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ELECTRICAL.!NSPECTOR RECORD <br />Rev.08-07-2015 <br />DATE ID/SIG COMMENTSAPPROVALS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />ft/eter Release <br />Rough <br />//Service [Vleter 7//FINAL 4//t /?1 / "1&. t,.Notes, Remarks, Etc// ' '/ <br />OWNF]R BUII,DER TTLCARATION <br />I hecby affrnl undcr pcnaly of Friury thal I er cxenrpl frum th€ ContractoB Liccnsc llw for thc following rcapn (Sqc.70ll.5 <br />Busincss and Profcssion Cixlc): Any City or County which rcquires a pcrmit lo construct, altq, irnprovc, dcmlish or rclair ily <br />structurc, prior b its issuancc. also rcquircs the applicanl for such pcmit b filc I signed slalamnl lhal ha or shc is licctrsd pusmt <br />to thc pmvisions of thc Contractor's l.iccnscd l,aw (Chapter 9. Comrncncing with Scction 7000 of Division 3 of thc Busincss and <br />Professionr Code) or that lt or she is exempt thnefionr and llE bsis for tlE alle8ed exenption. fuiy violatioo ofsection 7031.5 by any <br />applicant for u pcnnit subjecls the rpplicxnt to a civil pcnalty of not mrc than llv. hundrcd dollars ($500). <br />_1, as ouncr ol'the profr(y. or my cmplolccs with wagcs as thcir $lc com;rcnsaion, willdo the work and thc stMuc is mt <br />iilenlcd or offered for salc (Sec.7Ol4. Busirrcss nnd Prcfcssions Code: Thc Conlmclor's Liccnsc law docs nol apply lo m ownar of <br />the prcpeny wlx, builds or irnprows therdnl dd wlD dGs such work hinrself or lrcrself or through his or her own enployees, <br />providcd thal such improvcrrils trc fln intcndcd or ol'crcd for sh. If, howcvel $c buihinS o, itrprovcmil is sH within onc ycd <br />of conrplclbn. the Owrcr Buil.ler will lurvc ttr burdcn of previn8 thal h€ or shc dirl mt boil.l or improyc the pDpqty for the plrF)rc of <br />$le). <br />_1, as owner ofthe propcrty, am cxclusively coilractinS with licenwd contractors to constlcl tlrc prcject (Scc, 7044. Busincrs <br />and hotlssinCode:TheContractor'sLicetrseLawdoesnotapplytoanownerofpropertywhobuildsorimproveslhereoo. <br />and who conlracls for such projccts wilh a Cootraclor(s) liccnrcd pursuml to thc Contactor's Liccnse llw). <br />-l <br />d erdmpt urxler Scctiotr , B. & P.C. for this reason. <br />l)a1e:- <br />woRKt:Rs' c0Nfl'ENsA'l toN <br />DECLARATION <br />I hercby allirm undcr ofpcrjury onc ol thc tollowif,S dcclsatio6: <br />-l <br />havc n[inlrilaCe(ificateofC{nNenthSell:l[sureforworkers'crrrnpensatiul,as providedforbySection3T00ofthe <br />Latpr lErforiluncc ofthe work lbr which th! perntit is issued. <br />arxl will mainrain workcs' con{ELration insurancc, as rcquircd by Seclion 3700 ofthr tibor Codc, for lhc pcrfomar. of <br />work for which this lErnrit is issued- My workcrs' con[rcnsdion imurmcc cmicr uxl grlicy numbcr uc: <br />Policy t/ Dco '71rL C-z.c <br />_l ccf,ily that in thc |trfolnBNc of tlE work for which this pcrmit is issucd, I shall not cnrploy oy lErson in any manncr <br />so as to bcconr subjccl to thc workcrs' colipcnsation laws ofcalifonlia, and agrce thal if I sfnuu becorc suhjcct lo thc <br />workers' conrpensation provisions of Section l?U) of the Lubor Code, t shall, fonhwith corDply with tho* pruvirioN.. <br />WARNING: Failure to scure workers'compcnsation covcrugc is unlawful, md shall subFct an cmploycr lo Fiminal pcmhics fid <br />civil fircs up to onc huillrcd tk)usmd <br />Section l{)76 ot the trhor Codc, interest <br />Drre: )-L1 -^15 <br />dollars lhc cost of con{ENtio[ dmugcs s provided for lhc <br />I hereby ifltrnr under tretrrhy of perjury that I anl <br />LICENSED CONTRAC'TOR <br />I)DCI,ARATION <br />licen$d uilcr prcvision ofChuplcr 9 (conmEncing with Scction 70OO) ofDivbion 3 <br />of the lJusincss and Prcltssi()ns Coda. ail nry license is in lull force and elfcct. <br />Licensc loo L b,))alo <br />z - ?1. '1) <br />I hercby allirrn undcr pcnalty ofpcrjury that thcre is a construction lcnding agcrcy for thc pcrfonMrcc ofthc work lbr which this pcrmit is <br />issued (S.c. 1097. Ci!. C.). <br />knder's Nanre : <br />kiler's Ad,lres.: <br />I hercby tfl-mlundcr pcoahy of pcrjury <br />APPI,ICAN'T DT]CT,ARA'I]()N <br />tho li)llowing dccluations: <br />Dc nx) lit i()n I'cr ilrits- As hLsl os Irc(ierrl Rcguhlx)os ( l illc 40, I'a'16) <br />_Rcquircd b(cr <br />-I <br />thc Iedcral rcgulations rcgdding &sbcstos rcrmval ilc not applicablc to lhis projcct. <br />tlrar I rcad this applicatiur uxl stlle that with all City and Coutrty <br />ild Counly to entcr upon the <br />2-1 7 --2}abo!e <br />Applican( <br />I'cmri(cc nonrc <br />ftn' <br />lo buildinB