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ELECTRICAL.INSPECTOR RECORD <br />Rev.08-07-2015 <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUTLDER DELCARA'IION <br />I hoeby aflinn undo penalty of pcrjury that I m excmpt from the ContractoB' Licme Law for the following r6on (56.7031.5 <br />Businqs md Profssion Code): Any City or County which rcquirB a pqmit to coNlruct. alto. improvq dmolish or repair my <br />struduq prior to its issuuce. also requirs the applicmt for such pemi( to file a signcd statmot that he or shc is licmed pmumt <br />to the provisioN of thc Contractor's Licensed Law (Chapts 9, Commencing with Sstion 7000 of Division 3 of thc Busin$ md <br />ProfesiomCode)orlhathe orsheisexemptthsefro,nildthcb6isfortheallegcdexmption. AnyviolationofSationT03l.5byany <br />applicant for a pcnnit subjets thc applicant to a civil penalty of not more thm five hundred dolltrs ($500). <br />I. c owno of the property, or my employc with wag6 6 their sle compwtion. will do thc work ild the struclue is not <br />intmdel or offered for sle (Ss.7044. Businas md hofesions Code: Thc Contraoor's Licw t,w doe nol apply lo u oMer of <br />the prcpcity who builds or improve thqen. od who do6 such mrk himself or hmelf or thrcugh his or hr om employee, <br />provided that such improvmmts de not intoded or offsed for sle. lf, howwq. the building or improvmot is mH within one )s <br />ofcomplaion, the o\vnq Buildq will have the budm ofproving that he or she did not tilild or improve the prcpcty for the purpos of <br />rlc). <br />_1, c oma of the propsty, m exclNivcly conlracting with liceNed contracloB lo coNtruct thc projcct (S(. ?044, Buins <br />ed &ofBsiof, Code: The Contractor's Licose Law doe nol apply to m owns ofpropeny who buil& or improves thsso, <br />and who contBcts such pojccs with a Contracto(s) licffid pursuet to the Iaw). <br />Itun P for this <br />I hseby affrm undtr penalty ofpojury one ofthc following <br />I have ed will mintain a Cqtificate of CoNdt to Self-l6ure for workm' compouation. o provided for by Sction 3700 of thc <br />Labor Code, fo. the psfomucc of the work for which the pmit is issued. <br />_l have and will maintain workm' compcNation i6uruce. 6 rcquired by Sction 3700 of thc Labor Codc, for the pqfommcc of <br />thc work for which this psmit is iscd. My work6' @mpqtsation irourmce cmiq od policy numbo oe: <br />Cmir: <br />Policy Numbcr: Expirc: <br />_l certify thal in the pqfonmnce of the work for which this pornit is issued. I shall not mploy any prson in my mmncr <br />s 6tobc{omesubjecltothcwork6s'compemationlawsofCalifomia,mdagreethatiflshouldbecomcsubjsttothe <br />workffi' compeNtion provisiom of Sction 3700 of the Labor Code. I shall, forthwith comply with those provisions.. <br />WARNTNG: Failure to wuc workers'compemation covcrage is unlawful. and shall subjat ilploys to qimiml pstsltics md <br />in addilion to the cost of dmage o provided for thc <br />I <br />t)t.:( l.,^R,\'t ()N <br />I h6eby aflim undcr penalty of pqjury that I an licmsed undo provision of Chaplq 9 (comocing with Section 7000) of Division ! <br />of the Busins dd Profesions Code, md my licesc is in full force md effet. <br />Liceree Clrc:-Liccroe Numbel <br />l)alc: <br />CONSTRUCTION LENDINC ACENCY <br />I hqeby affirm undq p€nalty of perjury that thse is a coGtruction lqding agency for thc pofomance of thc work for which this pamit b <br />issuui (Se. 3097. Civ. C.). <br />Lendq's Name: <br />[.ndq's Addr6s: <br />APPLICANT DECT,ARATION <br />I hetby affrm unds pqralty ofp€rjury one ofthc following dalaations: <br />Demolition Pamits-Asbetos Notification Fedral Rcgulatioro (Tille 40, Pm6) <br />-Requircd <br />Lctls of Notilication <br />&;:";::federal regulatiom rcguding rebstos ranoval ae not applicable to this prcjd. <br />I agr€ to comply with allrmd this application ud state that the above and <br />I o,tinanca and Statc Laws relating io oflhis City and upon the <br />I above mmtioned prcpeny for tI Applicanr or Agent <br />I l'rrrnittt rrrnrc u <br />7, <br />,?o?J <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht 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 />Bondinq / Groundinq / UFER z/*{p t W*.rtq+.t*f,e/ <br />Transformers a ur <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinss (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rouqh <br />Service Meter ?,(?4lnP',Ar+N\.tyrO /&) <br />FINAL zlull?A .1t*^^'-)6D <br />Notes Remarks Etc. <br />civil fines <br />Setion