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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DET,CARATION <br />I hseby affm undq poalty of pqjury thal I m qcmpt ftom thc Con|rrctoB' Lic@ Law for thc following rcen (Se.7031.5 <br />Busine ad hofeion Codc): Any City or Counry which rcquirc a pcmh to anstruc{, alts, improvc. danolish or rcpair uy <br />structuc. lrior to its issuucc. also rtquirc thc applicmt for such Fmit to file a signcd stalmmt thd hc or slrc b licanscd pwant <br />to thc provisioN of the Contr&tor's Liccnscd Law (Chspts 9, Comcncing with Sation 7000 of Division 3 of thc Bwin* ud <br />Profeions Code) or that he or shc is cxmpt thftfrom md thc basis for thc all€gad cxmption. Any violation of Setion 7031.5 by sy <br />applicmt for a pmit subjCts thc applicet to a civil pemlty of not morc thm fivc hundrtd dollm ($500). <br />_1. re omq of thc propcrty, or my mployc with wag6 I thcir sle compeGalion. will do thc rcrl. ed thc stnElE is noi <br />intodcd or offscd ftrr slc (Se.?044, Buins od Profasiom Codc: The Contractor's Licce Lsw do6 not ap?ly to m oma of <br />thc 1xopqty who buil& or improve th@n, dd who do6 $ch wrt himelf or hclf or thrcugh his or ha om mploye. <br />providcd thar such imprpmts rc rct intqrdcd or ollircd for slc. lf, howdq. thc building or irprovqMil is sH withitr ooc )€, <br />of complrio4 thc olrns Bsildr will harc th€ huda of prcving tha hc or she dil mt build o. inprorc the propqty for thc prupo*of <br />sh). <br />lr(ZI, c ome of the popaty. m cxcluivcly contructing with licos€d contncloE to construct thc fojet (S*. 7044. Bwins <br />urd Plroftsion Codc: Thc Contretor's Licmse Law do6 not apply to e omq of propcfiy who builds or imprcv6 thq@n, <br />md who contmcts for such pmjets with a Contmcto(s) licoscd puE@t to the Contraclor's Licre L8w). <br />-l <br />am exempt under Section-, B. & P.C.?q .>o <br />I hereby affrm under pmalty of perjury one of the following <br />_l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the <br />Labor Code, for the performance of the work for which the perrnit is issued. <br />_l have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of <br />the work for which this pennit is issued. My workers' compensation insurance crurier and policy number are: <br />Policy Number: Expires: <br />tl=t certiry that in the perfonnance of the work for which this permit is issued, I shall not cmploy any person in any manner <br />so as to become subject to the workers'compensation laws of California, and agree that if I should bccome subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with thosc provisions.. <br />WARNING: Failure to secure workers' <br />civil fines up to one hundred thousand <br />Se<tion 3076 of the Labor Code. interest <br />compensation coverage <br />I dollars ($100.000). in <br />and attorney's fecs. <br />is unlawful. and shall subject an employer to crirninal penalties and <br />addition to the cost compensation. damages as provided for thc <br />a >t) <br />I <br />I hcreby affrm undcr penalty of perjury that I am licenscd 9 (commencing with Section 7000) of Division 3 <br />of the Business and Profcssions Code. and my licensc is in full force and effect. <br />5 <br />License Class: License Number: <br />Contractori <br />CONSTRUCTION LEIIDING AGENCY <br />I h@by affm und6 pcralty of pcjury tha the is s constructbn knding agocy for thc pqfommcc of thc rcrk for which this pqmil b <br />issucd (Sa. 3097, Civ. C.). <br />[tnd6's Nmc: <br />Lender's Address: <br />r hq"b,yaffnn und6 pcnalty of pcrjury onc of *" ffin**"u*^*f* <br />Dcmolilion Pmits-Asbctos Notificarion Fcdml RcgulatioN (Titlc 40, Pan6) <br />-Rcquircd <br />lrtt6 of Notificalion <br />-l <br />cdiry that lhc fcd6d rcgulatiou regarding rbetos rmoval rc not eplic8blc to this prcjer. <br />[Cl cqri& that I have red this application md statc thal thc abovc infomatiotr is corcr. I agrc to comply with all City md County <br />ordimncG ed Statc kws rclating to building coNtruclio[ dd hcrcby suthorirc rcFMtalivc of this City md County to mtE upon thc <br />abovc mqtiotrcd prcpsty for impction purBpr;s- f);;;;;;;;;;;;;n*,"*,izu %4,.," . Q lH fzo <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltase <br />Fire Alarm lDampers <br />Communications Cable <br />Buildins <br />Under SIab / Floor ( <br />Bondins I Groundinq / UFER tow L>rffiiW ,a <br />Transformers Jr <br />Torqueincl <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinss (Hard & Soffit Roush <br />Ceilinqs ff-Bar Rouoh) <br />Meter Release <br />Rouqh I <br />Service Meter ii tolA,lvkrttM)N r( <br />FINAL lu 0ta)l)hovkDs ,g <br />Notes, Remarks, Etc. <br />Rev. 08-07-2015 <br />Carrier:- <br />Permiteenametprintl, K LU, a Ca-p. PaS