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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS 0WNI:R BUILDER I)EI,CARATI()N <br />I hcrchy aflirnr undcr penolty of pcriury that I &r cxcmpt fiom thc Conlruct)rs' l,iceDse Law for thc li)llowing rcas8i] (Scc.70ll.5 <br />Bxsinccs aftl Prolcssirn Co<lc): Any Ciry or Counly which rcquires a lrcrnlit lo conslrucl. altcr. imptove. dcnx)lish or reI,air n!' <br />stntcturc.priorloils issuancc.alsorcquircslhcRpplicanttir.suchFrnritkrfilcasigncdslatctrEnl lhathcorshcisliccnscd pursuanl <br />k) lhe provisions of thc Contrack)r's l-iccnscd l;rw (Chaplcr 9. Comrncncing with Scclion 7U)0 of Division 3 of lhe Busincss and <br />ProlcssionsCodc)or(halhcorsheiscxemptthcrcfronarrdlhcbasisl(irlhcallcgcdctcnrplion. AnyviolalionofSeclionT0Sl.5byuny <br />applicrnlfornpcrtrrilsubjcclslhc applicantk)ilcivilpenallyofnotnmrelhanlivehundrcddollnrs($5(X)). <br />_1, t\ owncr ol thc profrcrty. or nly cnrpk)yccs wilh waScs rs lhcil sole coil]pclsalir)n. willdo lhc work aril thc stnrlurc i1 nol <br />intcildc(l orollercdfor{alc(Scc.7(N,l.BusincssandProfcsst)nsC()dc:'IhcClonlrtrckris[-iccnscLawdocsnoltpplytoanowncrof <br />thcprrfEdy whohuildsorinprovesthcrfrnr.ilxlwho(,()cssuchworkhintscll'orhcrscllorlhroughhisorhcrowncmployccs. <br />pr(rvidc(l lhat such inrprovenEnls arc nol iilcndcd orollcrcd lbr srlc. li howcltr. lhc huilding or inprovcrnl is sold within ('n(' ycir <br />ol conlpbti(nr. thc Owncr Builder will hxvc lhc burdcn of provilg thnt hL or shc did nol huild or inprolc lhc pmlrf,y for lhc purpsc of <br />snlcl. <br />_1. rs owDcr ol thc l)rolrc(y. rtrt cxchr\ivcly conlracli[g wilh liccnsc(l conltilclots k) c()nslrucl lhe pr()jccl (Scc. ?044. Busirrcss <br />and l,trrltssinCrxlc:lhcContrxctor'sLicclscl,awdocsnotrpplyloanouncrofprrpcrtyshobuildsorillprovcslhcrcon. <br />and sho conlrnctsli)r\uch[()jcclswilhu('(nilrxcl(,r(s)liccnscdpursunilllolhcConlr^c(or'sLiccnsclnw). <br />I amercmnt undcr Section . B. & P.C. forthis rcason. <br />Dsle:-- owner:- <br />UOEtrEIXiSA&IEENTAIIAN <br />DECI.AEAIIQN <br />I hcreby affirm under pcnally of perjury one ofthe tblhwing declaratiotls: <br />_l have aml will tuintaiil a Ccrtificutc of ('orlscnl b Sclilnsurc fbr rvorkcrs' corqrnsulion. as pmvided for by Scction .17ff) of thc <br />Lnbor Codc. for thc pcrformancc ofthc work for which lhc pcrrrtil is issucd. <br />_l htvc and will lnainttin workcrs' c(rmpcnsation insurancc. as rcquircd hy Scclion 3700 ofthc Labor Codc. li)r lhc pcrfornmnce of <br />thc work for which this permil is issucd. My workcrs' cotrrpcnsalion insurtnce canier and ;xrlicy nunrbcr uc: <br />Policy Nunthcr: Expircs: <br />_l ccrtify thfll iil thc pcrti)rmilncc ol thc work litr which lhis pcrmit is issucd. I shrll nol cnrpk)y rny pcrson iil atry rnanncr <br />so xs kr hcconr \uhjccl to thc \rrrkcr\' coilrpcnsrtaon h*'s (,l Crlilornix. rnd agrc'c thrl if l should hccorrc subjccl lo lhc <br />workcr\' collpcnsrli()n provision( ()f Scclion J7{X)ol lhc [-ilk)r forlhwith comply !vith thosc provisions. <br />WARNING: Failurc k) ecurc uorkcrs' conrpcnsdli()n covcragc <br />civil llncs up b onc hundrcd thousnnd dolllrs ($l()().UX)). in <br />ic l. and shull subjcrt an cmployer to oininal lrcmllics and <br />cosl ()l'conrpcrsali{nl. dantlgcs as providctl li)r lhc <br />Sccli(nl <br />Dale: <br />]076ol rhc L:rtnr Corlc. intcrcst and alttrrcy s fcc(. <br />9'6.!t- nppri""",,{ - <br />I hcrchy aflirnt untlcr pcnalty of pcrjury lhal I anr liccntd undcr 9 (comnrcncin8 rvilh Scction ?(XX)) of Division ] <br />ol lhc Busincss und Pnrfcssions Codc. anrl nrv liccnsc is irr Iull lorcc an<l <br />I -iccr\c <br />I)hle: <br />Nu <br />1 Conlra(tor:( <br />I hcrchy utfirm undcr lEn0lly of fcrjury that thcrc is fl consruclion lcndinS ngcncy for thc pcrfortrEncc of lhc work for which this petnlit is <br />issucd (Scc. .1097. Civ. C.). <br />[*nrlcr's Nunrc: <br />- <br />lf,nder's Addrcs$: <br />APPLICANT DECLARATION <br />I lrcrcby allinrr untlcr pcnally of pcrjury onc of thc folblvin8 dcclaralions: <br />DctrrclilioD Permits-Ashcstos Nolificnlbn ltdcral RcSulations ( Iillc 40. PArt6) <br />-Rcquilcd <br />hltcr of Notilicalk)n <br />-l <br />ccrtify thul lhc lcdcrill rcgulalioils rcgtrdin8 nol rpnlicablc lo lhis pr)jccl. <br />-l <br />ccnify that I havc rcfld lhis upplicalion a,ld slalc wirh all City and County <br />ond County to cnlcr upon lhc <br />?' r(-r 1 <br />or(linrnccs flnd Stnlc Lilw\ rclitilg lo huildinB <br />0bovc rrctrtioncd p(rpcny for in(pcclion purFx,.es.A <br />Applicont or Agenl Signature: ' <br />Penlilec name (print):J.v,u <br />lhc <br />DRte: <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondino / Grounding / 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 Rough <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service [r/eter <br />FINAL lo -2/- t?D,Sth Ao <br />Notes, Remarks, Etc.