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ELECTRICAL.I NSPECTOR RECORD <br />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 Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rough <br />Ceilinqs (T-Bar Rouqh) <br />lt/eter Release <br />Rouqh <br />Service Meter <br />FINAL vft 'y'|,/ 5.\81 l;eru<" <br />Notes, Remarks, Etc <br />OWNER BUILDER DELCARATION <br />I hocby affirm undo poalty of pqjury thal I m exempl liom lhe Contraclos' Licmc Law for thc lollowing reen (Se.70-11.5 <br />Busines md Profmion Codc): Any Cily or County which rcquire a pomil lo conslruct, all6. improve. dmolish or rcpair any <br />structue. prior to its issuilce. aLso requirG lhe applicet for such pemit to file a signed statcrndt that he or she is licEnsed pursunnl <br />to lhe govisions of lhe Contractor's Licensed larv (Chaptq 9, Commencing with Seclion 7000 of Division 3 of the Business ant <br />ProfesionsCode)orthatheorsheisexemplthfferiomildthcb6sisfortheallegedcxsnplion. AnyviolalionofselionT0ll.5byany <br />applicantforapennitsubj(lslhe applicantloacivilpenaltyofnotmorethanllvehundreddollils($500). L <br />_1. o owns of the prefrcrly. or rny employs wilh *,a96 6 their rcle compeNtion. u'ill do the q'ork md the slruclue is not <br />intmdql oroffqedforsale(Sa.TM4.BusinessandProfessionsCode:TheContractor'sLicmseLawdosnotapplytoanownerof <br />the fmpeny who builds or improve th6@n. ild who do6 such rvork himself or hmclf or through his or hc orvo cmployee. <br />provided thal such Lnprovqnots tre nol intmdql or otlred for sle. lf, horvo,q. thc tuildinS or improvemt is old within one yar - <br />ofcomploion. the Owner lluilds will have the budo ofproving that he or she did ilot build or imfrove the prcpsty for the ptrpor of <br />sle). <br />_1. m owner of the propcty. m exclusivcly contradiilg with licensed contractoB to construct lhe project (See-. 7044. Brsincss <br />and I'rofssionCode:'[heContractor's[-icensel,awdo6notapplytoanosnqofpropertyshobuildsorimprovGthqeon. <br />and who conlmcts flor such pnjccts with a Cor{racto(s) liceNed pursuilt lo the Contractor's License Law). <br />-l <br />m exempt undq S6tion . B. & P.C. for this reoon <br />Dele:OEner:_ <br />WORI(ERS' COMPENSATION <br />DECLARATION <br />I hoeby alTirm undr penalty ofpcjury one ofthc following deloations: <br />--l <br />have md rvill maintain a Cenificale of Co$ent lo Self-lNure for workos'cornpmation. m provided for by S(tion 3700 of the <br />t?bor Code. for lhe pqfonnmce ofthe work for rvhich the pornit is issued. <br />lhavcandwillmaintairrvorkm conrpensationinsurance.o requiredbyStrlionST00oftheLaborCode,forthepqfomanceof <br />lhc work for lvhich lhis pmnit is issued. My workqs compostion ircurance cario md Sxrlicy numbe ue: <br />Cmiq:- <br />Policy Number:Erpires: <br />-l cct'lify that in the performance ofthe rvork for which this pornit is issucd. I shall not ernploy any person in any nranner <br />m mrcbecomesubjrtlothervorkm'compmsationlarvsofCalifomia.andagrethatiflshouldbecomesubjstlothe <br />*orkm' cornpenstion provisions ofSetion 3700 ofthe l-abor Code. I shall. fonhwilh comply rvith thos provisions.. <br />WARNINC: Failure to secure workss'cornpensation coverage is unlarvful. mcl shall subjet m onpkryer to firninal poalliG and <br />civil fioes up lo one hundred thousand dollffi in addition kr lhe cosl ofcompensattrn. damages as proricled lirr the <br />Sslion 3076 ofthe libor Code. intqGl and [ees <br />o,,". /o-3( -)o t 1 <br />I hcreby aflirnr undo permhy ofperjury I ailr provision ofChapto 9 (commencing with Sstion 7000) ofDivision l <br />of thc Business and Profssions ('odc. md rny licmsc in full force and elTect. <br />Liceroc Clasr- <br />ort"' /o"21 '0 &_ <br />o t'? <br />Liccnsc <br />ao <br />"o <br />I hoeby aflinn undo pmalty ofperjury lhal <br />issued (Se. 3097. Civ. C.). <br />Lender's Name: <br />ts agmcy for the Ffonnance of lhe rvork ft r Nhich lhis fnnrit is <br />Lcnder's Ad&asr <br />APPLICANT DECLARATION <br />I hodry affm undo pmahy ofperjury one ofthe follos'irg delaations: <br />Demolition Pemils-Asbstos Notification Fedtral ReSulalions ( Iille 40. Pan6) <br />Required l-etter of Nolification <br />_l cff the laloal regulations regrding mtmlos rernoval are ml applicable to this prejet. <br />wilh all ('ily and ('ounly <br />md County to ento ugrn the <br />above <br />Applicrnl or Date:/a qrro/7 <br />I'ermilee <br />ftrr inspect <br />5o-> tpL 4qrr, 4 <br />\