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ELECTRICAL-INSPECTOR RECORD <br />Rev.0B-07-2015 <br />APPROVALS DATE ID/SIG COMMENTS <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 />Building <br />Under Slab / Floor b\ <br />?{l/,tt+t-<Bondinq / Grounding / UFER //4lp M a9/ <br />tTransformers <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 Rough <br />Ceilings (T-Bar Rough) <br />Meter Release Vfit{c.o 1 ,rta) <br />Ilt <br />Rough <br />Service [Vleter ela./Pft rr?) <br />W.)*.,l)tjlp -J6>)F!NAL <br />Notes, Remarks, Etc.t UI <br />I <br />owNl)t BUI1,t)t,Il <br />I hoeby affinn unds penalty of po'jury that I m exempt from the Contracton' Licmse law for the following rwn (Sa.7031.5 <br />Busines md Profsion Code): Any City or County which rcquire a pcmit to con$ruct. alto. improve, dmolish or rcpair my <br />structue, prior lo its issuucc. also requirB the applicmt for such pmit to filc a signcd statmot that he or she is licmcd pmuat <br />to the provisiom of the Contractor's Licensed taw (Chaplq I, Commencing with Sstion 7000 of Division 3 of the Buine md <br />Profe$ionsCode)orthatheorsheisexemptthgefromsdthcbasisfortheallegedexmption. AnyviolationofSstionT03l.5byany <br />applicmtforapennitsubj(tsthe applicanttoacivilpcnaltyofnotmorethmlivehun&cddollos($500). <br />_1. 6 owner of the property. or my employm with wages s their sole compruation, will do lhe work md the structue is not <br />intmded or offqed for salc (Ss.7M4, Businas ud Professions Cods The Contractor's Liceree [-aw dos not apply to m ownq of <br />thepropfty whobuildsorirnprovcthqoqmdwhodoesuchworkhirnselforhoselforthroughhisorhoomemployes. <br />provided that such improvonols re not inodel oroffoql for sle. lf. howwq. the building or improvemmt is mld within one yw <br />ofcompletion, the Ownq Buildo will have the bwdo ofprovirrg tha he or she did not build or improvc thc prcpqty for the purpo* of <br />ele). <br />l. I o$rtr of lhe propsty, m exclusively contrauing with licmed contractoE to coGtruct the projd (56. 7044. Bsin6 <br />od ftofesion Code: The Contractor's License Law doe not apply to e owns ofproperty who builds or improvc thsmn. <br />and rvho contmcts for such pro.iets rvith a Contracto(s) licrucd puE@t to thc Contractor's Licosc Law). <br />_l an exempt uod6 Sstion-. B. & P.C. for this r6on. <br />WORKER^S' COMPENSATION <br />DECLARATION <br />I hereby aflirrn under poalty ofpojury one ofthe folkrwing dccluatiom: <br />_l have ad will maintain I Certificale of Commt lo Self-lmure for work6' compcnstion, a provided for by Setion 3700 of the <br />Labor Codc, for thc pqfonnmcc of the work fo. which lhe p6nil is i$ued. <br />have and will rnaintain workm' compemalion insurance. c required by S(tion 3700 of the tabor Code, for the pofoonecc of <br />\vhich this psmit is issued. My rvorkm' compeNtion iEuilce cmia md policy numba ae: <br />l'olicy Z /r/rr <br />_l cedify that in the pcrfonnance of the work fot which this pcrmit is issued, I shall not mploy any peEon in any rnunq <br />rc a to beome subjet lo the work6' composation laws of Califonlia. ild agre that ill should b€come subjet to the <br />work6'compensationprovisionsofSection3T00oftheLaborCode.lshall.fonhwithcomplywiththowprovisiom.. <br />WARNING: Failurc lo surc workm'compcnsation covmge is unlax'ful. od shall subjat m onployer to siminal pqBlties md <br />civil fines up to onc hundred thouwd dollm ($in addition lo the cost of corrJrcnsalion. danages c providcd for the <br />Section 3076 Code. intsd <br />I hoeby allirm undcr penalty ofperiury that I an licenstl undq ofChapts 9 (corn,nencing with Seclion 7000) ofDivision -l <br />of the Busin6s ild Profsions Code. md my licose is irr full force od effect. <br />I-icensc Numbs: <br />I hereby aflirm undcr pcnaltyof perjurythat thfic is a <br />issued (Sec. 3097. Civ. C.). <br />the ptrftrilance of the work for which this lmuit is <br />Lender's Namc: <br />Lodo's Addrs: <br />APPLICANT DECLARATION <br />I hotby affm undq poahy ofperjury one ofthe following dcluationsr <br />Demolition P6mits-Asb6tos Notification Federal Regulations ('l itle 40, Pdt6) <br />Required l-dto of Notification <br />_l cstify that thc fcdflal rcgulations regading obelos removal rc not applicable to this prcjet. <br />that have rcad rhis application rvith all City antl County <br />ordinanc6 and Slatc Laws rclating and Counly lo enlq ur$n lhc <br />above mentioned propeny for <br />Applic8nt or Agent Signsture: <br />Pcrmits nrme (print)l <br />lo <br />ard slate thal <br />o,." l/-r4 <br />I <br />tl <br />c*u,ffl?,r7FAVD