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ELECTR!CAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouoh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />lt/eter Release <br />Rouqh <br />Service Meter <br />FINAL I i- 7 -/g JK -3/zl -f //t.t- <br />Notes, Remarks, Etc <br />OWNI]R BUILDI:R DEI,CARATION <br />I hcrchy allirnr under penalty ofpcrjury thal I am cxcmpl lioD lhc Contractors' Licensc Law for thc following rcay)n (Scc.7031.5 <br />Ilusiness and Prolbssion Codc): Any City or County which rcquircs a FErmit to construcl. alter. inrprovc. demolish or repair any <br />structurc. prior to ils issuancc- also rcquircs lhc applicatrt tbr such pcnnil to nlc a signed slatcrrenl lhal hc or shc is licctrscd pursuunt <br />lo the provisions of tlrc Conlraclor's Liccnscd Law (Chaptcr 9, Conlncncing with Seclion 70(D of Division 3 oI thc Busincss and <br />ProfcssionsCodc)orthdlhcorsheiscxcnrpllhcrcfromatrdlhcbasisforthcilllcgcdcxcmplk)n. AnyviolationofScclionT0ll.5hyany <br />applicanlforapermitsubjcclslhc applicnnlk)acivilpcnilltyofnotmorcthrnlivchundrcddollars($5(){)). <br />-1. <br />as owncr of lhc prolErty. or ilry cilrpk)yccs wilh wagcs xs thcir solc conrpctrs0tion. will do thc work and the slruclw is nol <br />inlcnded oroffcredforsalc(Scc.7(M4.BusincssandProfcssiotrsCodeiThcContracmr'sl,iccnscLawdocsnolapplytoanownerof <br />the prcFEny who builds or iilrp(rvcs thcmn. and who (lms such work himsclfor hcrsclfor through his or hcr own cmployces, <br />providcd lh{l such impro\cmnts m not illcndcd or oflcrcd for slc. ll. howevcr. thc huikling or iDrprovcnrnt is mkl withirr onc ycar <br />ofcoilrphliur. lhc Owncr Buildcr will ha\c lhe hurdcn of provirg thal h( or shc did not huikl or improvc thc pmlEny for lhe purJfiE of <br />sale). <br />_1, rs owner of thc proFrly. am cxclusivcly conlracli,lg with liccnscd coDlractors to construcl thc p()icct (Scc. 7(ll,l. Busincss <br />and Pn)fcssbn Codc: 'l hc Contractor's Liccnsc Law docs not apply lo an owncr ofpropcrty who huilds or itnprovcs thcrcon. <br />and who contracls lbr such prl)jccts wilh il Contraclor(s) liccnscd pursunnl lo lhc Conlrack)r's Liccnsc ljw). <br />_l anr cxcmpt lndcr P.(,*", 5- I f^t t <br />DI,tCl.AR,\l't0N <br />I hcrchy aliirnr undcr pcnally ol pcrjury onc ol lhc (lcclrrrti()ns: <br />I hr\c and will nHiiltrln n ('cililicrtc Scll'lnsurclorworkcrs'cotrpcns{tion.as p.ovidcdli)rhyScctionlT(nofthc <br />tntx)r Codc. for lhc performncc of thc work for which lhc permil is issued. <br />_lhavcan(lwillnrilintninw(,rkers compcnsalioninsurancc.ils rcqniredbyScction.lT(X)oflhctJborCodc.lbrthcpcrfornEnceoI <br />lhc work li)r which this pcrrnit is issual. My workcrs' conrpcnsxlknr insurnncc camicr and fnlicy numbcr [c: <br />Policy Nurnhcr: Expircs: <br />-l <br />ccnily lh{l iD thc Frlbrtrrrncc ol lhc work for which this pcrmit is issucd. I shall nol enrpk)y any pcrson in any manncr <br />so rs lo becomc suhjccl lo thc workcrs'conrpcnsalion hws ofCalili)rniil. and agrcc thal il l should hccomc suhjcct lo lhe <br />workcrs'compcnsrtionprovisionsofScclion-lT0OoflhcLrtxrrCodc.lshilll.l'onhwilhcomplywiththoscprovisions.. <br />WARNIN(I: Frilurc k) sccurc workcrs'coillpcnsiltion covcrrgc is unhwful. ond shall suhjcct an cmpkrycr to friilrinal lEnilltics aild <br />civil lincs up to onc hundrcd thousand dollars lSloO.UD).lo cost of daroges as providcd for thc <br />Scctiotr .1076 oflhc tntbr Codc. intcrcst and allorrcy s fees. <br />l)nlr:,Ftf't ( <br />I hcrcby allirnr undcr 1)clxlly ol pcrjury lhnl I anl <br />of thc Busincss and l'rolessions (ixlc. an<l rty <br />provi\t)n of Chnllcr 9 (conrnrncing wilh Scction 7(XX)) (,[ t)ivision J <br />in lirll li)rcc xn(l cllict. <br />I)alo:Conlmclon_ <br />CONSTRUCTION LENDINC A(;ENCY <br />I hcrcby afllrm undcr FEnally of pcrjury lhat lhcrc is a conslruclion hnding agcncy for Ihc pcrl'ormarEe of the work for which lhis Frcrmil is <br />issucd (Scc. 3097. Civ. C.). <br />Lcndcr's Nrmcl <br />lrndcr's Addrcss: <br />APPLICANT DECI ARATION <br />I hcrcby affimundcr pcnally of perjury onc of the tbllowing dcclarations: <br />DenDlilion Permils-Asbcstos Notilication Fedcral Regulalions (Title 40. Pdl6) <br />-Rcquircd <br />Lrttcr of Nolification <br />_l ccrlily lhal thc ltderillrcEulalions rcgarding nshc\k)s rcrnovrl urc nol rpplicrhlc lo lhis prejcct <br />-l <br />ccnily lhrl I havc rcrd lhis applicalion and slatc lhal lhc xtx'vc infonnrlion is coficcl. I agrs k) coilrply with xll Ciry and (i)uDly <br />(trdinancc\ aDd Stalc Ijws rclaling lo building rcprcscnlalivcs ol lhis City and County to cntcr uFil lhc <br />rh()vc trlcflliorrcd |r()l)erlv tin *,"3--/{-rfApplicanl or AgeDt Signature: _ <br />Prnnilee nanre (prinl): <br />rnd <br />tle cl5- <br />Liccnsc Clilss'_Liccrrrc Nunrhcr: