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ELECTRICAL.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Und und <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 />Buildinq <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueino <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 />lrleter Release <br />Rouqh <br />Service N/eter ll-l't- IZ IN <br />FINAL ffi A -\r{1 ] <br />Remarks Etc I ,^\T-a-(lrAl!,,Yt{41 <br />o\YNER BUII,I)ER DELCARA'InN <br />Ihcrcbyall]rnrundcrfcnflllyolpcrjurylhatIrmcxcilrpttionlthcConlrilcbrs l-iccnseLawlbrlhcfollowirrgrcason(Scc.70-11.5 <br />Busincs\ affl Profcssiol Code): Atry Cily or Counly uhich rcquircs a Jrrnril lo conslnrcl. allcr. inrprovc. dcmolish or rcpair rny <br />struclurc. pri(tr lo its issuan(c. also rcquircs thc rpplicrnt for such pcrmil tr lilc a signcd stntcnEnl lhilt hc or shc is liccnscd pursulrrf <br />to lhc piovisioils of thc Conlraclor's l-iccnscd [;rrv (('hapl$ 9. Conrnrcncing wilh Seclion 7(XX) of Division -j of lhc Busincss xn(l <br />Profcssions(i)dc)orthf,thcorshciscxcnrfllhcrclionlaldthchnsisli)rlhcxllegc(lcxemplion. AnyviohtionofSeclionT0-ll.5byany <br />nfJ,licxnt for u permil subjccls lhc alplicnnl to n civil pcnxlty of ilol ntrrc lhrn lltc hundrc(l dollars (55(X)). <br />_1. ns owncr of lhc pmfErly. or nry cnlpk)yces with wrgcs as thcir solc coilllrcilsali()n. will do thc work 0nd lhc slruclurc is nol <br />iDlcrxlcd or ofcrcd lirr slc (Se.7(I1.1. Busincss nnd Pmlcssions Codcr 'fhe Cinilractor's l-iccnse I-a,f doc{ not apply h an otrrcr of <br />lhcpropcfly whobuildsorimprovcslhcrqnr.andwhodocssuchworkhinrsclforhcrsclforthroughhisorherownimpkryccs. <br />providedthalsuch inprovctrrnlsrtrcnolirilcndcdorolltrcdtor$lc.ll.howcvcr.thchuildingorinprovcmnlis$klwilhinoncyctr <br />ofcomplction. thc Owner Buildcr will hdvc lhc bunlcn o[ proving lhilt he or she did nol build or iiprovc lhc prclrcfly for lhc pu{nsc of <br />salc). <br />_1. ns owtrcr oilhc l)ropcrty. um cxclusivclv conlracling wilh liccnsc(l coDlruck)rs k) cotrslrucl thc prcjecl (Scc. ?()44. Bu\ine\\ <br />rrrd l\rllssirrCodc:_l-hcConlruclor'sLiccnscl.nwdoc\nolrpplyloano!vncrofpropcrlywhobuildsorinlprovcslhcrcon. <br />rnd who contracls tbr such projccts with a Corilrack)(s) liccnscd pursunnl b thc Contrrctor's l,icense l,ilw). <br />I am excmDt undcr Section-. B. & P.C. for lhis reNon. <br />Dete:_ o*ner:_ <br />lVORKERS' CONIPENSA]ION <br />DECLARA'IION <br />I hcrchy nffirill un(lcr l)cnuhy ofpcrjury onc ofthc lirlkrwing dcclrratkrns: <br />_l havc atil will maitilain a Ccrtificatc of Conscnl lo Sclf lnsurc lbr workcrs' corlpcnsation, as providcd for hy Scction 37(X) of thc <br />l,abor Codc. lirr thc pcrfornunce ofthe work for which lhc pcrmii is issucd. <br />_lhrvcandwillnllinlrinworkcrs compcnsalioninsurancc.as rcquircdbyScctionJT(X)ollhcl,rhor(irdc.li)rthcpcrfornunccof <br />thc $r)rk for which thi\ pcrnil is issucd. My workcrs c()nlpensali(rn i[\urilncc cdtricr ilnd policy rrunrhcr arc: <br />Policy Numbcr: Expircs: <br />_l ccrlify lhnt in lhc pcrfornuncc of lhc work li)r which lhis pcrnlil is issuctl. I shall nol cilrploy nny pcrson iil trny rnnnner <br />souslohcconrsuhjcclk)lhcworkcrs'corrrpen\alk)nlnwsofCalifornil.nndrgrcelhalifl\houldhcconEsubjccttolhc <br />workcr\'conrpcnsrti([provisionsofSecti(n37(X)ofthcl,atnrCodc.lshall.l(nlhwithconrplywilhlho$provisions.. <br />IVARNING: Fuilurc lo sccurc workcrs'compcnsxtion coverilgc is unldwlirl. and shilll suhjccl an cnrploycr p-*nrltics an,.l <br />civil lincs up to onc hundlcd rlollars irr lo lhc cosl of ion.rs providcd lbr thc <br />Scclion J{)76 oflhc t.atnr (ixlc.unrl fccr. <br />l)ale: <br />I hcrchy aftirm undcr pcnalt y o f pcrjury that I ant liccnsd undcr pr)vis ion of Chnpler 9 (conrrrcncing with Secl ion 70fi)) of Divis ion .3 <br />o, lhc Busincss and Prolessions Codc. und rny liccnsc is irr lull lbrcc nnd ctltct. <br />I hcrchy atfirm undcr pnalty ofpcrjury lhal t is lcndilg.gcncy for lhc pcr[onrancc ofthc work for which thi( frrillit is <br />irrucd (Scc. 1097. ('iv. C.). <br />l-cDdcr's Nanrc: <br />trnds's Addrcss: <br />APPI ICANT DECI ARATION <br />I hcrcby affirm !ndcr pcnalty of pcrjury onc oI lhc lollowing dcclurations: <br />Dcfr)lition Pcrmils-Asbcstos Nolificotion l;cdcral RcBuhlions (Titlc 40. Pan6) <br />_Rcquircd [f, tlcr of Nolilicali(nl <br />projecl. <br />s ith rll (-ilv irrxl (\,urilv <br />City and County b cnter ulnn lhe <br />I)rlc <br />Liccnsc Class <br />Dalc:- <br />- <br />qT