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ELECTRICAL.INSPECTOR RECORD <br />Bev.08-07-2015 <br />APPROVALS DATE ID/SIG.COMMENTS OWNITR BT'II,DI]R DI]I,CARATION <br />I hcrcby affrm undcr pcnalry of pcrjury that I atr cxcDrpt frutrl lhe Clontmcto6' Liccnsc l:w for the following rcaen (SqJ.7031.5 <br />Busincss ard Profcssion Codc): Any City or Counly which rcquircs a [LTrnil lo construct. slts, irnprovc, dcmlish or rcpair My <br />struclure, prior h ils issuancc. aJso cquiEs thc applicut fm sucl FEmril lo filc a signcd slatemnt that lE or shc is licensd pur$art <br />to tlrc pmvisions of thc Contractor's l-kcnscd kw (Chaptcr 9. Commcncing with S€tion 7U)0 o, Division 3 of lhc Business and <br />hofe$ions Code) or that lt or she is exenrpt theEfron snd tlP b6is for tl* alleged exenrption. Any violalion of Srction 7031.5 by any <br />applicantforaFnnitsubjdtsthe applicunttoacivilpcnnhyofnotmrcthanfivchundrcddollars($500). <br />_1. as owncr ol tlr prclEny, or my crnployccs with wagcs as thcir slc cornltnsnlion, willdo thc work and thc slMuc is mt <br />inteBlad or ollcred for salc (Se.7(X4. Busincss and Prcfcssions Codc: Thc Contractor's Liccnsc llw does nol apply lo ill owner of <br />the ptupeny wlb builds or in[roves lhrrdE and wlx] d(rs such ur)* himself or lErself or lhrough his or her own enployees, <br />provided that such irnprovcrrcnts ec frx iilcftlcd or ollcrcd lor $lc. ll, howevcr. thc boilding or irrprovcmnl is $ld within one ycd <br />of compbliotr tlE Owrcr Buil&r will luvc thc burd.n of prcvin8 lhat hc or she did ftn buikl or impsvc thc pmpdty for the purpos of <br />sdle). <br />_1, as owner ofthc property, am cxclusively coutracling with liccnsd conlracloft lo consfuct lhc pojcct (Scc. 7{N4, Businc$ <br />and PrctlssionCode:TheCulrachr'sLicenseLawdoesDotapplytoanownerofpropenywhobuildsorinrproverlhe,eon. <br />and who conlracls for such projccts with a Conlracb(s) licctrscd pursuut to thc Contraclor's Liccnsc Law). <br />-l <br />anr exempt undcr Sectioil-, B. & P.C. lbr this raasoil. <br />tv( )RKltRs' coMt,lINSA'I I(rN <br />I)I;CI,ARA'I'ION <br />I lNrcby afl'irnr u[dd' |cnrlly i,l pcriury onc ()l lhc l(,lkrwing (lcclirrali('ns: <br />_l have ild will nlaintair a Ceniticate of Co[setrt h Self-lnsurc for workcrs' conDcnsation, as pruvided for by Scctioil 3700 of the <br />kbor Code, for the perfornrancc o[lhc work tor which thc pcflrit is issucd. <br />_l have aD{j will truintain workers'c(mrpe[sali()n insuraucc, as rcquircd by Scclion 3700 oflhc Labor Code, for the perfornunce of <br />thc work for which lhis lrrnlit is issucd. My workcrs' conrlrcusation insuruce cmicr iurl u)licy numbcr ile: <br />Policy Numbcr: Expitcs: <br />_l ccnify that in thc Frlilrnuncc of thc work for wltich this pcroil is issucd, I shall not cmploy any Frson in any manncr <br />so as to bccom suhject lo thc workcrs' conrpcnsation laws of California. and agrce that if I should bccorrc subjcct to thc <br />*orkers'cotrrpensalionprovisionsofSection3?00ofthetnborCodc,lshall.fonhwithcon)plywiththo$provisiorN.. <br />WARNING: Failurc to scurc workcrs'compcnsation covcmgc is unlawful, aDd shall subjcct 0n .mployer to riminal pcnahio and <br />civil fincs up b one hundrcd thousand dollars ($l00,m0). ir addilion b lhc cosl of compcrelion, danuScs d provid.d for lhc <br />Scclion 3076 of thc Latbr Cdc, intcrcst md athrNy s [ccs. <br />LICENSED CONTRACTOR <br />DI;CI,ARATION <br />I hcrcby affrm undcr pcnalry of pcrjury rhal I anr licensd undcr provision ofchaptq 9 (cotrrnEncints with Scction 7000) of Division 3 <br />of thc Busircss a0d Pmf.ssions Codc. etrl my liccn€ is in full fore und cffecl. <br />Liccose Numbcr: <br />- <br />Dsle'- Contraclor'- <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby aflirm undcr pcnalty ofpcrj!ry thd thcrc is a construction lcnding a8crcy to. the [Erlbrmarcc ofthc *ork fbr which this frcrmit is <br />issucd (Scc. 309?, Civ. C.). <br />Lender's Nanre <br />kndcr's Addrcss: <br />APPI,ICAN'T DECI,ARATION <br />I tscby Jfflrmundcr lf,nalty of pcljury onc of thc [olbwing declilati(,ns: <br />Dcffi)lition Pcrmits-Ask+sbs Notificati()n Fcdcral RcSulati(,ns (Titlc 40. Pd6) <br />-Rcquircd <br />tdtcr of Milification <br />| <br />-l <br />cdily thar thc ltdcralrcgulali rns rcgdding asbcstos rctmvaluc not applicablc to this prejcct. <br />I| _l ccnify rhat I havc rcad this applicalior ilrd s(atc that lhc ahrvc inti,Imalion is corccl. I aSre b conDly with all Cilyand County <br />I rrrdinanccs and Statc laws rclating k) building construc(ir]n. md hcrcby authorizc rcprcsntativcs of lhis Ci(y and County to cnter upon thc <br />I abovc rncntioncd prrpef,y for insp.ction purposs. <br />Applicant or Agent <br />I'crnritcc nonrc <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht 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 A\ <br />Bondinq / Grounding / UFER xwla <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 />Ceilinos (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />lMeter Release <br />Rouqh h I tVt(us9 <br />Service lVleter VhWY h -l J.lu,>tY <br />FINAL lo rOV)t'i>lM -'g otJ 4lqlz.,> <br />Notes, Remark$, Etc I <br />9-I VtCtrs vlllM\J\J <br />'{ -2-7"7 <br />g*fr-t