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APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <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 />Bonding / Grounding / UFER 1'jt. tb J ),*k */ <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 />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />N/leter Release I <br />Rouqh <br />Service Meter | 7.il-l( -)) rl>l't I w)rl-*)FINAL ?/ro/zur--yg\ <br />Notes, Remarks, Etc. <br />\o):( <br />ELECTRICAL-INSPECTOR RECOn - <br />0Wnrn --.-- <br />I hcreby allirnr uodcr pcnrlty ol pcr.iury thnt I am cxcmpl liom thc Contractors LrccrsE u!,. ... <br />Busincss and Pnrlissirxr Codc): Any Cily or County which rcquircs a pcmlil k) construcl. rllcr, irrprrvc. dcrnolish or reprrr arry <br />slruclurc.frriorloils issuucc.nlsorcquircslhcal,plicanlforsuchJrcrmillolilctrsigncdslalctrlcnt thillhcorshcirliccnscd pursua[t <br />h thc prcvisions o[ thc Conlrilclor's l,iccnscd Law (Chapter 9. Conrmcnci[g wilh Sccliotr ?(X)0 of l)ivision .3 of lhc Busincss and <br />ProttssionsCodc)orthrlhcorshciscxctrrlrlhcrcfromandthcbasisforlheallcgcdcxcmption. Ailyvi(,latio[oiSccthn70.3l.5hyany <br />applicaillli)rapcnnilsuhjcclslhc spplicaillk)ucivilpcnallyofnotnrorclhanfivchundrcddollars($500). <br />_l. as owncr ol lhc propcrly. or my crnpk)yces wilh w0ges as thcir solc cotrrpcns{lion. will do lhc work and lhc slNllrc is nol <br />intcndclj orollercdforsalc(Scr.T044.BusincssandPrefcssionsCodc:ThcConlraclor'sLiccnscliwdocsnotufplyn)anowncrof <br />lhc pmFily wlx) builds or irnprovcs ttrcmn. aM who dms such work himsclf or hcrsclf or lhrough his or hcr own cnrpkryces. <br />providedlhalsuch irnpnrvcnrnlsurcnotinlof,lcdoroffcrcdforsalc.lf.howcvcr.lhcbuildirrgorinrprovcrrcntissoldwithinoncycrr <br />ofcon{rhtion. llE Owncr Buildcr will hrvc thc hurdcn ofproving thal he or shc did Dol huild o, irnprovc thc pmfMy for lhc purln* of <br />eh). <br />_1. as owrcr of lhe propcny. am cxclusivcly conlracling with licensed contractors to conslruct the p()jccl (Scc. 7014. Busircss <br />arrd Profssirn Codc: Thc Contraclor's Liccrlsc Law docs nol apply to an owncr ofpropcrly who huilds or improvcs lhcrcon. <br />and who contracts for such projccts with a Conlracto(s) liccnscd pursuant lo lhc Conlraclor's Liccnsc [!w). <br />-lanrcxcmptundersNlion-'B.&P.c,forlhisreason. <br />Dste:O*ner: <br />WORKERS' COIIIPENSATION <br />IIECI.ABAIII}N <br />I hcrchy uffirm unrlcr pcnally ofpcrjury onc ofthc following dcclarations: <br />Latxrr Codc. lirr thc pcrl(xlililncc ol lhc work ti)r which thc Frmit is issucd. <br />thc work for lhis I)crnrit is issuc<|. My conucnslilion insurililcc carricr and "ud':"'"'" <br />33r )3ft)licy <br />_l ccaify lhat in thc pcrlbrmancc of thc work tor which this pcrrnit is issucd. I shall ilot cnrpk)y rny Jrcrson in any mnnncr <br />so as to ruconrc suhjcci k) thc workcrs' conlPcnsalion hws ofcalilbrnia. and agrcc lhnt if I shoukl hLconE suhjccl lo lhc <br />workcrs'comJxnsalir)nprovisionsofScclion3T0OoflhctjtnrCodc.lshxll.fonhwithconrplywithlk)$provisioDs.. <br />WARNIN(l: Frailurc lo \ccurc st)rkcrs' coiltpcnsalion is unlawful, md shall subjcct an cnlploycr lo siriinal lrcnaltics and <br />civil fines up to onc hundrcd lhousand dollars ($in addition lo Ihc cost of darmgcs a\ providcd for thc <br />Seclion -]076 of thc titnr Gldc. <br />o*",1 ''Zln,)5'"" <br />and <br />I hcrcby allirnr undcr pcnrlly of pcrjury lhilt liccnscd undcr <br />Liccnsc <br />ofChrptcr 9 (conrnrncing with Scclbn 7(XX)) of Divisk)n 3 <br />o[ lhc Busincss and Prrlissions Codc. an<l my liccnsc is in litll lbrcc atd clTcct. <br />thc fcdcral rcgulations rcguding ashcslos rcnhlal arc not applicrhlc lo this projcct <br />q <br />Nutrrhcr l <br />is il consl rucl hn lcnding ngency li)r I hc pcrli)flmncc ol I hc w(r k lirr which I hir pr nrit isI hcreby alllrill undcr rcnillty of pcrjury <br />issucd (Scc..3097. Civ. C.). <br />Lcndcr's Nilnrc: <br />kndcr's Addrcss <br />APPI ICANT DECLARATION <br />I hcrcby aflinr undcr pcnalty of pcrjury onc of thc following dcclarations: <br />Demlilion Permits-Ashcslos Nolification Fcdcral Rcgulations (Title zl0. Pan6) <br />-Rcquired <br />[Jttcr (,f Nolificulbn <br />_l <br />I ccflifv <br />I havc rcad <br />ordinanccs <br />ahovc <br />ion ilild stalc thnl lhc atnvc inlororation is coficct. I agre to c(nnply <br />I reprcscntalivcs ol thi\ Cily <br />with !ll City and Coutrly <br />and Counly lo cntcr uFln thc <br />na n7 tA1 ( <br />Applicent or <br />Statc liws rclal to building authorizc <br />,,,,r",-J rylp'\8 <br />l)ale: <br />t: