions of tlrc. Contractor's l,iccnscd taw (Chaptcr 9, Commcncing with Scction 7fl)0 ol' Division 3 ol'thc Bu.sincss and <br />Pnrfessions Ctxlc t or that lrc or slrc is exenrpt therefronr and the basis for the alleged exenlption. Any violatittn of Section 703 L5 by any <br />applicant fior a pennit subjects the applicant to il civil penalty of not rnre than five hundred dollars ($5tttt1. <br />_1. as owncr ol'tlrc prop(-rty. or tny ernplovccs with wagcs as thcir solc cornpcnsation. willdo thc work and thc structurc is not <br />interxJed or offeretl for sale ( Sec.7()1.1. Busincss and Professiorx Ctxle: The Contraclor's Licensc Law does not apply to an owner of <br />the pnrllerty wlxr txrilds or inqrroves tlrreon, arxl wlxr dtrcs such work hintself or lrerself or through his or lrcr own entployees, <br />provided that such irnprovtlncnts arc not intcndcd orolfcrcd for salc. ll. howcvcr. thc building or itnprrvetnent is sold within one ycar <br />of conpletion, tlre Owrrcr Builder will have tlrc burden of pmving that lre or she ditl mt build or impnrve the propelty for tlre purprse of <br />srlt'). <br />_1. as owner of tlre propetly, ilm exclusively contracting with licensed contractors to construct thc project (Sec. 7(X4. Business <br />aud hulbssiorr Code: The Corrtructor's Liceuse Law does not apply l() an owner o[ property who builds or intproves thereott. <br />an<l who contracts lor such prcr.iects with a C()ntract()r(s) liccnscd pursuant to thc Contractor's Liccnse taw). <br />_l anr exempt under Sectiorr-, B. & P.C. lbr tlti.s reasott. <br />WORKI,ITS' COMPI,NSATION <br />DECLARATTON <br />I hc'rcby affirnr unrlcr pcnalty of pcrjury onc ol'tltc lirlkrwing dcclarations: <br />_l have and will ruaintain a Certilicate of Consent to Self-lnsure frrr workers' cornperuation, as pruvirled f<rr by Section 3700 of the <br />Latxrr Codc, [<rr thc Jrrfonrurncc of thc work tirr which tnh pcrntit is lssucd. <br />_llraveandwill ruaintainworkc.r.s'conrpcnsalioninsurulrce,as requiredbySectiotr3T00oftheLaborCode,firrlhelrcrftrrttuttreof <br />thc work lirr wlticlr this My insurarrcc cun'icr antl lxrlicy ttuntlrcr iu'c: <br />\L V t/A <br />0tPolicy <br />_l ccrrify that in thc l,"-rlornrancc ol'tlrc work for whiclr tlris pcrnril is issucd. I slrall ttot cntpkty an! lErst)tl any manllcr <br />so as to bccoltrc suhjcct to thc workcrs' conrlrcnsation laws of California. and agree that if I should bccolne subjcct to thc <br />workers' coru;rcnsation provisiuns of Section 3700 of the Labor Code, I shall, forthwith colnply with tlxrse provi.siotrs.. <br />WARNING: Failure to secure workers'contlrnsation covemge is illl and <br />thecivil lines ujr lo ()ue hutdred llruusand dollars (Sl <br />Sc'clion 3076 <br />i'd" <br />Crxlc, intcrcst and <br />I hereby affinu under lrcnalty of perjury that I tnr licensetl under provisiotr of Chapter 9 (cotrurrcncing with Section 7000) of Division 3 <br />of the Business and Professions Code. and rnv license is in full force untl et'fect. <br />=Licerrse <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby alf irm undcr pcnalty of pcrjury that thcrc is a construction lcnding agency for the performancc of the work l'or which this permit is <br />issued (Sec. 3097. Cir'. C.). <br />Lcnder's Name: <br />lrnder's Address: <br />APPI,ICANT DECI,ARATTON <br />I lrrc*ry aft-rnr unrlcr ;rnalty of pcrjury onc of thc folkrwing dt'clarations: <br />Dcnxrlit ion Pcrnrits-Asbcstos Notification Fctlcral Rcgulat ions (Titlc 40. Prut6) <br />_Rcquircd Lcttcr of Notilication <br />_l ccrtify that thc lcdcral rcgulations rcgarding asbcslos rcrnovat arc not applicablc to this projcct. <br />_l ccrtify thal I havc rcatl this ap;rlication and inlirrnralion is corrccl. I agrcc to conply with all City and County <br />ordinancc.s and Statc [.aws rclating to <br />above rrrcntioned proprty for <br />0Applit'ant or,,\gt'nt <br />lDcrmilce nanrc <br />authrrize rcprr'scntativcs o[ this City and t() cntcr thr' <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safetv /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq I Groundins I UFER <br />Transformers <br />Torqueincr <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factorv Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinos (Hard & Soffit Rouqh <br />Ceilinqs [-Bar Rouqh) <br />[/eter Release <br />Rough <br />Service lVleter <br />FINAL /lzt'.2)ILC, <br />Notes, Remarks, Etc <br />l)ate: