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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNIiR RtltLl)llR l)l'ILCARATION <br />I hereby al'firnr ![der petrilhy of p.riury that I aD e\ernpt frotrr lhc (bntraclors' License bw for tlE following reasotr (Sec.70]1.5 <br />lJusincss and Prolassir)n Codc): Any Cit!, or C,)unty which rcquircs a p-rmit h con\trucl, allcr. improlc. dcrnolish or rtprir any <br />slnlclure,prior!,ils i\surilce.ils()requirestheapllicxrildrsuclpcrnilt,fleasigDedstalenElt lhallEorsheirlicensd pursuant <br />b lhc provixions ol llt Coillrilclor's Liccnscd Inw (Chaptcr 9. CornrncncinS with Scclion 7(XN) ol Division 3 ol thc Busincss and <br />npplicnntforrpcnnitrubjectslhc ipplicrnltorciyilpennltvoInotnnethilnIlvehundrcddollars($5{x)). <br />_1. as owncr ol llt prolErtv. or n1y ctrrplovccs wilh waScs as lhcir \olc cornlrhsalion, will do thc work and thc strmture is nol <br />inerxlcr.l or offered lirr $le {Se(.7(}44. Ilusirress and Profcssiurs Crxle: The (lontractor's Liccnra Law d(Es not apply t) nn owner of <br />the pn)plrly who hilds or in{rroves llrrdilr, and wlx) docs such work llinNclf or herselt or lh(}ugh his or her owD enlpl()yees, <br />providcd lhat such irnpnrltnrnls arc nrt inlcrxlcd ()rollcrcd li)r slc. ll. howcvt-r. thc huilding or irnprovcrmnt is sold wilhin one year <br />ofconpletiul tlrc (lwner lluilder will luvc thc burden of provin8 llu{ lc or she did rtx buil.l r)r iDprovc tlE p()pcny for lh.. purlDse of <br />srle). <br />_1. rs owncr ofthe l)rolcrty. dm cxclusively conlrn(ting with lircnEd conlrack)rs lo colslrucl tlrc projelt (Sec. 7Ol{. Bu\iness <br />arrd f'roli'ssirr Code: -l'he Contractor's Lrcensr l,aw docs not apply lo an owDer ofprop(y wh() huilds or in)Iroves thereon. <br />atrd who conlracls for \uch proiccts with a Conlrack,r(s) liccnscd pursuanl to thL G)otractor's Liccnsc Law). <br />-liln|exen\nuDdeIScctirln-.B,&P,C,li)rtllisreilsotrDate,-i- <br />W(rRKIi:RS' C0l\lIUNSAll0N <br />DECLARATION <br />I lNrchy allirn) un(lcr l\-nrhv r)f pcriurv {)trc (,1 lllc li,ll(,s ing (lcclarali(ills: <br />-l <br />havc ul will nraiilain a Ccnilicale of C()nsetrt t) Se lllnsurc for uorlers'con4rnsation, as providcd for hy S€ction 3700 of thc <br />LalNr C-dlc, for thc trrforDurcc o[thc work lirr which thc pcrlit is issucd. <br />_l have ail will ilHirtrtin workers c(nnpensilli(il insuratrce. as rcquired by Seclior 3700 ofllrc lrbor Ci)de, for the pcrf{)rnnnce of <br />thc worl lor which tlris pcrDlit is issuc(I. My workcrs'con4^-nsation i[surercc cm'icr ilxl1xrlicy nun*rr uc: <br />Policy Numbcr: Erpi,cs: <br />_l ccnily lhrt in lhc ltrli)rtrHilcc ()f tltc work f(!r rvhich this lcrnlil is issulat, I shall not cnrpkry any lEasoo in any nranncr <br />so as to hccorrc suhjcct to thc workcrs' coilrpcmation laws ol Calilornia. atrd agrcc that if I should hccorrc subjccl to thc <br />sorkers'corr\EnsrlionprovirionsofSectionl?00oftheLahrrCorle,lshall,fonhwilhcorlrplywithtlusprovisions.. <br />WARNINGT Failure $ secure workers conrpensation aoveraSc is unlawful. md shnll subjecl in cmployer lo criminnl penaltics trnd <br />Scction 3076 ot thc tnlxI Codc, iilcrcst and atbrrcv's lccs. <br />a <br />LICENSED CONTRACTOR <br />DI]CI,ARA'I'IoN <br />I hereby nftrnr under tEnnlly of Ftjury thrl I inr licencd under provision of Chapter 9 ( cornnEncing with Section 7fi)0) of Division :l <br />o[ lhe Irusiness and l)rolessiors ('ode. atrd rnv liccn\e is in full force xnd effcct. <br />Licetrse Cluss:_Liccnse Nunlberl <br />CONSTRUCTION LENDING AGENCY <br />I hcreby allirrn undcr pnalty ol pcrjury that thctc is a construction hnding aScncy lor the pcrfoilnancc o[ thc work lbr which this pcrrnit is <br />issued (Se(. 1097. Cir. C.). <br />lJnder's Nanrc: <br />lf,nder's Addrcs\: <br />APPI,ICANT DECI-ARATION <br />I hrrty affirnlundcr pcnally of pcrjury onc ofthc following deldati(,ns: <br />Dcnrliti{)n Perorits-Asb.stos Notificatbn Fedcral Rcg!lati(tni (Title 40. Pd6) <br />_Rcquircd Lctlcr of Nolification <br />_l cenili lhd lhc tederalrcSulations rcgildin8 asbeshs rcrmval tue not applicablc to this pmj€t. <br />_l cenify tlul I luve rcad this afplicalion od stalc lhal llrc ah)ve itrformtion is corect. I agre to conply with sll City ud County <br />ordillmcs md State bws rclating to building consttuction. ud hcreby authorize rcprcsntalives of lhis City atrd County lo entd upon thc <br />abovc trenlioncd propcny for <br />Appli(atrt or Ag0t <br />l'cmrilcc [anrc <br />PUrlx)scs. <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueing <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 />Ceilings (T-Bar Rough) <br />lVeter Release <br />Rouqh <br />Service lVleter <br />FINAL <br />Notes, Remarks, Etc.