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ELECTRICAL.INSPECTO R R ECOR D <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 Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding I Grounding I UFER <br />Transformers ( <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factorv Wired Unit <br />Walls (Conduit)I <br />lt-l TL|U >rrff6 7Walls (Roush) <br />Ceilings (Hard & Soffit Rouqh I <br />Ceilings (T-Bar Rouqh) <br />N/eter Release <br />Rouqh <br />Service [/eter I I <br />JZI l,ilA I7FINAL <br />Notes, Remarks, Etc./t <br />\ <br />/ <br />I hereby affirnr under penalty of perjury that I am exenrpt frorn the Contractos' License [-aw for the following, reason (Sec.7031.5 <br />Business and Prolbssion Codc): Any City or County which requircs a permit to construct, alter, irnprove, dcmolish or repair any <br />structure, prior to its issuance. also requires tlre applicant for such pernrit to file a signed staternent that lre or slte is licerrscd pursuant <br />to thc provisions of thc Contractor's Licenscd l-aw (Chapter 9, Commcncing with Section 7fi)0 of Division 3 of the Business and <br />Professions Code) or that he or slre is exempt therefronr and tlre basis for the alleged exenption. Any violation of Section 703 t.5 by any <br />applicant for u pennit subjects the applicant to a civil penalty of not more than five hundred dollars ($stttl). <br />_1. as owncr ol'thc propcrty. or my crnployces with wages as thcir sole compensation, will do thc work and the structure is not <br />interxlctl or offered for sale (Sec.7@4. Business and hofcssions Code: The Contractor's Liccnsc Law does not apply to an owncr of <br />the property wlro builds or impnrves thereon, and who does such work himself or lrcrself or through his or lrer own employees, <br />providcd that such improvcrncnts arc not intcndcd or olTcrcd for sah. Il. howevct the building or improvenrcnt is sold within onc year <br />of comphtior\ the OwrEr Buikler will have the burden of proving tlru he or she tlid not buikl or inrpmve thc property ftrr thc purposc of <br />sale). <br />_1. as owner of the propeny, am exclusively contracting with licensed contractoni to construct thc project (Sec. 7044, Business <br />and Pmtbssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. <br />and who contract.s for such projccts with a Contractor(s) licensed pursuant to the Contractor's Licensc kw). <br />_l anr exempt under B. & P.C. ltrr this reasorl. <br />Date: <br />WORKERS' COM PI..N SATTON <br />DECLARATION <br />I hereby aftirm under penalty of perjury one of thc following declarations: <br />' I have and will nrainlain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Scction 3700 of the <br />Codc, for the Srcrforrnancc of thc work lirr which tlrc pcnnit is issucd. <br />thc <br />have and will nraintain workers' conrpensation insurarrce, as required by Seclion 3700 of thc [:bor Code, for the perfornnnce of <br />work for which this prmit is issucd. My workcrs' compensation insurancc carrier and grulicy nurnber are: <br />v-) <br />/"o- t{o zl to/t <br />_l ccrlify lhat in thc lrcrfornuncc o[thc work for which this pcrmit is issucd, I shall not cnlploy any t)crson in any mannct <br />so as to bccornc subjcct to thc workcrs' conrpcrrsation laws of California. and agrcc that if I should bccolnc subject to the <br />worliers' conrlrcnsation provisions of Section 3700 of the Labor Cotle, I slull, forrhwith conply with those provisiolts.. <br />WARNTNG: Failure to secure workers' compcnsation coverage is unlawful, and shall subjcct an employer to crirninal pcnaltias and <br />civil fines up to one hundred thousarrd dollars ($100.000). in addition to tlte cost of compensation, danuges as provided for lhe <br />Scction 3076 of thc Codc, intcrcst and attorney's [ecs. <br />nrr.rtr.rrrrft <br />I hercby affrrn under penalty of perjury that <br />of the Business and Professions Code. arvj <br />LICENSED CONTRACTOR <br />DECLAITATION <br />I anr licensed under provision of Chupter 9 (conrmencing with Secti<rn 7000) of Division 3 <br />my license is in full force arxJ effect. <br />Number:7Ll{ tt 7 <br />v <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby affirrn undcr pcnalty of perjury that thcrc is a construction lending agency for thc pcrformancc of thc work for which this pcrmit is <br />issuetl (Sec. 3097, Civ. C.). <br />lcnder's Name: <br />APPI,ICANT DECI,ARATION <br />I hcreby affirnr under pcnalty of pcrjury onc of thc following declarations: <br />Demolition Pcrnrits-Astrcstos Notification Fcdcral Regulations (Title 40, Part6) <br />_Rcquircd lrttcr of Notification <br />_l certily that thc I'cdcral rcgulations rcgarding esbcstos rcrnoval are not applicablc to this projcct. <br />with all City antl County <br />and County to c:nlcr uF)n thc <br />above rncntioned propcrty <br />or Agent <br />I'crnritec namc <br />o*",F t;4o <br />08-07-2015 <br />W {-rrnlronlrrr'