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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safetv /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Grounding / UFER /*7o-17 B*/oS <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 />Ceilinqs (T-Bar Rouqh) <br />Meter Release /?-/?-/9 b'd /o, <br />Rouqh /o-lo-tq AUcrro> <br />Service N/eter /o-/tt'/,fr\d/A <br />FINAL (tZo -?-o e*t:p lo?m ffi <br />Notes, Remarks, Etc. <br />I hcrcby allirur under pcilahy of pcrjury lhrl I ant cxcrtpl ftom lhc Contrrclors' I-iccnsc Law li)r lhc l'olhwing.rcason (Scc.7o.ll.I <br />Busincss and Prolcssion (-(xlc): Any City or County uhich rcquircs a ltrrnil lo conslruct. altcr. improvc. dcrrrlish or rcprir uny <br />slnrcture. pri()r k) its issuancc. also rcquircs thc applicaDt lt)r silch l*rtrril lo lile il signcd slalcnlcnt lhat hc or shc is liccnscd pursuatrl <br />k) thc prolisiurs o[ ttrc Contrrck)r's Lictrrscd [-arv (Chaplcr 9. Conrncncing wilh Scctiotr 7(n) of Division .l ol thc Busincss flnd <br />ProfcssioDsCodc)orthnthcorshciscxctrrptlhcrcfromanrlthchasislbrlhcsllcgcdcxcmplhn. Anyviohlio[ofScclhnT(Xl.5byar.y <br />appliciltrl lbr n pcrnril subjccls lhc applicrnt h a civil pcilrlly of 0ol ilx)rc lhnn tlvc hundrc(l dollnrs (S5(X)). <br />_1. as owncr of lhc propcny. or nly cmployccs with wrgcs as thcir s()lc conlpcnsilli()n. willdo lhc work rnd lhc slftluc is nol <br />intcndcd oroilcrcdforsalc(S$.7{NJ.BusincssandhofcsrionsCodc:ThcG)nlraclor'sLiccnscLxwdocsnolapplytoanowncrof <br />thc prrpeny who builds or iqrrorcs tlrcrd)n. and who docs \uch work hiilr\clflor hcrscll (rr lhrough his or hcr own employecs. <br />provi(lcd that such improvctrcnls irc nol iilcrrlcd or otltrc(l for salc. Il. howcvcr. lhc huilding or improvcrcnt is sold within (nrc ,ril <br />ol coilrphtion. lhc Osncr Buildcr will hilve lhc burdcn of prorirrg that hc or shc did nol build or irnpro\r thc proFdy for thc Jruryns of <br />sslc). <br />_1. ts owncr ol lhc propcny. am cxclusively conlmcliDg u ith liccnsc(l conlract)rs k) conslruct thc projccl (Scc. 7044. Busirrcss <br />and ['nrL\sin]Codc:ThcConlraclor'sLiccnseLawdoesnolapplytoanowncrofl)r)fcrtywhohuildsoriilrprcvcsthcrcon. <br />and $'ho cotrtrrcls lbr such projccts with a Corilrxclor(s) liccn\cd puNuant lo thc Contruck)is Liccnsc l-aiv). <br />_l rnl cxcDrpt undcr Sccl U. & P.('. li)r this rca\on. <br />()$ner <br />WORXERS' COIlIPENSA'TION <br />DECLARATION <br />I hcrcby uffirmundcr pcnallyof pcrjury onc of lhe followiilg dcclarations: <br />44havcanclwill mai[lainaCerlificalcofConsenttoself-lnsurclorworkcrs'compensalion.as providcdti)rbyScclion3Tfi)ofthc <br />tntx)r C(xrc. for thc pcrfonnancc oflhc work for which lhc pcrnrit is i\sucd- <br />fit ^r" ru.ls ill rrrrirtrin workrrs' (otrlpctrsnli(rn insurrncc. ls rcquircd hy I <br />thc!v0rklrtrqhichthrrpenrritirirsuctl.Mywrrkers (rrilrncrr\nlionin\lrrrrxt <br />Scctioil -17(X) ol thc Lrhor Grdc. for thc perli)rnrancc of <br />carricr md Jmlicy nunrher arcr )gur@,lN$\i*)rco <br />ttrlicy N zy'/zoo <br />Poue_l ccrtify lhill in thc pcrfornu which this pcrmit shall nol ernploy any pcrson in any manner <br />so ns lo bccoilrc suhjcct to thc w()rkcrs'conrpcnsation laws ol'Californiu. ilild dgrcc thal il I shoukl becomc suhjccl k) thc <br />workcrs conrJrcn\ation prrristrns ofScctir)n 370{) ol lhc l-ahor ('il|c. I \hnll. li)flhwilh c(nnfly with lhos provisk)ns.. <br />WARNIN(;: Fililurc to *cnrc s,orkcrs'conlpc[\rli(,n coicrarc i\ unlilq'lul. an(l shall (uhiccl an cnrpkrycr lo ohninal pcDahics rnd <br />civil fines up lo onc hundrcd thousdnd dollars (Sl(X).(x)o). in addilion k) thc cost ofconrpcnsation.as providcd for lhc <br />Scctiotr 3076 ofthc Lahor C'ode. intcrcst trnd illlonEy's fccs. <br />I)ille:Applionl: <br />l)t,.( t-,\ti,\'l l()N <br />I hcrchy alllrilr undcr pcnalty of pcrjury that I uil liccn*d under p()vision of Chapter 9 (connncncirg with Scction 7Un) of I)ivision 3 <br />of lhc Busincss and Prcfcssions Codc. and my liccnsc is in full force ud erfccl. <br />Nrrrrrhcr a lgL.t?rf <br />3/zr conrracror: -$- S (LVf$&0 <br />CONSTRUCTION LENDING AGENCY <br />I hcrchy uffirm under Fnalty of pcrjury thut lhcrc is a conslruclion lcnding rgcDcy for lhc pcrfoflnancc of thc work for which lhis pcrmil is <br />issucd (Scc.1097. Civ. C.). <br />Lcndcr's Addrcssi <br />APPLICANT DECLARATION <br />I hcrchy aflinn undcr pcnally of pcrjury onc of the following dcclaralirrns: <br />Dcmolilion ['crnlils-Ashestos Nolificalion Fcderal Rcgulations (l itlc 40. Pan6) <br />_Requircd l.llcr of Nolificati(nr <br />I ccrlil,y thrl thc Ldcral rcgulilli{)trs rcgxrding ashcshs rcriloval nrc nol ilpplicahlc lo lhis projccl. <br />-I <br />ccil ily that hrvc rcatl lhis npplicdtior and lhr(thc alxrvc itrfornnti(rl t\c()rccl.rgrcc lo cotrtply <br />ivc( ofthis City <br />q,ilh rll ('ily anrl Count <br />orrlinartccs rnrl Slatc [nws rclaling altl reprcscnlal arxl (bunty <br />nrcnti(xrcd propeny <br />,^gsrl Q.n, <br />atrrve <br />nxnrt pri ill ): <br />for <br />bu ikl ir8 <br />\lxlc <br />Wtt+S sfL- <br />l)rilc:a/rt <br />urilcr upon thc <br />D6te:-- <br />9/,t <br />lrndcr's Numc: