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ELECTRICAL-I NSPECTOR RECOR D APPROVALS DATE ID/S!G.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Poo!, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor -t \ Bondinq I Groundinq / UFER tl'il la,l Dtrn /y2-qffi Transformers I Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouoh Ceilinqs [-Bar Rouoh)I N/eter Release It ?4lz))tyv9,-/ I / Rough I .l ,- Service N/eter I /l2t 120 n-a-Y/ FINAL l>t*d C/ Notes, Remarks, Etc./I -' \--I! I hereby affirnr under penalty of perjury that I arn exenrpt fronr the Cbntractors' License law for the following rcax)n (Sec.7031.5 Busincss and Prol'ession Code): Any City or County which rcquires a pcrrnit to construct, altcr, irnprove, dcmolish or rcpair any structure, prior to its issuance. also requires the applicarl for such pcrnrit to file a signed slatemenl that lr or she is licenscd pursuanl to thc provisions of thc Contractor's l-icensed law (Chaptcr 9. Commencing with Section 7fi)0 of Division 3 ol'the Business and Professions Code) or that lrc or she is exenryt therefrom and tlre basis for the alleged exenrption. Any violation of Section 7031 .5 by arty applicant for a pennit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). _1, as owncr ol'thc propcrty. or my cmployecs with wages as their sole compcnsation, will do the worft and thc structure is not interxled or offeretl for salc (Sec.7Bn. Business and Profcssions Codc: Thc Contractor's Licensc l-aw docs not apply to an owner of the prcperty who builds or inrproves lhereon, and wlm doe.s such work himself or lrerself or ttrough his or her own employees, providcd that such irnproverrcnts are rnt intendcd orolTcrcd for sah. I[. howevcr, thc building or inprovcnrcnt is sold within onc ]r'ar of completioru the Owner Builder will lrave the burden of proving that lrc or she did not build or improve the property for thc purpose of sale). _1, as owner of the properly, anr exclusively contracting with licensetl conlractoni to construct thc project (Sec. 7044, Business arx, htrfrlssbn Code: The Contractor's License Law does not apply to an owner of property who builds or improves there<ln. and who contracts lor such projccts with a Contractor(s) liccnscd pursuant to thc Conuactor's License Law). -IantexemptunderSecti.rtt-,B.&P.C.tbrtltisreas<ln. WORKER.S' COM Ptr]NSATION DECLARATION I hereby affirm under pcnalty of pcrjury onc of the tbllowing declarations: _l have alxt will nuintain a Certificate of Consent to Sclt'-lnsure for workers' con4rensation, as provided for by Section 3700 of the Labor Code, for the pcrfonnancc of thc work for which thc pernrit is issued. ! nur. and will nraintain workers'conpensation insurance, as required by Seclicln 3700 of the Labor Codc, for the perfonnance of I thc work for which this pernrit is issucd. My workers' compcnsation insurance carrier ard policy number are: I ??*6t fr,Cn ?o-r.rr€C!r,rr..raL \xrS. Policy o _l ccnity tlut in thc lrcrtbrnuncc of thc work for which this pcrnrit is issucd, I slull not enrploy any pcrson in any manncr so as to bccomc subjcct to thc workers'compensation laws of California. and agrec that if I should become subject to thc workers' conrlrnsation provision.s of Section 3700 of the Labor C'ode, I slrall, f<lrthwith comply with those pnrvisions.. WARNING: Failure to secure workers' compensation coverdgc is unlawful, and shall subjcct an employer to criminal pcnahies and danuges as provided f<lr lhe - to[soffou> civil firrcs up to orrc hundred tltousand dollars ($100.fit0t. Scction 3076 of thc Lalxrr Codc, intcrcst and atlorrrcy's fccs. in addition to the ,",., - t?\r4t?,OAo I hereby affirnr under pnalty of perjury that I anr licensetl of the Business and Prolessions Cotle. ard mv license is in full forcc and effect. 9 (comnrencing with Section 7000) of Division 3 a a License Nunrber:,1 CONSTRUCTION LENDING AGENCY I hereby allirm under pcnalty of pcrjury that thcrc is a construction lcnding aBcncy for thc perl'ormance of the work lbr which this pcrrnit is issued (Sec. 3097. Civ. C.). Usz rt lrnder's Name; I*nder's Address: APPLICANT DECLARATION I hrcby affirnr undcr pnalty of pcrjury onc of thc folkrwing dcclarations: Dcnnlition Pcrnrits-Asbcstos Notification Fcdcral Rcgulations (Tille 40. Pan6) _Rcqu irccl [.cttcr of Not ifrcat krn _l ccrtily that thc fcdcral rcgulations rcgarding asbcstos above rnentioned property for inspection purynscs. Applicant or Agent I'crnritcc nanrc rernoval are not applicablc to this pmjcct. ahlve infornration is corrcct. I agrcc to conrply with all City and County hcrchy authorizc reprcscntativcs of this Cily and entcr uJxrn tlrc a ?4) 08-07-201 5 I IttlLtlt*s wt