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ELECTRICAL.INSPECTOR RECORD
<br />Hev.08-07-2015
<br />APPROVALS DATE ID/SIG.COMMENTS OWNI:,R BUll,l)llR l)I.),CARA'IIoN
<br />I hereby affirnr under peDalty of perjury that I anr exempt fiun) the Contraclos' License Law for the followilg reason (Sec.7031.5
<br />Busincss and Prolcssion Code): Any City or County which rcquircs a pcrtnit t) construct, altcr. irnprovc. dcmolish or rcpair any
<br />structurc, prior k) its issrance. also requires the applicaut lbr such pertrit b file a sigiled statemeilt llut he or she is Iicensed pursuatt
<br />to thc p.ovisions of thc Conractor's Liccnscd lrw (Chaptcr 9, Comrncncing wilh Scction 7(yJ0 ol Division J ol thc Busincss and
<br />ProflssioD$Code)orthatltorsltisexemlntlEretronraildthebasisfartheallegedexen4niotr. AnyviolatiolofSeclionT03l.5byany
<br />npplictrDtforupernitsubjectrthe.pplicanttoacivilper)altyofnotnmrethunfivehund,cddollars($500).
<br />_1. as owncr ol-th!. proJr(y. or ilry crnployccs with wagcs as thck solc comlcnsali(n, will do thc work and thc {ructurc is mt
<br />irlenrled oroffcrerl for sab fsec.7()'l4. Busirress and Prcfessi<rrs Code: The CoDImclor's License Law does not apply tr an owner of
<br />theffi)pc(y wlrcl)uildsorirrprovcslherdnr,aildwhodoessuchworkhimselforherselfortltroughhisorherowilenlployees,
<br />providcd that such inrp()vclrcnts arc nd intcndcd or ollcrcd for salc. Il, howcvct thc tuildinS or irnprovcrrcnl is sold within onc ycaa
<br />ofconlretion, the Owrrer ltuiltler will have the burden otproving tlut he or she did not build or improve tlre pm[Efly for the purF)se of
<br />sale).
<br />_1. as owner ofthe prcpefly, ilm exclusi\el) cotrlrnclin8 with licensed conn aclo s to consl uct lhe prcject (Sec. 7(N4. Business
<br />and [\utessidlCode:'l'hcContruct()r'sLicerseLawdoesnotapl)lytoanownerofpropefrywhobuildsorimproveslhcreon.
<br />and wh() conu'acts lirr such pK,jccts wilh r Contrackrr(s) liccnscd pursuanl to thc Contmclor's Liccnsc Law).
<br />I anrcxcnrpt uDder Secli(,D-, B. & P.C. lin this rea\(nl-
<br />I)atc:-
<br />WORKIiRS' COM I'I]NSATION
<br />DECLARATION
<br />I hcrcby affirDr undcr pcilalty ofpcrjury onc oIthc li,lhwing dccluations:
<br />_lluve andwill nuintaira(leililicateofConsenttoSelf:lNureforworkets'corrpensation,as providedforbySection3T00ofthe
<br />lnhor Codc, for thc pcrlbrnmnce ol thc work lor which tlrc permit is issucd.
<br />\/ have anr.l will nraintxiD workers (olrfensali(n irrsurance, as required by Section 3700 ofthe Labor Code, for the perforDunce of
<br />llic work lbr wlich lhis l,crnrit is i\sucd. My workcrs' comlEilsation insumncc cfricr aod f[ticy trumhcr del
<br /><z\-h{,'I- }r>(.
<br />Policy o\Gt-v
<br />_l ccnify that in thc pcrtilrrancc of thc work lix which this pcrnit is issucd, I shall not cn{roy aDy l)crson i[ ary manncr
<br />so as to bccolrc suhjcct to thc workcrs' conrpcilsalion hws of Culi lbrnia. aDd agrce th{t iI I should becoDr subjcct to thc
<br />uorkers'col4rensationprolisionsofSection3T00oftheLaborCode,lshall,fonhwithcorrplywithlhosprovisions..
<br />WARNING: Failure to secure wokers'conrpensalion coverage is unlawful, and shall subject an crnploycr to crirninal penallies nnd
<br />civil fiues up to ure hrndred th(,usilnd dollars ($100.m0). ir additiul lo cosl of conrpensaliur, danrages as provided lbr lhe
<br />Scction 3076 of lhc Lnlxrr Codc, intercst and attorncy s
<br />,r,"' ?- lV-f,
<br />I hereby affirrl unrler 1)eDahl,of pedury thal , un, ,,."n..d u*#ffi##Chapter 9 {coDunencinS with section ?000) of Division 3
<br />of the Business and l'mfesNions Code. ard rny license is in Iull lbrce and elTect.
<br />LiccDre CA.>NrrrJ,OoY Lto'?
<br />D,ru,-----l-i-l-9-a J
<br />CONSTRUCTION LENDING AGENCY
<br />I hcrcby al linn undc'r Jf,nally ol rcrjury thil thcrc is a co[slruclion lcnding ag('ncy lor thc pcrlbilnancc ol lhc work l'or which this pcflnil is
<br />issued (Sec. 3097, Civ. C.).
<br />Lender's Nrnre:
<br />knder's Addres.:
<br />APPLICANT DECLAR/tTlON
<br />I hcrcby afftrm undcr lrcnalty of pcrjury onc of thc lbllowing dcclarati(,ns:
<br />Denulition Pern)its-Asbcsk)s Notificati()n lrcdcral RcSulations (Titlc 40, Pa(6)
<br />_Rcquircd Lcttcr of Ndilic{tion
<br />_l ccilily that thc I'cdcral rcgulalirnis retading astrcsbs rcrnovalarc nol applicablc to lhjs projcct.
<br />shtc t|al lhc nh)vc inlbrtrhli(nr is corcct. I rgrcc k) con)ply wilh all City aDd Counly
<br />nnd hcrcby nuth(rizc rcprcscntativcs ofthis Cilv and County kr cntcr ulnn tlrc
<br />ilboYe nreilti(nred pfi)ltflv ftn'
<br />Alrplicant or Agcnt
<br />llcrilrilcc ilxnr(
<br />D^t"' '74V'7)'
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinos (T-Bar Rouqh)
<br />ft/eter Release
<br />Rouqh
<br />Service lt/eter I
<br />FINAL '5/l/ /7n /485!1r,
<br />Notes, Remarks, Etc.I
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