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ELECTRIGAL.I NSPECTOR RECORD <br />f).'.t f'lc ,'t-2 lfi"t,:t <br />APPROVALS DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION <br />I h6cby affum unda pcnalty of pajury thar I m cxcmpt from thc ContrscloB' Liccnrc kw for thc following rmn (Sc.7031.5 <br />Bwine and Prcfeion Codc): Any City or County which rcquim a pornh to construct. slt6. imprcvc, &mlish or rcpair uy <br />structuq prbr to its iswcc. also rcquiB thc applicet for such pqrdt to fil€ a signcd ststmmt tha hc or shc b licarcd pwmt <br />to thc provisiom of thc Contractor'! Lienscd Lrw (Chapta 9. Commcing with Sction 7000 of Division 3 of the Busin$ md <br />PrcfsioroCodc)orthathcorshcbqcmptth@fromedthcbosisforthcallegcdcr@p(ion. AnyvioldiooofS€lbr703l.5bymy <br />appliciltforapcntritsubjetsthc applicuttoacivilpcraltyofnotmrcthefivchundrcddollus($500). <br />_1. s ome of thc Fopcny. or my cmplo)6 with wag6I thcir mlc comFrution. will do tlrc work ed thc gnrlrc b rct <br />intodod or olfscd for slc (Sc.7044. BEitrs md Profcssiore Codc: Thc Contrsctor's LiccB Law do6 not apply to 4 omq of <br />thcpropqty whobuildsorimpovstho@n,ildwhodoBschwrthimsclforhcrclforthrcughhisorhaomcmploye. <br />providcd that such imFovffits rc rct intad.d or oIftred for slc. tf. howffi, thc buiHing or imFoffit is sld wthin one yw <br />of complction. thc Ownq Builds will havc thc fudo of Foving thd hc or shc did not buiH or imprcw thc Fopdly for thc purpos of <br />slc). <br />_1. I oM6 of the prepaty, m cxclusivcly contmcting with licqNcd contractoB to conslruct thc prejer (Se. 7044, Buins <br />ud Proftssion Code: The Conlrsclor's Liccrc Law do6 not apply to e ownq ofprcpcrty who builds or imprcvs th6@r, <br />md who contncts for swh prcjccls with a Contracto(s) licoscd pmuant to thc Contraclor's Liccre Law). <br />-[ <br />m cxcmpt undq Sction-. B. & P.C. forthis rcen- <br />I)olo' <br />WORKERS' CONTPENSATION <br />DECLARATION <br />I hereby affrnn under penalty of po'jury one of thc ficllorving declarations: <br />_l have and rvill maintain a Certilicate of Consent to Self-lnsure for workers' conlpensalion, as provided for by Section 3700 of the <br />I-abor Code. for the poformance of the work for which the permit is issued. <br />-l <br />have and u'ill maintain workers' compensation insurance. as required by Section -1700 of the labor Code. for the performance of <br />the work for which this pennit is issued. My workers' compensalion insurance carier and policy number are: <br />Policy Number: Expires: <br />a <br />-l <br />ccnifythat in the pqfomecc of thc work for which this pmit is issued, I shall not mploy any pqson in any ma <br />s a to beomc subjet to thc wo*6' composation laws of Califomia, ed agrc that if I should b€comc aubjst to thc <br />wo*s' compffition prcvisioro of Scaion 3700 of the l^abor Codq I stull, forthwith omply with thos prcvisioB.. <br />WARNINC: Failurc to sw workm' compcnsation cov@ge is unlawful. ud shall subjet m oployo to qimiml pqnltie ed <br />civil fmes up to onc hundrcd thosd dollm ($100.000), in addition to the cost of compcMtion, damage r provided for thc <br />Sation 3076 of thc l6bor Codc itrt66t and anorney's fe. <br />I)o to. <br />LTCENSED CONTITACTOR <br />DECI.ARATION <br />I hereby affirm under penalty of pcrjury that I am liccnsd under provision of Chapter 9 (commencing with Ser-tion 7000) of Division 3 <br />of the Business and Professions Code. and my licerse is in full force and effect. <br />License Class: License Number: <br />fl.rto. <br />W <br />I hreby alfum undr pcmlty of psjury thar thqc is a construclion loding agocy for thc pofomcc of thc rcrk for which this pcmit b <br />issued (Se. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPLICAI\T DECLARATION <br />I hereb}, affirm undcr penalty of perjury onc of thc following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Tille 40, Part6) <br />-Required <br />Later of Notification <br />-l <br />certify that the federalrcgulations rcgarding asbe$os removal are not applicable to this projed. <br />_l cerri& that I have read this application and state that the above information is correct. I agre to comply rvith all City and County <br />and County to entef, upon theordinances and State laws relating to building authorize representatives of this City <br />,. Pernritee <br />for inspection <br />construclion. <br />?-.-- <br />l <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Poo!, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire AIarm lDampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilings (Hard & Soffit Roush <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release EXPIT lFn <br />Rough nFc tll ztn <br />Service Meter .-1 <br />F!NAL ,AMU A1C, Zt o, 506, 067 =NW{Notes, Remarks, Etc.(./u V <br />\ <br />Carricr: <br />{