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ELECTRICAL.INSPECTOR RECORD <br />!D/SIG COMMENTSAPPROVALSDATE <br />Site-Work <br />Underqround 7-zl-1(.t)rS&-t ,(v) <br />Pole Bases <br />Light Standards <br />tu)Spas, Pool, Fountains ?'4o-(e J)-Q{p1 <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor {aBonding / Grounding / UFER ?- ?cs --tQ ./"t5* <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 Rough <br />Ceilings (T-Bar Rough) <br />ltleter Release <br />Jes'tRouqh7-7 O -{q ,@ <br />Service Meter <br />{o-tr4? -hle9-1-f,tr)FINAL <br />Notes, Remarks, Etc <br />OWNER BUII,DER DEL(]ARATION <br />I hereby affirm under pmalty of perjur] thal I arr erernpl fiom the Conlracto6' License l,arv for the following remn (Sec.703 1.5' <br />Busincs and Profssion Code): Any City or Counly u'lrich requirc a pmnit to conslrucl. alta. improve demolish or repair my <br />slruclue, prior lo ils issumce, also require the applicant for such pmr{t to file a signed slatqnflt that he or she is licmsed pursuanl <br />to the provisions of lhc Conlraclor's Licensed Larv (Chapto 9, Commencing $;llr tsslion 7000 of Division I of the Busincss and <br />Profe$ionsCodclorthalheorsheisexcrnptthsefromandlhebasisfortheallcgederemplion- AnyviolationofSectionT0-ll.5byany <br />applicantforapmitsubjslslhe applicanlloacivilpenaltyofnotmorelhanfir'ehundreddollas($500). <br />_1. as ouner of lhe froperty, or ily employs wilh wags 6 lheir- sole compensation. rvill do the work md the stnl.lue is nol <br />intodql or ollercd for ule (Sa.7044. Busines and Profcsions Code: The Contractor's Licase lnw do6 not apply lo m owner of <br />the pmfmy rvho huilds or improve thson. md u ho doe such *ork himself or hsself or lhrough his or hq oM cmployec. <br />providedthalsuch irntrovcnfflsoenolinladedorolTgqiforsle. If.horvo'o.thetrrildingorimprovmmlissoldwithinoneytr <br />ofcomplction. the (hvner Buildq will have the burdq ofprcving that he or she did not build or i,ntrove lhc Ftrotsry for the purynse of <br />sle). <br />, l. as o\rer ofthc propely. anr cxclusircly contracting $'ith licensed conttack)F lo constnrcl the projel (S*. ?0J4. llusinss <br />and l,rofcssionCodc:'lheContractor'sLicenseLawdo6notapplyloanownerofproperlywhobuilclsorimprovesthermn. <br />and who conlracls for such proiecls with a Corrlraclo(s) liceilscd puNuanl lo the Conlraclor's License Law). <br />I en erempl unds Sstion . A. & P.C. for this reason <br />I)a(c _ Owtrer: <br />WORKERS' COI\IPENSAllON <br />DECLARATION <br />I hereby affirm uncler penalty oIpojury one ofthe follo\ving dslarations: <br />_l have md u ill mainlain a Certificate of CoNmt to Self-lnsure for rvorkm comlmstion. s prolidcd for by Setion 3700 of the <br />tabor Code. for the lrfomancc of the work for rvhich thc ponit is isued. <br />_lhaveandrvillmaintainu'orkss'compensationinsurance,6 rcquirctlbySetion3T00oftheLahorCode.forthepsfomanccof <br />the Nork for rvhich this pmnh is isued. My workm' compdation iNurancc canio od policy numbo uc: <br />Cmiq:_ <br />Policy Nurnbe:-Ii\pir cs: <br />I cenity thal in lhe perlornrance ofthe rvork for rvhich this pcrrnil is issuetl. I shall nu onploy any person ir any mannc <br />so as to bccome subiecl to the s'orkfls' coillpensation larvs of Cali foilri.. and sgrec that i f I should beconre subjet to lhe <br />rvorkes'cornperLsalionprorisionsofSelinnlT00ofthel-atpr(.ode.lshall.fonhuithconrplyrtithlhoseprovisions.. <br />WARNINC: Failure lo secure rvorkers' <br />civil fines up to one hundred thousand <br />conrl)ensation covoage is unla$ful. and shall subiecl an lo qirninal penaltis and <br />dollars ($in addition lo lhe cost of darnages ru provided for the <br />Setion 3076 Code. intsGl <br />I hoeby afl'irm unda poahy ofperjury that unrler 9 (comnrmcing rvith Srction 7000) of Dir ision l <br />of the l]usin6s 6nd Profssions ('ode. and nty licose is in lull fotce md effccl. <br />1Iqt <br />I hereby affirm under pef,alty <br />issucd (Sa. 3097. Civ. C.). <br />Lendcr's Narne: <br />- <br />ofpcriury lhal is a conslrilction lcncling agency [or the pe'[o[nance oftlrc rvotk ftrr which tltis perrtrit is <br />[,endcr's Addras: <br />APPLICANT DECLARATION <br />t heetry allinn undo penalty ofpojury one ofthe folbwing dalaratfuns: <br />Dmolition Pernits-Asbestos Notification Fcdsal Regulations ( l itle 40. Pan6) <br />Required I-etler of Notificalion <br />I cdify thil the federal regulalions reguding rubcslos rernoval are nol applicable to lhis project. <br />read lhis and state that the at[\'c agreto comply rvith all Cily and ('ouf,ly*.:"'fl;[i":.l.aws <br />abo!,e iltcnt Pr opcil\ <br />Applicsnt <br />n"..it""n\tp,f, <br />huilding conslrucli()n. and hcrehy <br />is coret. I <br />I rcprsenlal