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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS Owner-Bui lder Declaration a <br />Law for the following rcason (scc.703 1.5 BusinessI hercby affirm under pcnalty of perjury that I am excmpt form the Contractors' License <br />!d prcfc$ion Co&): Any Ciry or CMry which rcquiro r pm[ ro @trrrucq dt6, improvc, dcmlilh or rcprL my rmctuc, prior to ht <br />istuucg rlrc rcquircr thJ rpplimt for uch pcmir !o filc r lfrcd lutcmcnt thr hc or th ir liccn*d puruut to tlr prcvirios of thc <br />Conrrcror'r Lien:cd Ltw (Cheps 9, Cornnqrcing wirh Serion ?o00 ofDivilion , ofthc Butincs ud Profclsioro Codc) or rhrt hc or <br />th. b dcmpt rbssfrom ud thc bsir br tbc rllcgcd *cmption .Any viol.don of Scctiotr 703 I . 5 by my rpplicrnl for r pmit lubjcs! rhc <br />rpplicmt o r civil pcndty of not mrc thrn f,vc hundrcd dollu (t500). <br />_I, u oms of th€ prcpcny, or my cmploye! with wrgc! r! thcir rclc smpcniliot! will do thc work ud thc rnaw ir not inrcndcd <br />6iifcrcd for ulc ( Si.Zo44, Susini[ rid Frofcrrionr Codc: Thc Coilre'tor'! Lienp Lsw doc! not rpply to e omlr ofthc prcpcrty <br />who buildt or improv6 rh66q ud who dog mh work himrclf or hadf or through hir or hcr om cmployes, prcvidcd rhet ruch <br />improvcmcntt & not imcndcd or offcrcd for ulc. tf, howcvs, thc building or imprcvcmcnr ir rcld within onc ycu of@mpldioq thc <br />Omd-Buildcr will hrw tho budcn ofprcving 0[t hc or lhc not build or improvc for thc purpore of$lc). <br />_I, I om.r of thc propsty, u qclusivcly coilrscing with liccrocd otrtnctotr !o @ofiruct thr prcjet ( Sc 7044, Budncts ud <br />Prcfcsioo Codc; Thc Conmaor'r Lienrc Lrw dct trot rpply to m ovmcr of propaty who builds or improvcs thcrcon , ud who <br />oilrrctt for och prcjcts with r Contn6or(t) licancd prot to thc Cootncor't Liccnr Lsw.). <br />_I anr exempt under Section for this re8.son. <br />Date: Owner: <br />I hercby affrrm under penElty of perjury onc <br />_I hrvc md will mriDbin r Ccnifiqt! of Corent o Sclf-Iwc for sIkfl' ompcurlioq u providcd for by Scaion 3700 of thc <br />Lrbor Codc, for thc pcrfomm of thc worh for which thc pcmit ir irucd. <br />_I hrve and will maintrin worker!' compcn$tion insurance, t! <br />work for which this permit ic issued. My workcrs' compcnsation <br />rcquird by Scction 3700 of thc Labor Code, for the perfbrmtncc of the <br />insurance cErricr and policy numbcr are: <br />Policy <br />(This section not bc completcd if the permit is for One hundred dollur ($100) or less) <br />I certify that in the pcrformancc of the work for which this permit is issued, I shall not employ any person in any manncr so Es to <br />became subjcct to the workcrs ' compcnsrtion laws of California, and agrec that if I should become subjcct to the workers' <br />compcnsstion provisions of Section 3700 of the Labor Code,fonhwith comply with those provisions.. <br />WARNING: Failure to rccurc workert' compensation <br />fines up to one hundred thousrnd dollars ($100,000),in <br />the Labor Code, interest and Enorncy's fees. <br />covcrEge is and shall ur cmployer to criminal pcnalties and civil <br />addition to the cost damagcs as provided for the Section 3076 of <br />LICENSED CONTRAC'TONS DECI./IRATION <br />I hscby sfiirm unds pcnrlty of pcrjury thril m liccrcd undcr prcvirion of Chrptcr 9 (omcncing with Sccrion 7000) of Division 3 of <br />dr Businor md Profasioro Codc, rad my liccn:c is in full forcc ud cffct. <br />Liccnse <br />Date: <br />License Number <br />l^a-o.-aaa' <br />@ <br />I hcrcby aftirm unda pcnrlry of pqjury rhrt thcrc ir r co ruction lcnding rScncy for lhc pcrfomcc of thc work for which $is pcrmit ir <br />issued (Sec. 3097, Civ, C.). <br />Lender's Name: <br />APPLICANT' S DECI.ARATTON <br />Demolition Permits-Asbestos Notification Fedcral Regulations (Title 40, Pan 6) <br />_ Roquired Lettcr of Notificetion <br />_I certi$ that thc fcderal regulations rcguding asbestos rcmoval Erc not apPlictblc to this projcct. <br />_ I ceni$ that I havc rcad thit epplicrtion and Jtstc that thc above informrtion ic correci. I agrec to comply with all City and County <br />ordinances End State Laws representEtives of this City and County to cnter uPon the <br />above mentioncd property for <br />Applicant or agcnt <br />Permittce name (print): <br />constructior\ and <br />1 <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding I UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release E\'EIIE )EFI <br />Ei7 la ra <br />Rough nFn t0 'nv.\l <br />Service Meter <br />FINAL SAMU U-4C, Zt v, cDti, oo /etl <br />Notes,Etc. <br />t <br />l--