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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER RUII,DER DEI,CARA'IION <br />I hecby aflinn under poalty of psjury that I m cxempl from lhe Contractos Licme lav for thc following remn (Sc.7Cl1.5 <br />Busilss and Profsion Codc): Any City or County rvhich rcquires a pmnit lo construcl, alt(. improve, dmohsh or repair my <br />structure. Frior lo its isuance. also rcquirB the applicant for such [Emit to file a signed statonml that he or shc is licosed pursuilt <br />lo the provisions ofthe Conlractor's Liccnsed Larv (Chapts 9. Comrnencing rvith Selion 7000 of Division 3 ofthc Businesl md <br />Professions Code) or that he or she is exempl thsefrom and the bsis for the alleged exemption. Any violalion ofSdtion 703 L5 by any <br />applicant for a pmit subjsts the applicant to a civil penalty of nol morc thm five hundrcd dolles ($500). <br />I. c orvnr ofthe prop€(y. or my employeG with wag6 6 their sle cornpquation, *ill do the work ad thc sructwe is not <br />inlodql orolleredforslc(Se.T044.BusinsadProfesionsCode:ThcContractor'sLicoselrwdo6ootapplyloanownflof <br />theprcpeny whobuilGorirnprovGthqon.ildwhodo6suchworkhimselforherselforthroughhisorherownemployeG, <br />provided lhat such improvmots oc not inlmded oroffocd for ele. lf. horvevs. the building or improvenent is sld rvhhin one ya <br />ofcornpletion. the Orvns Builds will have the budfl ofproving lhd he or she did not build or improvc the prcpsly for the pupo* of <br />sle). <br />l. d owncr ofthe fropdy. m erclusively contracting with lictrsed conlractoE to conslruct the prejd (Ss. 7044. Buins <br />and PrefrsionCode:'lheContractor'sLicenseLawdo6notapplytoanownsofpropffy$'hobuildsorirnprovBlhs@n. <br />and rvho contracts for such projets with a Contracto(s) licensed pulsuant to the Contrack)r's Licmse Larv). <br />I m exemDt ud6 Sstion-. B. & P.C. for ihis reqson. <br />l)rte:Owner:_ <br />ruaBKEES:CAitTXENS <br />DECLARATION <br />I hoeby affrrm undo penalty ofpsjury onc ofthc follorving declaations: <br />_ _l have md will maintain a Cmificate of CoBot to Self-lnsure for work6s' compmation. 6 provided for by Sdtion ]700 of the <br />Labor Code. for the pofomucc of thc rvork for which the psrnit is isued. <br />qaf'f,Ive and rvill maintain workm' compensation insurance. as required by Sslion 3700 of the Labor Codc. for the pcfomecc of <br />thc srrrk lirr UC: <br />t o- /-\3 <br />- I ce(ify that in the poforrnance ofthe rvork for rvhich this psmit is issued. I shall nol mploy any peNon in any mann6 <br />so 6 lo become subj(l to the workqs' cornpensalion la\r's o f Califomia. and agrtr lhal if I should tEcome subj(t to the <br />workqs' compensation provisions ofSmion 3700 ofthe l,abor Codc, I shall. forlhwith comply with those provisions.. <br />IVARNINC: Failure to scue \rorkers'compwlion covqage is unlarvful. and shall subiect m mploye to oirninal pelaltie and <br />civil fines up to one hundred thousand dollaE ($100,000), in ad(lilion lo dmagcs m provided for the <br />Sation 30?6 of the l:bor Code. intqGt ud anomey's fe. <br />a <br />DECLARATTON <br />I hreby affinn unds p€nalty ofpqjury that I m licssql undtr prevision otChapts 9 (commenciog with S(lion 7000) ofDirision 3 <br />of the Businas md Proicsions Code, md my licose is in full force od effect. <br />! <br />License Class:- <br /><l 3ts7t"pLiceme Number: <br />Date:contractor:-F <br />-ZNCONSI'RUCTION LENDINC AGENCY <br />I hoeby aflirm undo lrralty of perjury that lhqe is a construction loding agsrcy tor the pqfomance of the work for which lhis pcfinit is <br />issued (Sa. 3097. Civ. C.). <br />Lods's Addr6: <br />- <br />I hedry amm unds pcnahy orpalury one of ,n" "ffiffiffiffiloNDenolition Permits-Asbestos Nolification Fedsal Rcgulations (Title 40. Pan6) <br />-Required <br />Letls of Notification <br />LIPAj;U tl|atrhe fcdqBlregulatioN reSdding dbestos rqnoval6re oot applicablc lo lhis projet. <br />I/[*t, ,n, I have rad rhis applicarion ed srat)ilhat rhc abore rnfonnatron B corect. I agre to comply wilh all crty and County <br />ordinancG md Stale Laws relating to building coy'1r{rction. md [elebyTuthorize reprBqtativs ofthis City md County lo cntq upon thcff*;H:il,:::Elg& D.'u,.- t - )3')p <br />Pemitenamelprint;: D(, <br />- <br />E otOA!F-4 - <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <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 />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL Z-Zo-zp I 21 /o\ <br />Notes, Remarks, Etc <br />-|) <br />cmir:-l Q'Rza-|'l <br />Policy Nurnbe: t y\rd5 -s 4T;E I <br />a <br />Lender's Name: