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ELECTRIGAL.INSPECTOR RECORD <br />Bev.08-07-2015 <br />APPROVALS DATE ID/SIG COMMENTS <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 / Groundinq / 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 />Ceilinqs (T-Bar Rouqh) <br />l\Ieter Release <br />Rough <br />Service [\4eter It I <br />FINAL 1/'Lp'W <br />Notes, Remarks, Etc. <br />owNlrR BUIt,l)l,iR 'l I()N <br />Ilrcrebyaffrrlunrlerp€naltyofperjurythalIiuDcxemplfronrthcContractos Licensel-awforth.followinBreaen(Scc.7031.5 <br />Business and Prolession Codc): Any City or Coun(y which rcquircs a lErmit to construcl, altcr. irnprove. dcmolish or rcpair any <br />structure, prior to its issuancc. also rcquires thc applicilil lbr such Frcmil to fih a sitsued slatcnEnl lhat lE or shc is liccrl€d pursant <br />lo thc provisions of thc Conlraclor's l-iccnscd llw (Chaptcr 9. Cohmcncing with Scction 7U)0 ol Divisioh 3 ol thc Busincss md <br />Professions Code) or that he or she is exemlt thercfrom and tlE basis for tlt alleSed er.n)plion. Any violllion of Section 703 1.5 by any <br />tpplicintforcpennitsubjectsthe applicanttorcivilp€naltyofnotnDrethanfivchundreddolhrs($5fi)). <br />_1. &s owncr of lhc propcf,y, or my cmphyces with wagcs as thcir slc compcnsation, will do thc wtrk and thc sMft is mt <br />intcnlal or offercd for slc (Se.7(X4. BusiDess and Profcssions Codc: Thc Conractor's Licc[E lrw d@s nol apply lo o owncr of <br />theprc[Efly wlFbuildsorim{nowsllHqnlardwlEdBsuchwo.khimselforhersclforthrcuthhisorherownenrployes, <br />prolidcd fiat such imprevorcnts re mt intcndcd or otfcrcd tor saL. Il, lnwevs. orc boilding or irrprovcm0t is $ld within orc )€il <br />ofcotrpletion, the Owrer Buikler will havc thc bordcn ofpmving thd hc or shc did mt build or impovc 0E pmpdy tor thc plrpos of <br />as owrcr of the prcpmy, am cxclusivcly contracting with liccnrd contretoa to conslrucl ltE prcjcct (Scc. 7Ot4, Busirc$ <br />Code: The Conkactq'3 License Law des not apply to o owrcr of propeny who builds or improves thd@n. <br />and s'ho conms for such proj(6 with a Codmto(s) lteNcd pursud to tlE Contrador's LiceN L.w). <br />-l <br />illexempt undff S*tion-, B. & P.C. for thi! Ea$n. <br />WORKI.'RS' COMPf,,NSA'rlON <br />DECLARATION <br />I hcreby atlirm under penahy of perjury onc of thc tbllowin8 decldatioN: <br />_lhaveandwill nEintainaCeniticatcofConsenttoSel[lNureforworkrs'conrFnsation,as prcvidcdforbySection3T00ofthe <br />tibor Code, for the frcrfornt4e of thc work lbr which lhc pcrnit is issucd. <br />and will nEirilaiD workers'insurancc. as by Scclion 3?00 oflhc lakrr Codc, for thc FErfomBrree of <br />nunrht'r a'c: <br />Policy /r) <br />_l ccnily that in lhc lErfornrancc of tlrc work for which this pcrnril is issucd, I shilll not cn[k)y any lEr$on in any milnncr <br />so aslobccorrcsuhjcctlolhcworkcrN'compcnsnlionlawsofCalilorDia.andagrccthatiflshouldhccotrrsuhjccttothc <br />workers'conrlxnsationprovisiorsofSectionlT00oftheLahrrCode,lshall,fonhwithcorDplywithtlosprovisions.. <br />WARNNG: Failure Io secure workers'compensalion covcragc is unlawful, tnd shall subjccl nn empbycr lo cyiminal pcnahies and <br />conrpetrsali{ill, danugcs as provided for thecivil fiDes up to oDe hundred thousatrd dollars ($l in ilddili)[ ti) llr cost 0f <br />atbrncy's <br />l-tCENSEt)CON]R ("IOR <br />I hercby affrnrunder penalty ofpcrjury that I anr liceu*d <br />t)t:(:l.ARA1l()N <br />umirr prov,sii)[ 0l rChapter 9 (cotrurrncinS with Scction ?000) ofDivision 3 <br />of the Business and Codc. ard my lic.ns. is in full fore snd cf[.ct. <br />LiccDse Nunrber: <br />CONSTRUCTION LENDING AGENCY <br />I hercby afiirm undcr pcnalty of perjury thd thcrc is a construclion bMing agcrcy tor thc pcrlorMrcc of thc work lbr which this psmit is <br />issucd (Scc. 3097. Civ, C.). <br />knder's Nanrc: <br />[.nder's Addrcss: <br />AlttlsNl.pgc!&M <br />I hachyaffmundcr pnalty of pcrjury ore of thc folbwing deldalions: <br />DcnFlition Pcrmits-Asbcsbs Notification Fcdcral RcSulations (Tillc 40, Pd6) <br />_Requirei btter of Ndificatbn <br />ccrtily thd thc fcderal rcgulations rcgtding asbcstos remval uc not applicablc to this pmj(1. <br />ccnify that I lEvc rcad this application axl statc thal lhc ak)vc inforrilation is corccl. I agre to with all City and Coun(y <br />and State liws rclating to County to cnter ufbn <br />abovc rrcn(ioncd propcny for inspcction <br />ADplicant 0r Agrnl <br />It'rnrilcc nanrc <br />ard hcrcby auttnria rcprc$ntativcs ofthis