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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />La-t{.,b2ABonding / Grounding / UFER )k$l?o\)A) <br />Transformers ,U I <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment ?/Zlqp',7'W) <br />Factory Wired Unit u <br />Walls (Conduit) <br />Walls (Rough) <br />_Qc ilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL qll.ylp',tM /y9/ <br />Notes, Remarks, Etc.a-T <br />OWNER BUII,DER DELCARATION <br />I hoeby affirm unde penalty of psjury that I m exempl flrom the Conlaclors' License Larv for the following re6on (Ss.70:.i.5 <br />Businqs md Prof6sion Code): Any Cily or Counly \vhich requirs a ponit k) conslruct. aho. improve. danolish or repair my <br />stntcture. prior to ils issuance. also requirs the applicant for such pemrit to filc a signed slatment that he or she is licmsed pusumt <br />lo lhe provisioN of lhc Conlractor's Licensed Larv (Chapts 9, ('ommencing $'ith Sstion 7000 of Division 3 of the Busines lnd <br />Profe$ionsCodc)orlhatheorshciserempllhqefromandthebdisfortheallegedexemption. AnyviolationofSationTOsl.5br_any <br />applicantforapemitsubj(tsthe applicanttoacivilpenBhyofnolrnorelhmfivehundreddollils(g500). <br />l. as o$'ns of the preftry. or my employffi rvilh rvage a their mle cornposation. will do thc work md the slruclrre is not <br />intsded or offtrcd lor sle (S4.7044, Businas and Prof*ions Code: I he Contractor's l-icerce Law doe not apply to an o*rtr of <br />thepnrpeny whobuildsorimprovethd@n,dd\vhodo6such$orkhimselforherselforthroughhisorherownemployes. <br />providedthatsuch improvonmtsilenolintodedoroffqcdforsle.ll.horveve.thebuildingorimprovsnotissoldrvithinoneyw <br />ofcomplaion. the Ormq Buildq s'ill havc the burdm ofproving that hc or she did not build or funprove the prcpqty for lhe purposeof <br />sle). <br />-1. <br />ro ownq of the propqly. m erclusively conlracling with licmsed contradon to connrud th€ proJect (S(. 7044. Busin6 <br />md PmftssionCode:ThcContraclor'sLicenscLawdoenotapplyloanownsofpropcrlywhobuildsorimproveslhq@n, <br />and who contracls for such projecls with a Contracto(s) licensed puBumt lo thc Contraclor's Licmse Larv). <br />__l m exqnpl undq Sstion__ , B. & P.C. for this re6on. <br />l)A tc: <br />WORKERS' COMPENSA'TION <br />DECLARAI'ION <br />I hocby allirrn uuder penalty ofpojury one oflhe follorving declaations: <br />- Iha|emduillmaintainaCertificatcofConsmtloSelf-lnsureforworkcs'composation.m providedforbyS(tion3700ofthe <br />Labor Codq for thc pofomrdce of the sork for u,hich lhc pmnit is isued. <br />-l havc and will mainlain workm compmsalion iNurancc, 6 required by Setion 3700 of thc kbor Code. for the psfommcc of <br />the work for which this p€onit is i$uod. My work6 compeosation iBurmcc cmicr od policy numbcr rc: <br />Cmim: <br />Pcrlicy Nurnbo:Expires: <br />-l <br />colify lhat irt lhe perfonnance of the work for which this permit is issued. I shall not anploy any person in any rnoner <br />st c to become subjrct lo the workds' compensal ion laws of Califomia. and agree thal i f I should becomc subjst to the <br />rvorkos'contpensationprovisionsofSectionlT00oftheLaborCode.lshall.forthwithcomplywiththoseprovisiom.. <br />WARNINC: l"ailure to scure rvorkcs' conltmsalion is unlarvful. and shall subjat a onployo to oiminal petraltis md <br />civil fines up lo one hundred thousmd dollars ion to the cosl of danages for the <br />Scclion -1076 oflhc l,atx)r Code. iDter6t aDd <br />l)alc:/r- zS '?za1 <br />I hoeby allirm under penalty of psjury thal I licensed under provision ofChaplq 9 (cornmencing wilh Sslion 7000)t ol')ir ision 3 <br />of the Businm and Profssions Code. md mv liccnse is in full fbrce md effect <br />License ('lass:L -qc <br />-Licemc <br />Number: <br />I)8te:t(- L='/1 qt-=+-.rq- S t (c-,': <br />I hoeby aflirm undo pmalty ofperjury <br />issued (S*. 3097. Civ. C.). <br />is a construction loding agocy for the pqfonnmce of the work for which this pfinil is <br />l-cndcr's Name: <br />Lcndcr's Addres: <br />APPLTCANl' DECT.,tRA'TION <br />I hottry affm unda poahy of pajury onc of thc following dwlaations: <br />Demolition Psmits-Asbestos Notification Fedtral Regulations (Tille 40. Pan6) <br />Required kil6of Notificalio. <br />Perrrilce 'a ctsc o 4c^" +- Vc Z- (1r r e^ert <br />fl <br />( )rv ncr: <br />letz e tA <br />_/o,,", // - zs -/(