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ELECTRICAL.INSPECTOR RECORD <br />Rev.08-07-2015 <br />APPROVALS DATE !D/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq / 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 />Meter Release <br />Rough ;ilService It/eter <br />Ittrlflutr-ultl'b'iF!NAL .l <br />Notes, Remarks, Etc.a UI <br />OWNI'R BUII,DT]R DI',LCARATION <br />I hcrcby affrnr unrJcr penahy of Friury tha( I anr .iempt frcnr thc ContectoN' Ltensc l:w for thc following Easn (Se.701 1.5 <br />Bu$incss and Prolbssion Codc): Any Ci(y or County which requircs a lErmit lo construc(, altcr. improve. dcmolish or rcparr any <br />slructure, prior b its issusnce. also requires thc appliczut for such Jrmit lo file a sigred slalcmnl lbat IE or sha is licen*d puNuanl <br />to thc pmvisions ol thc Contraclor's l-iccnscd lrw (Chaptcr 9. Commcncing wilh Scclion 7000 qT Division -l o[ the Busincss and <br />Professions Code) or that he or she is cxenlpt therefrom and llE b6is tor tlE alleBed erenption. Any violati,n+{,Seclion 703 | .5 by any <br />npplicantforapennitsubjcctsthc applicanttoacivilpenaltyofnotmrethanllvchundreddollars($500). <br />_1. as owner ol'llr prolrcny. or my crnployccs wilh wagcs as thcir sole cornpcnsation, will do thc work and thc struduc is mt <br />irlcrxlql oroffcrer.l forslc(Se.7(X.1.BusincssandPNfcssioNCqlc:TheConlraclor'sLicansLawd@snotapplylooo*ncrof <br />the |m)[Eny wlx, builds or ir{troves tlErsr! ux.l wlx) dM such wrrk himself or lrr*lf or lhrough his or her own cnrployees, <br />providcd that such improverrcnts uc nrt intcndcd or olfcrcd for slc. Il: howcver. thl buildinS or inprovcmnt is sld within onc )ee <br />ofconrpletion, tlE Owrcr Builder will luvc the burden ofprcviDS that he or she dir.l not build or irprcve the prupefly for rhc purgrsc of <br />yrle). <br />_1, s owner of thc prolEny, am cxclusivcly conlructing with liccnsd conlracloN lo consltucl lhc prcject (56. 7(X4. Busine$ <br />arrl ProlbsionCode:TheContracklr'sLicenseLawd(EsnotapplytoanownerofprolEilywkrbuildsorinrprovcsthercon. <br />and who contracts for such pr(,jccts with a Contrachr(s) liccnsd purswt h thc Conractor's Liccnsc tlw). <br />-l <br />anr urdcr B &PC li,rlhis <br />I hcrchy al'llnn un(lcr pcriury one ofllrc lirlk)win8 <br />_l have nEintairaCtnificateofCorNenlk)Self-lnsuRfor*orkrs'con{rnsation,as prcvidedforbyScclionJT00ofthc <br />[rlx)r thc pcrfofimncc (,f(hc work lor which thc pcrtrlil is ilsucd. <br />atrd will nrririlair workers aonrpensation ilsurance, rs rcquired by Secti(ilr 3700 oflhe Lahor Code, for the perfornunce of <br />tlt work for wlich this grrlit is issucd. My workcrs' conrF:ilsatiur itrsurmcc canicr iuxJ policy <br />l'}oL(y /p-d-?d <br />_l ccflify llut ir thc FrlornHDcc olllrc work for which this Frnril is issucd. I shall not cnploy any person in any nrilner <br />s as to beco,rc sub.)ccl lo thc workcrs' conlpcnsation laws of California. and a8rcc that if I stnuld bccorrc subjcct lo the <br />workcft' conrpensation prolisions of Section 1700 of th€ Labor Code, I shall, fonhwith cornply with tho* provision$.. <br />WARNING: F-a;lurc to *cura workers'compcnsnlion covcraSc is unlawful, {nd slrall subjcct sn cmploy$ lo sinrinal pcnaltis and <br />civil llnes up k) one hutrdrcd thousand dollars in addilion lo llE cost of compcrNtion, dmugcs as providcd for the <br />Seclion r bhor intcrcst and <br />I hcrcby affrtu undcr pcnally uf pcrjury lhat I anr lie[sl undcr pruvision of Chapler 9 (commE-int with Se(irn 7000) of Division 3 <br />of th€ Busincss and Pmfessions Codc. and mv liccns is in full forc und cffcct. <br />Liccnsc Number: <br />I undcr [tnally that thcre is a consttuctil)n lcnding aScmy for thc pcrlbnnarce oflhc work l'or which lhis pcrmil is <br />issued (Sec. 3097. Cir. C.). <br />Lrndet's Naure: <br />[rndcr's Addrcss: <br />APPI,ICANT DECI,ARATION <br />I hrcby affmrundcr pcnalty ofpcrjury onc ofthc following dccl{ationsl <br />Dcnnrlilion Pernriis-As6ustos Notification Fcdcral Rcgulations (Tillc 40, Pd6) <br />_RcquLcd lJttcr of Ndification <br />_l cdify that fcdcral rcgulalions re84dinE asbcstos rclmval uc nol applicablc lo this pmjcc(. <br />rca<l this apllicalirrr anl stillc lhill lhc rlx,vc itrlbrnrali(n is c(xrccl. I agrcc k) conrdy with rll Ciry and Couilty <br />Liws rclalin8 t) <br />abovc <br />Aplrlicant <br />l'crnrilcc <br />ABdt <br />for <br />ofthis Cily md County lo eotcr uF)n thc <br />*,",1/A/?)