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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS O$'ncr-Buildcr Dcclaration <br />IherebyafTirnrunderpenaltyofpcrjurythatIamexemptformtheContraclors LicenseIawforthefollowingrqson(sec.70JL5BrNincss <br />and Profesion Codc): Any City or County which rcquira a pmit lo construc-i. altcr. improvc. demlish or rcpair any slrucl(c. prior to its <br />issuancc.alsorcquircsthcspplicantforsuchpcnnillofilcasigncdstatcmcnt thathcorshcislicens.d puBuanttothcprovisionsofthc <br />Contrsclor's [,rcensed Law (Chaple, 9, Commencing with Srction 7000 ofDivision 3 oflhe Busin6s 8nd Prof*sions Code) or thal hc or <br />shc is cxcmpl lhercfrom and thc bsis for lhc .llegcd cxcmplion .Any violation ofscclion 703 I .5 by any applicant for a pcmit subjccts thc <br />spplicsnl to a civil pcnalty ofnot morc lhan fivc hundrcd dollam ($500). <br />I, !s owncr oflhc property, or my .mployce with wago as lhcir solc compcnsation. will do thc work and thc slructurc is not intcndcd <br />or offc..d for $le ( Ss 7044, Busin6s snd Professions Codc Thc Contractor's Liceree Law do* rct apply to an owner of thc prcpcny <br />who builds or improvo thcrcon. 8nd who do6 such work himsclfor hcrsclfor through his or hcr own cmployccs, providcd thEt such <br />improvcmcnls arc not intcndcd or offscd fo. s!lc. If. howcvcr. lhc building or improvcm.nt is sold within onc ycu ofcomplction. thc <br />Owncr-Buildar will havc lhc burdcn of proving that hc or shc not build or improvc for thc purposc ofsalc). <br />_1. 6 owncr of thc propcny. am cxclusivcly contractinS with liccNcd conlrscton to coEtruct thc projdt ( S(. 7044, Busif,css ind <br />Pref6sion Codc: Thc Conlraclor's License Lrw doe not apply to an ownfi of propcny who builds or improve lhercon . and who <br />contract! for iuch projdts with a Contractor(s) liccnsed pursuont to thc Contrtdor's Licensc f,aw ; <br />,",:":' <br />*l <br />---',-. x'p'2lu :1^1 <br />I hcrcby affirm urdcrr"*n, orr..;r'onffi <br />_l havc ed will msinlain a C(dificalc of Conscnt lo S.lflnsure for workers compeNtion. 8s provided for by Setion lToo of thc <br />hbor Code. for lhc pcrfomancc of lhe work for which thc pcrmit is issucd. <br />_ I have and will maintain workers' @mpenslion insumnce, as required by Section 3700 ofthe kbor Code, for the performance ofthc <br />work for which this pcrmit is issued My workers' compcnstion insurance errier and policy numbcr are <br />Canio:_ <br />Policy Numbtr:_Expircs: <br />(-[his scction nced nol b€ cornplctcd iflhc permit is for One hundrcd dollare {$1001 or lcss) <br />I ce(ify thal in lhe pcrformancc of thc work for which this pmil <br />became subject to the workers' @mpensation laws ofCalifornia, and <br />is issued. I shall nol any pcmoo in any manocr so N to <br />that if I should subjecl lo the workers' <br />compcnsation provisions ofSction 1700 ofthc tabor Code. I shall.with <br />Datc:*-;":":.":"kWARNINC failure to srcure unlarvful. and subject an cmploycr lo criminal pcnaltie snd civil <br />fin6 up lo onc hundrcd thouand dollars ($l 00.000).in addition to thc cosl ofcompcnstion. damagcs as providcd for thc S(tion J076 of <br />lhc lrbor Codc. inlcrest and atlorney s fEs. <br />LICENSED CONTRACTORS DECLARATION <br />I hcrcby alTim undcr pcnally of pcrjury lhat I am licenscd under provision ofChaptcr 9 (commencing wilh Scction 7000) of Division 3 of <br />the Busincss and Professions Code. and my liccnsc is in [ull forcc and effect. <br />Liccroc Class: <br />D6lc: <br />License Number <br />( ()trlriclor: <br />CONSTRUCTION LENDTNC AGENCY <br />I hcrcby alfim undcr pcnally ofpcrjury lhat thcrc is a coNtruction lcoding agcncy for thc pcrfomance ofthc work for which this pcrrnit is <br />issucd (Scc. 1097. Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPLICANT'S Df, CLARATION <br />Dctnolirion Pcrmits-Asbcstos Notificarion Feddal Rcgularions (Tillc 40. Parl 6) <br />_ Rcquircd Leilcr ofNotification <br />_l ccnify th8t thc fcdcralrcgulations rcgarding sbGlos rcmovalarc not applicablc to this prejdt. <br />_ . I c.rlify thal I have rcad this application and slatc infomation is corccl. I agrcc to comply with Ell City and Couty <br />ordinanccs and Statc Liws rclating authorize represcntalivcs ofthis City and County to cnler upon thc <br />abovc mcnlioncd propcny for <br />Applicant or agcnl sig.: <br />Pcrmittcc namc (print):}( <br />Datcl <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter I t\I <br />F!NAL I L ,\,,IXJ 4L <br />Notes, Remarks, Etc.(l