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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS owncr-BuildcrDcclararion <br />-- <br />I hereby affirm under penalty ofperjury that I am exempt form the Contractors' License Law for the following resson (sec 701 L5 Busincss. <br />and Prof6sion Codc): Any Cily or County which rcquire a pcmil to coNtruct. 8hcr, improvc. dcmolish or rcpair any struclwc. prior to its <br />issuancc,alsorcquirothcspplicsntforsuchpemitlofilcasigncdslstcment thathcorshcislicc$cd puEumttothcpmvisio$ofthc <br />Contraclor's Lrcensed LEw (Chapter 9, Conrmencing with Section ?000 of Division 3 of lhe Busin6s and Professiom Code) or that hc or <br />shc is excmpt thcrefrom and th€ basis for thc allcged cxcmption .Any violation of Scction 701 L5 by any applicant for a pemil subjecrs lhc <br />applicant to a civil pcnalty ofnot more the fivc hundrcd dollan ($500). <br />_1. 6 ownc, of the propcny. or my cmployccs with wagc as thcir solc compcnsation. will do thc work and thc strucluc is nol inlfldcd <br />or offered for ssle ( S@ 7044. Business and Ptofessions Code: The Contractor's License Law does nol apply to an owner ofthe propeny <br />who builds or improves thcrcon. ed who docs such work himsclfor hcnclfor through his or hcr owo employccs, providcd that such <br />irnprovcmcnts arc not intcndcd or offercd for salc. lf. howcvcr, the building or irnprovcmcnt is sold wilhin onc ycar ofcomplction. thc <br />Owncr-Buildo will havc thc burdcn ofproving thal hc or shc not build or improvc for thc purposc ofsale). <br />_1. s owncr of lhc propcny. am cxclusivcly contracting wilh liccNcd contraclors to coEtruct thc projcct ( Scc. 7044. Busincss md <br />Prof.ssion Codcr Thc Contractor's Licans. t{w do.s not apply to an owner ofprope(y who builds or improves thereon , 6nd who <br />contracts for such projecls with a Cootractor(s) licensed pursuant to lhc Contractor's Licensc [Aw.) <br />_l an cxempt uoder Scclion & P.C. for lhis reason. <br />Datc:Owner: <br />WORXERS COMPENSATION DECLARATION <br />I hcrcby amm undo pcnalty ofpcrjury onc ofthc following dcclamtio$: <br />_l havc and will maintain s Ccfiificatc of Co6cnt to Sclf-tNure for workers' compeNtion, as provided for by S6tion 37oo of the <br />kbor Codc. for thc pcrfomecc of thc work for which thc p6mh is isucd. <br />-l <br />have and will maintain workers' @mp.nsation insurance, as required by Section 3700 ofthe Lsbor Codq for the performncc ofthc <br />work for which this pcmit is issued. My workers' @mpcn$tion iruursnce erricr and policy numbcr are: <br />Cuiq: <br />Policy Numbcr:_Expircs: <br />(This srction nccd not be complctcd ifthe pcrmit is for (hc hundrcd dollan {$100j or less) <br />I cc(ify lhal in lhc performance ofthc work for which this permil is issued. I shall nol employ any in any manncr so 6 lo <br />became subject lo the workers ' compensation laws of California, and aSree thAt if I should to thc workers' <br />;:I#;* i"':? <br />""""'"Labor Code. I shall. <br />Applicanl <br />WARNING Farlure lo secure workers' <br />tin6 up to onc hundred thousand dollam <br />compensation <br />($l 00.000).in <br />coverage is unlarvful. and shall an cmployer to crirninal penallies and civil <br />.ddition to thc cost of damages as providcd for thc Scction 1076 of <br />thc Labor Codc. itrtfiet ud attorney's fe6 <br />LICENSED CONTRACTORS DECLARATION <br />I hqcby arlirm undcr pcmlty of pcrjury thst I m liccnscd undcr provision of Chaptcr 9 (comcncing with Section 7000) of Division 3 of <br />lhc Bwincss and Prof6sions Codc. and mv liceroe is in full force and cffet.s.tqLiccnsc Class:_76 <br />[)ate: <br />I hqcby affm undcr pcn.lty ofpqjury that thcrc <br />issucd (Scc. 3097. Civ. C.). <br />Lcnder's Name: <br />a conslruction lcnding agcncy for lhe pcrfomance ofthe work for which this pcnnit is <br />[rcnder's Address: _ <br />APPLICANT'S DECLARATION <br />Dcmolition P.mits-Asbcstos Notification Fcd@l RcgulatioB (Titlc 40. P8n 6) <br />_ Requircd lrtro ofNolification <br />2l cenify rhat thc fedcral rcgulations regarding asbestos rcmoval arc not applicablc to this prcjcct. <br />_ I ccniry that I have rcad Ihis applicstion and ststc lhat thc abovc infomation i! corect. I agrcc to comply with all Cily and County <br />ordinancG and Slatc Laws r€lating to building coNtruction.authorizc rcprcsentalivcs oflhis City and County to enter upon lhc <br />atx)\'e menlioned propeny <br />Applicsd or aBent sig. <br />Pcrmitlce name (print)l <br />o <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Com.munications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL 'il*ol/L:=B/rt r,n lrlt1/VV Y"Notes, Remarks, Etc. <br />lrl co:c 07 ar <br />4 <br />l/l {t "[q