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ELECTRICAL.INSPECTOR RECORD <br />i- <br />APPROVALS DATE !D/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Lioht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safetv /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER 7.at- tR J)..{ot frn) <br />Transformers <br />Torqueino <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 />Ceilinos (T-Bar Rouqh) <br />lVeter Release ?1 <br />Rouqh <br />Service ]t/eter //'7.it, tO -l)zirfl ,?)j).Sd1zFINAL)-to-zozp ki) <br />Notes, Remarks, Etc <br />OWNITR BUII,DER DELCARATION <br />I hercby aflrm undcr pcnally of pcrjury lhat I m cxcmpl liom the Conlrilclors' Licensc kw for lhc followirg rcason (Sec.70-31.5 <br />Busincss and Profcssion Codc): Any Cily or Counly which rcquircs d lrcrnlil lo construct. alicr. imprcve. dcrmlish or rcpair any <br />sltuclurc, prior lo its issunncc. also rcquires thc applicant li)r such lErmil b filc a signcd statcnrcnt that hc or shc is liccnscd pursuant <br />lo thc pmvisions of lhc Contractor's Liccnscd [aw (Chsftcr 9, Corrrrcncing wilh Scctbn ?UX) of Division 3 of thc Business and <br />ProfcssionsCode)orlhalhcorsheiscxcnrptlhcrctiomandlhcbasisforthcnllcgcdcxemption. AnyviolalionofSccli(,n70ll.5bysny <br />applicunllbrapcrmilsubjcctslhc spplicaillloacivilpcnrllyofnotmorclharllvchundrcddollars($5(D). <br />_1. as owner of thc proJrcny. or my cnrpk)yccs with wagcs as thcir solc cornJrcnsal ion. will do tlrc work ilrd lhc slR1ure is ret <br />inlcndcd oroffcrcdf(rrulc(Se.TOl4.BusincssandProltssionsCodc:'[heContrtrctor'sLiccnscLiwdocsnotapplytoanownerof <br />lhcprefrc(y whohuildsorimprovcsthcrsnmdwhodocssuchworkhintsclfr)rhcrsclforlhrolghhisorhcrowncnrpk)yccs. <br />providcdthdtsuch inpiovcmntsarcnolinlcndcdoroflcredforsulc.lf.howcvcr.lhcbuildingorirnprovcnrntissoklwilhinoncycrr <br />ofcoDplction. lhc Owncr Builder will havc lhc burdcn ofproviDs lhat hc or shc did nol build or ioDrovc lhc pmFny lor lhc purfDrc of <br />salc ). <br />_1. as owncr of lhc propcny. am exclusivcly contracling with Iiccnsed cont[rck)rs k) construct thn [rrojcct (Scc. 70.1,1. l]usrncss <br />rnd PnrltssionCodc:-I'hcContractor'sLiccil\cLawdocsnoltrpplytorDowncrofproperlywhohuildsoriillprovcslhercon. <br />an(l who conlracls li)r such projccls wilh a Contrrctor(s) Iiccnscd pursurnt k) lhc Contrack)r's l-iccnse Law). <br />_l rnr cxcmpl undcr B. & P.('. lbr this rcason. <br />Dstc:_ O*ner:__, <br />WORKI' RS' C(IMPENSATI(IN <br />DECI ARATION <br />I hcrcby aflrm undcr pcnolty ofpcrjury onc ofthc folkrwing dcclarations: <br />_l havc ud will Duinlain a Certificalc of Conscnl lo Sclf- Itrsurc for workcrs' compensation. as providcd for by Scction 37fi) of thc <br />[2[x)r Codc. for lhc pcrforilunce o[thc work for which thc pcrmil is issued. <br />_lhavcandwillmaintilinworkcrs'conrpcnsalioninsuratrcc.ns rcquircdbyScctitrn-1700ofthcl-flborCode.lbrthcpcrtirrnrtrnccol' <br />lhc work tbr which this pcrmil is issucd. My contpcn\al ion insurancc crrricr ttttrtthcr atc: <br />Policy 3.31 ,1q <br />_l ccnily Ihat in lhc pcrlormancc of thc work for which lhis pennit is issuc(|. I shilll not cillploy ilDy ;rcrson in any manucr <br />so as k) bccomc subjccl k) lhc workcrs' corlpcilsation lnws ofcrlitbrnia. r[d agrrc lhill if I shoukl hcconrc subjcct to thc <br />workcrs'conrpcnsationfrovist)nsofSccli(n.lT00ofthclrhrrClodc.lshnll.li)rlhwithcomplywiththo*provisirns.. <br />WARNINC: Flihrc to rcurc Eorkcrs' <br />civil t'incs up t(, onc huDdrcd thousilnd <br />covcragc is unlawtirl. rnd shall subjcct tn cillpk)ycr to crirnirral lrcnlltics and <br />in nddition k) thc cost of.-dilmages as providcd for thc <br />Scctirrn 10?6 ol thc l.ahrr (lxlc.an(l <br />-l <br />t'lDarq l. L <br />I hcrcby affirm undcr <br />' TTCInRATI()N <br />I am liccnsd undcr provision ofChrplcr 9 (cofiilrcncing with Seclioil 7(XX)) of Division .'l <br />of thc llusincss nD(l Prrltssions Codc. and ilry liccnsc is in lill l()rcc and clltct. <br />lo D-3\l6DStLiccnsc <br />Datei- <br />NunraLr: <br />I <br />I hcrchy affirm under frcnalt y of perjury <br />issucd (Scc. 3097. Civ. C.). <br />lJndcr's Name: <br />lhcre is a constnrctiotr lcnding agcncy li)r lhe p$li)rilrarcc (,l lhc work lirr uhich tlris prnrit is <br />lrndcr's Addrcss: <br />APPLICANT DECLARATION <br />I hcrcby affmunder pcnnlly of perjury onc of thc following dcclarations: <br />Derft)lition Pcrnlits'Ashcstos Notificslion Fcdcral Rcgulations (Titlc 40, Prn6) <br />_Rcquircd Lclter of Notifi cation <br />nfpliclhlc lo lhis projccl. <br />ion i\ conccl. I agre to conuly wilh all City and Counly <br />rcprcscntalivcs oflhis City and Counly to entcr uF)n ttr <br />,,," <br />-1 '2^l' lt <br />I'ennilN O(1r (-.Wver