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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEL('ARATION <br />I hereby aflinn undo penalty of psjury lhal I m excmpt iiom lhe ('ontractor' l,icmse Law for the following re6on (Sec.70-] 1.5 <br />Busines md Profssion Code): Any City or County which requirs a pmit to construct. allo. improvq dmolish or rcpair my <br />structure. prior lo its issuilc€. also requirG thc applicant for such frcnhit lo file a signed stalment that he or she b licmed pmumt <br />to the prcvisions of the Contractor's Licensed law (Chapttr 9, Commencing with Strlion 7000 of Division 3 o[ lhe l]usincss and <br />ProfesionsCode)orthatheorshcisexemptthqefromandtheb6isfortheallcgedexmption. AnyviolalionofSalionT03l.5byany <br />applicant for a pmit subjsts the applicanl to a civil penally of not more lho five hundred dolltrs ($500). <br />_1, a ouner of the propqly, or my cmployc with wage as their ole compensation, will do the work md th€ srudue is not <br />intmded or offsed foi ule (Se.7044. Busines md hofsiom Code: The Conlraclor's Licme lnrv doe not apply to an orme of <br />lhepropqty whohuildsorinrgovcth6on.mdwhodo6suchworthimselforheselforthroughhisorheromemployes. <br />provided thal such improvmls tre nol intoded or offoed for sle. I[ ho*'os. the building or impovmot is $ld wilhin one ]@ <br />ofcornplelion. the (Ivnq Buildq will have the burdo ofproving tha he or she did not build or improve the propsly for thc purpowof <br />sle). <br />I. m orvner oflhe propqly. an exclusively contracling wilh licensed conlrack)rs lo construcl the project (Sec. 7044. Bsins <br />and hofsion Code: 'I he Contractor's Licensc Law doe not apply to an orvno of propmy who builds or improvG thtr@n. <br />and ulro contracts for such projats rvith a Contractor(s) licmsed puEumt to the ('onlraclor's LicN ti$). <br />I atr ermDl undq Sstion-, B. & P.C. for this reon. <br />l)alc:Owner: <br />WORXERS' COIIPENSA'IION <br />DECLARATION <br />I hocby aflinn undr pcnalty ofpqjury onc ofthe following delarations: <br />I have md will maif,lain a Cffificate of Consent to Sclf-lnsure for workm compmation, re provided for by Setion 3700 of thc <br />Labor Code. for the pefomance of the rvork for which the pmnit is issued. <br />*have ancl will mainlain workqs' compcnsation instrrance. 6 rcquircd by Section -1700 otthe Labor Code. for the pqfonnance of <br />s,ork for uhich lhis nutnbq ile: <br />2-ol-,?d<)lblicy Numtrcr r <br />---Expires:, <br />-l <br />cenify that in lhe ptrformance of thc work for which this perrnit is issued. I shall nol onploy any person in any mmnr <br />so astobecomcsubjecttotheworkss'conpensationlawsofcalifomia.andagrcethaliflshouldbccomesubj(ttothe <br />rorkm' compesation provisions of Scrtion -3700 of the tabor Code. I shall. fonhu,ith cornply rvilh lhos previsiom.. <br />WARNINGI l;ailu'c lo scure \!rkcrs'cornpensatioil covclage is unla*ful. aod shall suhjecl an onpkryt'r to oinrirral Jurallia and <br />civil fines up to one hundred thousand dollffi ($100,000). in addilion b thc cost of compensation. damages m [or <br />Setion of the Labor interGt dd allomey's fe6-s <br />t)I.( t,,1tL\ I t(.)N <br />I heeby affrm undo poally ofpsjury thal t m ticms€d undq Frovision ofChapts g (commmcing rvith Setion 7000) of Division 3 <br />of the Busins md Profqssions Code. md my licmse is in full force md eff*t. <br />LiceNe Nurnber: <br />.on,.".o,( f-$4Al <br />CONSTRUC'I'ION LENDING AGENCY <br />I hereby amrm under FEnalty of ptrjury that lh6e is a construction loding agmcy for the pqfonnuce of the work for uhich this pqmit is <br />issucd (Sc. 3097, Civ. C.). <br />t ndq's Nmc: <br />Lsrdq's Addrs: <br />-APPLICAN DECI,ARATION <br />I hettryalnnn undq penalty of pojury one of the follorving delarations: <br />Demolition Permits-Asb6los Nolification Federal Regulations (Tille 40. Pm6) <br />Required Lelter of Nolifi cation <br />_ I cffify that the fcdsal regulations rEgdding asbeskrs ronoval arc nol applicablc to this projrct. <br />iilforillalion is corrccl. I agre lo conrply with all Cit y and ('ounty <br />alrcr'e nrentioned propcny for <br />Applic6nt or Agent Signlture: <br />Prrmilce ntrnlc (priilt): <br />i\,6 of lhis Cit, adrfounly <br />-l/,^ru,t) 44 <br />to 6ttr lhe <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildins <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 (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter I <br />FINAL 2/z /zzl ,4-/5/41 t) <br />Notes Rem