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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Ownq-Buildcr Dcclaation <br />I hcrcby affim undcr pcnalty of pcrjury that I m cxcmpt fom thc Contractom' Liccnsc Law for thc following rc6on (scc.703 1.5 BusinBs <br />and Profcssion Codc)i Any City or County which require a pcmit to construct, altcr. improvc, dcmolish or rcpair any structurc, prior to it! <br />issumcc,alsorcquirethcapplicantforsuchpemittofilcasigncdstatcmat thathcorshcisliccnscd puEuuttothcprovisionsofthc <br />Contractor's Liccnscd Law (Chaptcr 9, Commcncing with Section 7000 of Division 3 ofthc Busin6s ud Prof6sions Codc) or tlrat hc or <br />shc is cxcmpt tho€from ud thc b6is fo thc allcgcd cxcmption .Any violation of Scction 703 1.5 by uy appli@t for a pcmir subjccts thc <br />applicut to a civil pcnalty of not mor. thu fivc hun&cd dollas ($500). <br />_1, c owncr of thc propcny, or my cmployccs with wag6 6 thcir solc compcnsation, will do thc work ild thc structuc is not intcndcd <br />or offcrcd fo salc ( Scc.7044, Buinos ild Profqsions Codc: Thc Contmctor's Liccnsc Law doe not apply to o owncr of thc propcny <br />who builds or improvo thqrcon, ild who doe such work hiruclfor hmclfor through his or hcr own cmployccs, providcd tlrat such <br />improvcmcnts rc not intcndcd or offcrcd for salc. [[, howcvcr, the building or improvcmcnt is sold within onc ycar ofcomplctron, lhc <br />Owncr-Buildcr will havc thc burdcn ofprovinS that hc or shc not build or improvc for thc purposc ofsalc). <br />_1, o owncr of the propcrty, m crclusivcly contracting with liccnscd contractors to construct thc projcct ( Scc. 7044, Bsin6s ud <br />Profcssion Codc: Thc Contractor's Liccnsc Law docs not apply to a owncr ofpropcny who builds or improvcs thqcon , and who <br />contracts for such projccts with a Contracto(s) li@nscd pursuilt to thc Contractor's Liccnsc Law ). <br />_l m cxcmpt undcr Scction & P C. for this rccon <br />Datc:Owner: <br />WORKERS COMPENSATION DECLARATION <br />I hcrcby affim undcr penalty ofperjury onc ofthc following dcclaations: <br />_lhavcmdwillmaintainsCcrtifi@tcofConsdttoSclf-Insurcforworkm'compcnsation,c providcdforbySction3TOOofthc <br />Labor Codc, for thc pcrfommcc of thc work for which thc pcmit is issucd. <br />_l havc ild will maintain workc6' compasation isurucc, d rcquircd by Scction 3?00 of thc Labor Codc, for thc pcrfommcc of thc <br />work for which this pqmit is issucd. My wo*m' compctrsstion insurucc triq 8d policy numbcr ac: <br />c"il... <br />Policy <br />I (This secdm nccd <br />l.(****^ <br />not be complcted if thc pmit is for Onc dolles ($100) or 16r) <br />thc pofomecc of thc work for which this ilmit <br />of CalifomiA" md <br />ii i$ucd, I shall not cmploy in any manner so s to <br />bccmc subjcct to thc workcro ' compcnsation lam agrcc that ift should thc <br />compcnsation l?00 ofthc Labor Codc, I shall, forthwith with <br />WARNING:to Sccurc workm'compcnsation <br />($100,000),in <br />il cmploycr Io triminal p€nalris ud civil <br />fincs up to onc hundrcd thousmd dollls addition (o damago ro providcd for thc Scction 3076 of <br />thc Labor Codc, intcrEt ud anomcy's fc6. <br />LICENSED CONTRACTORS DECLARATTON <br />I hcrcby affim undcr pcnalty of pcrjury that I m licensed undcr provision of Chapts 9 (@mmcncing with Scction 70Oo) of Division 3 of <br />thc Businss ild Profcsions Codc, md my licosc is in full forcc and cffcct. <br />Liccnsc Numbcr <br />Datcr <br />I hcrcby undcr pcnalty ofpqjury th8t tloc a agcncy for of thc work for which this p€mit is <br />issucd (Scc. 3097, Civ, C.). <br />Lcndcr's Nmc: <br />Lcndcr's Addr.ss: <br />APPLICANT'S DECLARATION <br />Dcmolition Pmits-Asbqtos Notification Fcdcral Rcgulations (Titlc 40, Pan 6) <br />_ Rcquircd Lcncr ofNotifi@tion <br />rcmoval arc not applicablc to this projcct. <br />corcct. I agrcc to comply with all and Counry <br />abovc mcntiohcd propcny for inspcction <br />Applicmt or <br />Pcmittcc nmc <br />thc above <br />of this City ud to thc <br />Site-Work <br />Underground <br />Pole Bases <br />Light 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 />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />ltrleter Release <br />Rough <br />Service Meter FXPIRI :D\ tt <br />FINAL )ts <br />Notes, Remarks, Etc.JUN 0E Zutu \