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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DEl,CARATION <br />I hcrcby allirm undcr pcnalty of pcrjury thal I &r crcnrpl liom thc Conlrack)6' Liccnsc lrw litr lhc following rcasn (Scc.70Jl.5 <br />Rusincss afil Protisst)n Cfilc): Any City or C()unty which rcqufcs a lErnrit to conslruct. altcr. improvc. dcmolish or rcpat any <br />structurc. prt)r lo its issuancc, also rcquircs thc applicant lir such Frcrnlit l, lilc a signcd slatenlcnl lhal he or shc is licenscd pursuant <br />lo thc provisions of thc Coiltractlr's Liccnscd l-aw (Chd[rlcr 9. Comnrcncing wilh Scction 70(X) of Division J of lhc Busincss and <br />ProltssionsCodc)ortllath('orshciscrcmptthcrcliomandthchasisti)rthcallcgedcxcmplion. AnyviolalionofScctionT0.ll.5byany <br />applicanl fi)r a frcmil suhjccls lhc applicaf,l to a civil penalty ol not nx)rc than fivc hundrcd dollars ($500). <br />_1. as owncr of thc profrcdy. or my cmployccs wilh wagcs as I hcir xolc cotrlpcnsation. will do lhc work and tlE slructw is not <br />0ncnlcd oroftcrcdforsdlc(Se.7(144,BusincssandProfcssi(rrsC(xle:ThcContracklr'sl-iccnscLawdocsnolapplyloanowncrof <br />thc pRlFrcny wlxr huilds ()r inrprovcs tlrG)n. and who d(rcs such work himscll or hcrscll or tltough his or hcr own cmployccs. <br />providcd thdt such iNprovcmnls irc nol intcftlcd or oficre{ tirr salc. If, howcvcr, thc huildmg or improvcnrcnt is sokl within onc ycu <br />ofcomplction. the Owncr Buildcr will havc lhc hurdcn of p()ving lhat hc or shc did not hilild or improvc thc prclE(y li)r thc puqx)* of <br />salc). <br />_[, rs owncr of thc lm)Ndy. anl crclusivcly eontrrctilg wilh li(cnscd conlrdck)B t) constnre t lhc pn)icct (Scc. ?044, Busircss <br />nnd Pr)lbssinCodc:'lhcCotrtrack)r'sl-icenscl-awdoesnolapplyk)anownctofpr()pcrlywhohuillsorimprovcslhercon, <br />and who conlracls Ii)r such projcels with a Ci)nlmctor(s) Iicchscd pursudnt k) Ihe Conlrac()r's [.iccn{c Law). <br />-l <br />am crcmpl undcr Sccli()n-, B. & P.C. tbr this rcason. <br />ll-,-._ n*-o.. <br />lvo8tsE8S3:qUTENS TAN <br />uEeuEaLlgN <br />I hcrcby rlllrm under pcnalty of pcrjury onc o[ lhc Ii)llowin8 dcclarations: <br />_l havc urd will rnaiilain a Ccrlilicalc of Conscnt k) Sclf:lnsurc fi)r workcrs' compcnsalion. as providcd lbr by Scclion -l7U) ol the <br />tihor C(xlc, lbr lhc pcrli)nnancc ol'lhc work li)r which lhc pcrmil is issucd. <br />_l havc and willnaintain Sccl(m J700 ol lhc I-!b{)r Ci)dc, lirr thc pcrltrrnrancc of <br />thc work li)r which caricr ail Jr)licy numhcr trc: <br />Policy tl/ c ) ///a a <br />_l ccdity lhat il thc 1-_rlbrmancc of lhc w()rk li)r which this pcrmit is issucJ. I shall nol cmploy any pcrson in any mmncr <br />\o as k) hcconrc suhjcct l(, lhc workcrs'compcn\ali()n laws olCalili)rnia, rnd xgrce thrt il I sh()uld becorc suhjcct k) lhc <br />workcrs'compcnsationprovisionso[Scction.lT(X)olthe[,alx)rG)dc.lshrll.lbfthwithconrplywiththoscprovisi(ms.. <br />IVARNING: Failurc kr rccurc workcrs'compcnsali()n covcragc ir shall [Errltics and <br />civil incs up b onc hutulrcd thousand doll$s ($l tn cosl r)l rs Prov;dcd lor thc <br />IScctirm .107(r ol inlcrcsl and alk)rncy s <br />I herchy allirm undcr p(nalty ofpcrjury that I am liccnscd undcr provision ol Chaptcr I (commcncing with Scction 7000) of Divisir)n 3 <br />of thc Busincss anil Prolissions Codc, anl my liccnse is in lull lbrc and cilcct. <br />/ /'r-//a 22 cl-icensc <br />l)ate ( r)il1 <br />W <br />I hcrcby alllm undcr Fnahy of perjury thal lhcrc is a conslructi()n bnding allcncy lbr thc lErfi)mucc of the work for which this lrcmit ir <br />rssued (Scc. ,1097, Civ. C.). <br />[*nrlcr's Namc: <br />knder's Address: <br />^CtUS.ANLUECIABAUqI hcreby allim undcr pcnalty of frcrjury onc of thc li)lbwinS dcclarations: <br />Dcfr)lition Pcrmits-Ashcskrs Nolillcation Fedcral RcBulati{)ns (-I illc 40. Pan6) <br />-Rcquircd <br />kttcr of Notitication <br />_l ccrlily lhat thc lcdcralrcgulali{)ns rcgddinl ashcsn)s rcrnovalde mil applicablc k) this pruFcl <br />_l ccnili thal I havc rcatl this I alre k) comnly witlr nll City and (irunly <br />ordinanccs rn(l Slatc Laws rclatirS k)oI this ('ity rnd County k) enlcr ulro0 thc <br />nlx)vc mnlioncd propcrty lbr <br />Applic{nt or Agent <br />I'rnnilc( tranrc <br />and slrlc lhxl thc rlx)vc intirrnrrtrm is <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinos (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />ltleter Release <br />Rouqh <br />Service Meter <br />FINAL <br />"h,Bl% <br />fh.-L{*qv) <br />Notes, Remarks, Etc.tl