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ELECTRICAL.I NSPEGTOR RECORD <br />APPROVALS DATE ID/SIG GOMMENTS Owncr-Builder Dcclsation : <br />I hereby affirm undcr penalty ofperjury that I m cxempt fom thc Contractors' Liccnse Law for thc following rcuon (scc.70};5 Dcs'incss <br />od Profession Code): Any City or County which rcquires a pcmit to construct, alter, improve, dcmolish or rcpair my structurc. prior to iE <br />issuance, also requires thc applicmt for such pemit to filc a signcd statement that he or she is liccnscd pursuut to thc provisions ofthc <br />Contractor's Licensed Law (Chaptcr 9, Commcncing with Section 7000 ofDivision 3 ofthc Busincss ild Profcssions Codc) or that hc or <br />shcisexempttherefromudtheb6isfortheallegedcxemption AnyviolationofSectionT03l.5byanyapplicutforapcmitsubjcctsthe <br />applicant to a civil pcnalty ofnot morc than fivc hundred dollars ($500). <br />_1, m owner of thc propcrty, or my cmployces with wagcs s their solc compcnsation, will do the work and thc structurc is not intcnded <br />or offercd for salc ( Scc.7044, Busin6s md Profcssions Codc The Contractor's Liccnsc Law docs not apply to m owncr ofthe propcny <br />who builds or improvcs thercon. ild who do6 such work himsclfor hemclfor through his or her own cmployces, provided that such <br />improvementsarcnotintcndcdoroffercdforsale If,howevor,thcbuildingorimprovcmcntissoldwithinoneycdofcompletion,the <br />Owner-Builder will have the burdcn ofproving that hc or shc not build or improvc for thc purposc of salc) <br />_1, c owncr of thc propcrty, m cxclusivcly contreting with Iicensed contractors to construct thc projcct ( Scc. 7044, Busincss ild <br />Profssion Code: Thc Contrrctor's Licensc Law does not apply to an owncr ofproperty who builds or improvcs thscon , md who <br />conracts for such projects with a Conractor(s) liccnsed pursumt to thc Contractor's Liccnsc Law.). <br />_l am exempt under Section _,B & P C for this reroon <br />Datcr <br />-owncr, <br />- <br />WORKERS COMPENSATION DECLARATION <br />I hereby affim under pcnalty ofperjury one ofthc following dcclarations: <br />_lhavemdwillmaintainaCertificateofConsenttoSelf-lnsurcforworkers'compcnsation,6 providcdforbySection3T00ofthe <br />Labor Codc, for the pcrfomace of thc work for which thc pmit is issucd. <br />_l have od will maintain workers' compcnsation insurmcc, c rcquircd by Scction 3700 ofthc Labor Codc, for the pcrformancc ofthe <br />work for which this pmit is issued. My workcrs' compcnsation insurilcc cmier od policy numbcr ac: <br />Policy Numbcr: Expiru: <br />4d;::not bc complcted if thc pmit is for Onc hundrcd dollas {$ 100} or lcss) <br />thc pofomancc of thc work for which this is issucd. I shall not cmploy any pmon <br />agrcc that ifl should bccomc subject to <br />in manncr so 6 to <br />bccmc subjcct to thc workcrs ' compcnsation laws of <br />compcnSation 3700 ofthe Labor Code,with thosc provisions. <br />WARNING,to sccurc worke6' compcnsation coveragc is unlawful, ud shall an cmploycr to riminal pcnaltics and civil <br />fincs up to onc hundrcd thousmd dollm ($100,000),in addition to thc cost of <br />thc Labor Codc. intcrcst md attomcy's fccs. <br />damagcs r provided for the Section 3076 of <br />LICENSED CONTRACTORS DECLARATION <br />I hereby affirm undcr pcnalty ofperjut] that I m licenscd undcr provision ofChapter 9 (commencing <br />thc Busincss md Profcssions Code, ud my liccnsc is in full forcc ud cffcct <br />with Section 7000) of Division 3 of <br />Date <br />I hcrcby affim under penalty ofpcrjury rhat thcrc is a construction lcnding agcncy for thc pcrfomoce ofthc work for which this pcmit is <br />issucd (Scc. 3097, Civ. C.) <br />Lcndcr's Nmc: <br />Lendcr's Addlcss: <br />APPLICANT'S DECLARATION <br />Dcmolition Pcmit$-Asbcstos Notification Fcderal Rcgulations (Titlc 40, Pat 6) <br />_ Rcquircd Letter ofNotification <br />_l ccnify that the federal regulations rcgarding Gbcstos removal ae not applicable ro this projcct <br />-Zdry lr"^vc rcad this ild statc that thc abovc infomation is corcct. I agrce to comply with all City dd County <br />ordinanccs md Statc Laws to building construction, and hereby <br />abovc mcntioncd propcny <br />^:::ry,, <br />purPoses. <br />rcprocntativcs of this City to cntcr upon the <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains )4f<5 L l>-' <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 <br />FINAL l.l'b-zo w( lo, <br />Notes, Remarks, Etc <br />x?f$