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ELECTRICAL.INSPECTOR RECOR D <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light 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 />Bondinq I Groundinq I UFER l7 'k) <br />Transformers <br />Torqueing I <br />Sub-Panels <br />Air Conditioners I <br />Roof Top Equipment l'1.7 '1r0 Dk*g I <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough)I <br />lVleter Release l1- <br />tt <br />Rough <br />Service l/eter Ir <br />FINAL \?o 7t)I <br />Notes, Remarks, Etc.rl <br />(/ <br />I <br />OWN IiR B[,lII,DI'R T)E,I,CA RATTON <br />I hercby afhrnr untler penalty of prjury that I arn exenlpt fnrm the Cbntractoni'License Law for the frrllowing reav)n (Sbc.7031.5 <br />Busincss and Prolbssion Codc): Any City or County which rcquircs a pcrrnit to construct, altcr. irnprove. dcrnolish or rcpair any <br />structure, prior to its issualrce. also requires tlre applicarrt lirr such penrilt to lile a signed slatenrcnl that he or she is licerrsed pursuanl <br />to thc provisions ol'the'Contractor's l.iccnscd law (Chaptcr 9. Commencing with Scction 7000 of l)ivision 3 ol'thc Busincss and <br />Prol'essiorrs Corle) or that lrc or slre is exen4rt tlrcrefronr and the basis for tlre alleged exentption. Any violation of Section T03 l .5 hy arry <br />applicant for u Jrnnit subjects the applicant to il civil penaltyof not rnore than five hundred dollars ($5(ru). <br />_1. as owncr ol'llr propc(v. or rny crnployccs with wages as thcir srtc colnpcnsation, willdo lhc work arxl thc structurc is rxrt <br />interxled or offeretl for sale (Sec.7(1t4. Business and Prufession.s Ctxle: The Conlraclor's License Law docs not apply to an owner of <br />tlrc pn)perty wlxr builds or in4rroves llrrurrr, and wlxr dtrs such work hinself or lrerself or through his or her owtt entployees, <br />providcd that such irnprovt'rncnts arc n)t intcxled or ollcrcd l'or salc. ll. hou cvcr. thc building or inprovcment is sold within one ycar <br />o[conrpletkrn, tlre Owrrcr Builder will have tlre burdcn of pruvirrg that lrc or she did not build or inpnrve thc pruprty for the purpose of <br />sale). <br />_1. as owner o[ the property, am exclusively contracting with liccnscd contraclors to construct tlre pruject (Sec. 7Ot4. Business <br />arxl hotbssitxr Code: The Contractor's License Law does not apply to an owner of proJrc(y who builds or inrproves thereou. <br />and who contt'acls l'or such pro.ic'cts with a C()ntractor(s) liccnscd pursuant to thc Contraclor's Liccnsc taw). <br />-Iantexenlptuttder.Sectitltt-.B.&P.C.lbrtltisreastltt.Date: <br />WO RK I,IIS' COTVI PFNSATION <br />DECLARATION <br />I hcreby affirnr undcr pcnalty of pcrjury onc of thc tirlkrwing <lcclarations: <br />_llravearxlwill nuinlafuraCertilicaleofCorrserrttoSelt-lnsureforworkers'conpensation,as pnrvidedfirrbySectionST00ofthe <br />Latnr Cocle, frrr thc Jrcrlrrrrrrancc of thc work lirr which tlrc pcrmit is issucd. <br />k have <br />wrlrk <br />andwill rnaintailrworkers'cornpensalioninsurarrce,as ret;uiredhySection3T0OoftheLaborCode,forllrclrerfrrrttuurceof <br />lirr whiclr this 1^-rrnit is issuctl.My workcrs' c()rnlrcnsatioryilsurartcc can'icr auxl lxrlicy nunttx'r iu'c:C--rt' /'rnJCanier:9tdu <br />l'olicy /2.ry-?l <br />_l ct'rtily that irr tlrc lrrlornurrcc of thc work frrr which this Jrcrnrit is issucd, I slrall not cnqrloy any lrcrson in any manncr <br />.so a.stobccorncsubjccttothcworke.rs'conlpcnsationlawsofCalifornia.andagrecthatiflshouldbccorncsubjecttothc <br />workers' corupensation pmvision.s of Section 3700 of the Labor Code, I shall. forthwith cornply with tlrose provisions.. <br />WARNING: Firilure to secure workers' compensation covemge is unlawful, and shall subject an employer to c'riminal penaltics tnd <br />civil firrcs up lo one lrundred thousand dollars ($100.000t. in to tlrc cost <br />n <br />of danuges as provided lor llre <br />.Sc'ction 3076 of thc l,alxrr Crxlc, inlr'rcst and attornc'y's l'cr's. <br />o^r,, l(, ?4 . 2d <br />l)l;(:l,AItA'l'l( )N <br />I hercby affirnr under pnalty of prjury tlrat I anr licensed under provision of Chapter 9 (corrunencing with Section 7000) of Division 3 <br />of the Business and Pmlessions Code. antl rny license is in full frrrce and effect. <br />License -ld Nunrber:/azdVG / <br />o*", ll. Z4 -Za <br />CONSTRUCTTON LENDING AGENCY <br />I hcreby al'lirm undcr pcnalty of pcrjury that therc is a construction lending agerrcy for the performancc of thc work for which this permit is <br />issued (Sec. 3097. Civ. C.). <br />Lender's Nanre: <br />Lender's Address: <br />APPI,ICANT DECI,A RATION <br />I lrrrhy affrrn untlcr p-nalty of pcrjury one ol'thc folkrwing dcclarations: <br />Dcnxrlit ion Pcrnrits-Asht'slos Notification Fctlcral Rcgu lat ions (Title 40, Part6) <br />Rcouircd [.cttcr of Notif,rcatkrn <br />6r..n,r, that thc l'cdcral rcgulations rcgarding asbcstos rcrnoval iue not applicablc to this projcct. <br />iurl statc tlrat thc ahrvc inlbrnntion is corrcct. I agrec to conrply with all City antl County <br />construction. arxl hcrcby authrrizc rcprescntativcs of this City and County to cntcr upon thc <br />ahrve rnentiorred property for <br />Applicant or Agent <br />IDcrnritcc nanrc <br />purJDses. <br />o*", / /. 741 d <br />I <br />U <br />I lrirvc rcatl this <br />and Statc Laws rclating