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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (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 />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouoh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL |Zg-zoztt'J)e,h-lt @ <br />Notes, Remarks, Etc. <br />0WNER BUII,DER DELCARATIoN <br />I herchy illirm undcr pcnrlty of lcrjury thrt I anr cxempt lionr thc Contrrctrrs' Liccnw liw lirr the following rcason (Scc.?0-'11.5 <br />Busincss and Proltssion Code): Any City or Coutrty which rcquircs a lErmit lo con\truct. altcr. imf,rovc. dcnrolish or rcprir any <br />structurc. pri(,r trr its issuuncc. also rcquircs thc applicant li)r such pcrmil to lilc a signcd slalcmcnl lhill hc or shc is liccnscd pursuanl <br />h thc lrovisions of thc Conlractor's Liccnscd Lilw (Chapter 9. Corlrrrcncing wilh Sccttrn 7(XD of Divisk)n -3 of thc Busincss cnd <br />Proltssi(,nsCodc)orlhalhcorshciscxcnrptlhcrclionrcndlhcbasisforthcallcgcdcxctrlplion. AnyvblalionofScctionT0ll.5byany <br />applicrnl lor a fcrmil suhjccts thc applicanl lo a civil pcnrhy o, not morc than fivc hundrcd dollrrs ($5fi)). <br />l. ss owncr ol thc pmfrcfly. or my cmpbyccs wilh wagcs as lhcir solc coillpcnsuli()n. willdo thc work md lhc slMlurc is nol <br />intcMcd orolltrcdlirrslc(SN.T044.BusincssandProlissionsCodc:ThcConlractoisLiccnschwdocsnotapplytoanowncrof <br />lhe preFny who huilds or improvcs lhcrmn. urd wlxr rlocs such wo* hirnsclf or hcrsclf or lhrough his or hcr opn cmpbyccs. <br />providcd that such impmvcorcnls m fiil inlcrxlcd or ollcrerl for salc. If. howcvcr. lhc huilding or irnprevcmnt is skl within onc )ntr <br />ofcorq)btbn. thc Owncr Buiklcr will havc lhc burdcn ol provirUl thal he or shc did not build or inprovc thc pmJmy lbr thc purJn* of <br />mh)- <br />_1. ns owncr ()l lhc propcny. am exclusivcly conlrrclirg wilh Iiccnscd conlractors k) conslnrct lhc frojcct (Scc- 70.14. Busincss <br />and Pr)liissionCo(lc: lhcContractor'sLiccnscl.uwdocsnotapplyloflnowncrofprol)crtywhobuildsorinrprovcsthcrcon. <br />and wh() conlrrcls lbr such pr(tects wilh a Contrrck)(s) liccnsed pursurnl to thc Conlr{ctor's Liccnse l-aw). <br />-l <br />am cxcrnpl undcr Scclion-. B. & P.C. lbr this rcason. <br />I)hlc:()s trer: <br />WORKERS' CONIPENSATION <br />DECLARATION <br />I hcrchy afllrm undcr pcnuhy of perjury onc ofthc lollowing dcclarations: <br />_l hovcandwill nuinlainaCcnificaleofConscnlloSclf-lnsurcforworkers'compensalion.as providedforbyScctionS?0Oofthc <br />tjtx r Gxlc. for thc Frformarce of thc work for which thc pcrmil is issued. <br />_lhavcanclwilllrainlninworkcrs'corrlpcnsaliolinsurancc.as rcquircdbyScctirrn.jT(I)oflhctrborCodc.forthcpcrlirrtrhnccof <br />the work li)r which this pcrmit is issucd. My workcrs' conrpcnsation insurrncc canicr and Jx)licy nunlbcr trc: <br />Policv Numbcr: ExDircs: <br />_l ccnify thal in lhc pcrforrorcc of thc work li)r which this 1rcrmit is issucd. I shnll not cmlloy any pcrson in aily manrcr <br />w as to bccorrc suhjel to lhc workers' compensatiotr laws ofcalifornia. and agm that if I should bccorrc subjcct to thc <br />workcrs'conlpcnsatk)npmvisionsofSection3T(nofthcbtnrCode. Ishall.forthwithcomplywilhthorprcvisions.. <br />IVARNING: |ailurc k) sccure workcrs'cotrrFnsati(,n covcraBc i\ unluwlul. ilnd \hdll suhjcct an cnrploycr to pnallicr rnd <br />civil fincs up to hun(lrcd lhousnnd dolhr\ {$l(x).{Xx)).lo lhc c()sl ol'provi(lcd for thc <br />Scclion.1076 i[tcrcsl arxl all(trilcy s li:cs. <br />allirtrr u pcnally ofpcrjury that I provision o[ ChaIrtcr 9 (cornnrncing with Scction 7U)0) of Divisi(il ] <br />of lhc Busirrcss and Profcssions Codc. md in lull tbrcc aild cllccl. <br />Liccnsc 3 <br />I hcrchy allirm undcr Jrcnillly ofpcrjury lhrl thcre <br />issucd (Scc.3097. Civ. C.). <br />lending flgcncy to lhc pcrli)nnance ofthe work for which this ltrnril ir <br />kndcr's Nrnrci <br />APPLICANT DFCLA&{TION <br />I hcrchy uffimr undcr pcnalty ofpcrjury onc of thc following dcclarations: <br />Dcmolitk)n Pcrniils-Asbcstos Notificalion Ftdcral Rcgulatbns (Titlc 40, Ptrd6) <br />_Rcquircd IJttcr of Notification <br />I ccrtily lhal lhc li(lcrxl rcSulillions rcgading nshc\k)s rcrn()vrl arc nol applicahlc to this frojccl. <br />I ccnily thit I hrvc rcad lhis spplicatioil and slnlc thill thc rh)vc inlbrnmlion is coffccl. I rgrcc lo conrply wilh {ll rnd (lrDty <br />ordinanccs and Statc lnws rclating to <br />abovc rrcntioocd pmpcny for <br />Appli(snl or Agrnl <br />Ittrnrilcc ilnnrr (prinll:. <br />ilnd ('l lhis City and lo th!' <br />?)/\'l c <br />l)alr: <br />lrrder's Ad&ess: