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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bondinq / Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release Rough s7+r1 .{,il1 /fq I Service Meter ! t,.' j ,/1 t' Y / F!NAL n//utr ttt, llil,llh 'ib Notes, Remarks, Etc. oL, 0u I hacby affrm undo penalty of psjury that I m exempt from lhe Contracto6 Licflse Lr\r' for the follorving reson (l(.?03 l.L Buines md Profcssion Code): Any Cily or County which rcquira a pmnit to construct. alta. irnproic. dmolish qr repair oy structuc. prior to its issumce. also requirs thc applicilt for such pemit to file a signed statment lhat he or she b licosed puNudt to thc provisiom of the Contractor's Liccnsed Law (Chapts 9. Commencing with Section 7000 of Division -3 of the Busin* and Profcssions Codc) or thsl he or shc is €xempt lhgcfiom md the b6is for lhe alleged exmplion. Any violation of Sstion 7031.5 by any applicantforapennitsubjctsthe applicanttoacivilpcnaltyofnotmorethilfivehun&eddollds($500). -1, s owner of lhe propeny. or my employ$ with wags d their sle comp€Nation, $illdo thc sork ild lhe stru(ue is nol intoded or offoed for slc (56.7044. Buinss md Profesiom Code: 'l'hc Conlraclor's Licosc larv dos not apply to il ouns of thc pmpqty who builds or irnprove thson md who doe such rvort himself or hmelf or through his or he orvn ernpkrles. provided that such imfrovmots &e not intmded oroffoql for slc. If. howo'q. the building or imJrovemmt is mld rvhhin one )a ofcomploion. the Omo Builds will havc thc budm ofproving tha hc ot she did not build or improve th€ prepfity tor the puTreE of sle). _1. as orvnq of the property, m exclusively coilraclirg with licmcd contractoE to construct thc prcject (Ss. 7044. Brsins md Prcfqion Code: Thc Conlraclor's License Law doc not apply lo an owns ofpropcrly who builds or improvcs thereon. and who contracts for such prcjsts with I Contmcto(s) licmcd puEumt to lhe Contraclor's Licruc Larv). Im u. & P.('fe60n. I hoeby aflirm undo penalty ofpojury one -l havc and rvill maintain I Cffificate of CoMt lo SclflBurc for rvorkos' compcroation, a provided for by S(tion 1700 of the Labor Code, for the pGfommcc of thc work for u,hich thc tmit is isued. I have and will maintain work6' comp€Gation insurance. m required by Setion 3700 of thc Labor Code, for thc psftrnnmce of the work for which this p@nit is issued. My workm' comlmation insurance cmi6 md policy nurnbo ac: Policv Numbq: Exoka: I ceniry that in the pqlonnancc of thc work for rvhich this psmil is issued. I shall not mploy any psson in any muner s I to become subj6t lo the works' compensation laws of Califomia, md agrre that if I should b€come subjst to lhe workm' compmtion provisiom of Scaion -1700 of lhe Labor Code, I shall. fonhwith comply with those provisions.. WARNING: Failure to surc workers'cornpflsalion covsage is unlawiul. and shall subjet an qnployfr to qirninal poahie md civil fines up to onc hundrcd thousnd dollrs ($100.000). in addition to the cost of compcnsalion. damago as provided for thc Sation 1076 of the Labor Code. intsBt trd,u,/ ryy' /tz-.., t ,../[ L-/ I hmby affm unda panalty of perjury Ihat I m provision of Chaptc 9 (commciog with Sstion 7000) of Division l L forcc md cffmt.of the Busines md Profsions Code, md my is in full License Class:Licensc Nurnber: ( ontrrtlor: CONSTRUCTION LENDINC ACENCY I hwby affm unda pcnalty of psjury thal lhec is a coulructioo lending agocy for the pofommce of the rvork for rvhich lhis pcrmit b issucd (Sc. -1097. Civ. C.). Name: Addrss: APPLICANT DECLARATION I harby aflim undo pmalty ofperjury onc ofthe following dsldations: Demolition Psmits-Asb6tos Notification Fedsal Rcgulations (Tille 40, Pd6) -Required Ldttr of Notificaliof, -l cerliry lhal thc fedgal regulatioN rcgoding sbGtos rmoval ae not applicablc to this prejct. I cqtiry lhd I have r@d lhis application ild stale lhat the atpve infonnation is coret. I atlrE lo comply I reprBentativ6 ofthis City\ wilh all ('ity and County ild Counly to entq upon th€ordinanca ad Statc larvs building consruction, ud hreby abovc mmtioned prcpcny for Applicont or Ageilt I'crnrilce nnme purpos6. o^,l\o n7 1A1E