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ELECTRICAL-!NSPECTOR RECORD <br />v. 08 -2015 <br />DATE ID/SIG.COMMENTSAPPROVALS <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 />Bondinq / 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 (Rouoh) <br />Ceilings (Hard & Soffit Rough ACeilings (T-Bar Rough) <br />Ivleter Release 3'3 -2'h .lu\h <br />Rouqh <br />Service lMeter 3-7-20 *,vk* <br />FINAL 3-z-20 Y.IMh I <br />Notes, Remarks, Etc. <br />-+ <br />OWNIiR BUILDER DDLCARATION <br />I hcr.by affmr under penalty of prjury that I atr cxenrpl ftonr thc ConmctoN' Liccn* law for thc following rcasn (S€c.703t.5 <br />Busincss ard Prolession Codc): Any City or County which requtes a pcrmit to construct, alt6. irnprovc. dcmlish or rcJair my <br />stNcturc, prior to its issuancc. also rcquircs thc applical for such [tmtrt to filc a si8rcd slalcmnl lhat lE or shc is liccMd pu$ant <br />ro rhc pmvisions of thc Contractor's l,iccnscd l2w (Chaptcr 9. Commencing with Scction 7u)0 ot Division 3 of thc Busincss md <br />ProfessionsCode)orthatheorsheisexemptdErefronrandtlEbsisfortlEallegedexcmption. AnyviolationofSeclionT03l.5byany <br />dpplicrntfornfEnnitsubjEtsthe applic0ntto0civilpenrltyofnotmrethanfivchundreddollars($500). <br />_1, a\ owncr of the pro[En),. or ilry ernp hyccs with wagc$ as their solc compcnsation, will do thc work and the struduc is not <br />iilcndcd or olTcred for sle (Se.7tN4. Business and Prcfessions Codc: Thc Conu aclor's Liccnsc Law docs nol apply to an owncr of <br />thcpl)lrrly whobuildsorinprovestherfrr!drjwlmdessuchworkhimelforltrsel[orthnrughhisorherowneorpk)yees, <br />providcd lhat such improvcrrcnts dc frx intcndcd or ollcrcd for sale. Il, however tlE building or itr{rrovemnt is sold within onc ycr <br />ofconpletb[ tlf, Owrer Buikhr will lrvc thc burdcn ofprcvir8 that lt or shc did fril buill or ifipmv. thc pmpetry for thc purpoE of <br />ele). <br />_1. &\ owncr of the prcpcny, am cxclusivcly conuactinS wi(h licen$d .ontr&tos to consttucl th. prcixt (Sc. ?044. Busircs <br />anl Pnrfesim Code: The Contrdctor's Liccuse law das not apply !o m owrcr of lfolEdy who builds or improvcs lhercorL <br />and who conuacts for such projccts with a Contrelo(s) liceNd pursuul to thd Conusdor's Licc6e kw). <br />-l <br />am exempt utrder Section , B. & P.C. tbr (lis rcason. <br />lhte:- <br />lvoRKt]Rs' c0MPENSA't r()N <br />DECLARATION <br />I hcrchy allirilr undcr pcnalty of pcljury onc ol llN ti'lk)wing dccluations: <br />_lhaveurdwillnuintairaCt(ilicateofCoDsentbSelf:lnsure forworkers'corlllEnsalion.as prcvidedforbySection3T00oftlE <br />lntx]r Code, tor {hc pcrlorilEncc of lhc trork f(rr which thc pcrnlil is issucd. <br />_l havc and will maintain workc6' conrpensali()n insumlcc, as rcquircd by Selion 3?00 of lhc tibor Codc, for lhc pcrfomln."-c of <br />tlrc work for wlich this Frnrit i3 issucd- My workcrs' conrlrcnsation imuruce coicr urd lnlicy nunrhcr ue: <br />V)a <br />Policy <br />- w<A o g _oL a l0- s -ZaLo <br />_l ccnily lhat irr thc lrcrfin'nlancc ol thc work for which this pcrnril is issucd, I shall n(tr cn{loy any lrcrson ir any nranncr <br />so as to bccolrc subjcct to thc workcrs' compcnsation lnws ofCalifomia. and agrcc thal if I should bccorrc subjcct (o thc <br />workers' conrlrensation provisions of Sectior 3?00 of lhe Lobor Code, I slull, fonhwith coDlply with thos provision!.. <br />WARNING: Failure to secura workcrs' conrpcnsalion unlawful, and shall subjcct an cmploycr to sitninsl pcnaftics dd <br />civil liDcs up to one hurdred thousaud dollars (to lhe of cdnpe,Lsatidr. danrages as provid.d li)r lhe <br />Scclion 3076 o[thc litor Cfllc. inte'rcst and <br />Dere:r a'L1 -L0 <br />I hcrcby affrtu under Fnalty of pcrjury that I anr licensd unrlcr prcvision ofChuptcr 9 (connEncins with Scctbn 7000) of Dilisior!l <br />of lhe Busincss and Pm[cssions Codc. ad rnv lic€nrc is in full fore und e[[ect. <br />Liccose a lrt <br />o <br />I)e1e; <br />"- <br />-L1 7o <br />W <br />I hcrcby allirm undcr pcnahyofperju.y that lhcrc ir a conslruclion hnding agcmy for thc pcr,brmarce ofthe work lbr which this Frmit is <br />issued (Scc. 3097. Civ. C.). <br />kndcr's Nanre: <br />kndcr's Address: <br />@LPEELASA'I.!AN <br />I llTchyafliro under pcnalty of pcrjury onc oIthc folk)win8 dcchations: <br />Dcnxrlition Pcrnrils-Ash+sk)s Notificatk'n Ftdcral RcSulalions (Titlc 40, Pd6) <br />_Rcquircd tJtlu of NNificrtion <br />_l ccaili thd lhc <br />{ ccnili rhar 1 lrauc <br />fcdcral rcgulations rcguding dsbcstos rcmoval ec not applicablc to this projcct. <br />rcud tlris application lhal lhc atx)vc is corccL l agre b conply wilh all City and County <br />ordiomccs ud Slatc liws rclating to and rcprcsntativcs ofthis City and County to cntcr upon $c <br />aboyc !rcntioncd pmpc(y for inspcction <br />Applicant or ASmt <br />clq <br />Dil..2-27-zo <br />t q z9/.^