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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building I <br />Under Slab / Floor ^l I ,ss2 <br />Bonding / Grounding / UFER 4'tvwfi.4 otxd <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit)I ,>e <br />Walls (Rouqh)(/(11 \A r),Q{t <br />Ceilings (Hard & Soffit Rouqh u o lt !.l'uTlLL<-{v <br />Ceilings (T-Bar Rough), <br />Meter Release !uctta /h,W <br />lt <br />Rough <br />Service Meter II It rl> <br />F!NAL w /tr)qtrI w60 <br />Notqs, ffgmarks, Etc.It i <br />l2_q <br />il ,o',\l\ili(o_PIrJzo Y&- <br />) <br />I hoeby affinn under pflahy of ptrjury that I m exempt frorn the Contractors' License Larv for the follorving rc6on (5(.703 1.5 <br />llusinBs ild Profesion Code): Any City or County which requira a pcnnit to construct. alto, improve, demolish or repair my <br />structue. prior lo its isuoce. also requira the applicant for such pemit to file a signed statonent that he or she is licosed puBuilt <br />to the provisions of lhe Contraclor's Liccnscd Law (Chapts 9. Cornrnencing wilh Sstion 7000 of Division I of thc Busines md <br />Profesions Code) or that he or shc is crempt thqefrom ild the b6is for the alleged ermption. Any violation of Sstion 7011.5 by any <br />applicant for a pmrit subjels the applicant to acivil penaltyofnot morelhil flve hundred dollils ($500). <br />l. G ownq of the proFErty. or my cmployB rvith rvaga r their mle composation. will do lhe wo* md the stnrlm b rcl <br />intmdql or offoed for sle (Se.7044. Busins ed hofsioc Code: The Contraclor's Licsc llw do6 nol apply to e oms of <br />the prefrty who buil& or improve thson. od who doe such sork himself or hqself or through his or ha om employee, <br />provided that such improvmmls dc mt inloded orolloed for sle. lf, howsq. the huilding or impovmt is mH within onc )er <br />ofcomplelion. the C)*ns Buildq will ha\e thc hrdo ofproving thm he or she did not huild or improve thc profEty for the purpos of <br />slc). <br />- <br />l. as o$'oo ofthe fnopdy. an erclusively contracting rvith licosed contractoE lo corelrucl the proj(t (Ss. 7044. B6ins <br />md Profssion Code: 'l hc Conlraclor's License Law do6 not apply lo an olvno of propdy u,ho builds or improvc lhomn. <br />and who contracts for such prejects uith a Contacto(s) licosed puEBnt lo the Conlraclor's License [rw). <br />I dn exempl undq Sslion_. B. & P.C. for this re6on. <br />Dnter Owner: <br />WORKERS' COIlIPENSATTON <br />DECLARATION <br />I hereby aflirm under pmalty of pojury one of the following dslaatio6: <br />lhaveudrvillmaintainaCe(ificateoIConsenttoSelf-lnsureforworkm conrpensalion.[s providedforbySection3T00ofthe <br />Labor ('ode. for thc pofonnance ofthe work for rvhich the pmnit is issued. <br />--IhavcandwillmaintainNorktrs'compensalioninsurance.o requiredbySation1700oftheliborCodc.forthepofomanceof <br />the work for which lhis psmit is issued. My workrs' compemation insurance canis md ;nlicy numbe oe:J S{*{r6trY <br />I z o_-1---r---ruu.uo, --9 7--l 10 <br />I certify lhat in the poforrnance ofthe work for s'hich this permit is issued. I shall not mploy any pereon in any marno <br />s 6lo becomc subjst to the u'orkm' compcrslion larvs of Califomia. and agre that if I should become subj(l lo lhc <br />rvo*ss' compemalion provisions of Smion 3700 of the tabor Code. I shall. forthrvith comply wilh thos prcr'isions.. <br />IVARNINC: Failure to sue lvorkm'compemtion coverage is unla*'ful. and shall subjat m mplo;o to qirninal penahis md <br />civil fins up to onc hundred lhousod dollars ($100.000). in addition to the cost of com;rmtion. dmages m provided for the r <br />ion 1076 ofthe Labor Code. inl66t md attomey's '*EnE/,/' ltlrtlP/e Applicflnl: <br />I,I('F]NSED ('ON'TRA("I'OR <br />l)E( LAti,(ilON <br />hereby allirtn undo pmahy ofpqjury lhal I m licensed under provision ofChapta 9 (commcncing rvith Srction 7000) of Division l <br />of lhc llusinas and l'rofesions Code. md nrv licose is in full force dd effect. <br />( lass:D "" *,4 o.f 9o <br />o^r", /l / 1-/'le rz <br />(.ONS'I'RUC'IION t,I.]NI)INC A(;I.]N('Y <br />I hoeby affrm unde gmalty of perjury that thqe is a construction lmding agmcy for the pafommcc of lhe work for which this pnnit is <br />issucd (Ss. -3097. Civ. C.). <br />Lender's Name: <br />APPLICANT DECLARATION <br />I hetby afEm unds poaky of ptrjury one oflhe following d(laationsl <br />Demolilion Pqmils-AstBlos Nolihcation Federal Regulations (Title 40. Pad6) <br />_Requircd LeIq of Nolificarion <br />_l cqtity thal the federal regulations regtrding cbestos rmoval de not applicablc lo lhis prcjst. <br />- <br />I cqtify lhat I have red this application and slale that the above infomalion is cor(1. I alirc to comply wilh all Cily and Counly <br />ordinancG ild Statc Larvs rclating to building construction. ad hoeby authorize reprBmtaliv6 ofthis City ild Counly to olq upon the <br />n[x)\ e nrcnli()ncd prolrrly for inspeclion <br />or Agrnl <br />nailtt utr ha6 <br />flo n-, 1nl ( <br />I <br />I <br />,' <br />WO <br />r^I <br />\\)(\t@L ( <br />_Expirs: _ <br />/(ontractor: <br />Lender's Addr6s: