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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUII,DER DELCARATION <br />I hcrcby allirm undcr pcnalty of pcrjury thal I m cxemll lionl thc Contrack)E' Liccn* hw ti)r llr lbllowinS rcas)n (SR...70]1.5 <br />Busincss ttil Pr()ttssion Cqle): Any City or County which rcquircs a fErnlit to constnlcl. allcr. improvc, dcnrllish or rcpair any <br />structurc. pri()r to its issuancc. also rcquires thc applicant lilr such lErnlil t) file a signcd statemcnl that he or shc is liccn*d pursuant <br />k) thc Fovisi()ns ot thc Conlraclor's Liccnscd ljw (Chaplcr 9. Connrcncing wilh Sccli()n 7(X)0 ol Division -J of tlr Busincss and <br />Pro|ssionsCodc)orthatlaorshciscrcmptthcrelromandthcbasisti)rlhcallcgcdcxcmplion. Anyvi()lationolScclionT0.ll.5byany <br />applicxntli)rapcrmitsuhjcctsthc alplicanttorcivilpcnallyofnotrnorcthdiltivchundrcddollus(S5fi)). <br />_1. as owncr of the proFrty. or my cmployccs wi(h wages ds lheir solc compcnsation. will do thc work drd thc stmtw is nd <br />intcndcd orotl'credlirrulc(Se.?044,BusincssandPrufassionsC(rlc:ThcContrack)r'sl-iccnsLawd(Esnotapplyk]mowncrof <br />thcpn)Fny whobuilds()rimpruvcslhcmn,iurlwlDdessuchworkhimsell'orhersclfotthruughhi\orhcrowncmployccs. <br />providcd that such irnprovemnts dc not if,tcndcd r)rollLrcd li)r salc. ll. howcvcr. the huilding or improvcnrcnl is sold within urc ycil <br />r)fcomplctiur. lhc Owncr Builder will havc the burdcn of proving tlut hc or shc did not build or intprovc thc prufrcny li)r thc purF)sc of <br />sah). <br />_1. ds owner ofthc propcrty. am cxclusively ()ntracting wIh liccnscd r(nilracl(ln t) constnlct thc p().iccl (Sec. 7044, Busircss <br />and PR)ltss([Codc:'l'hcConlraclor'sLiccnscl-awdoesnotapplyk)xnowncroflropcrtywhohuildsorimlrovcsthcrcon. <br />and who conlrarts li,r silch projccts with a Corilracb(s) liccnscd pursudnt to thc Conlrlclor's l-iccnsc Law). <br />llmcxcmDtunJcrsect(,n-.B,&P.C.1brthisrcason' <br />Dsle:- <br />]Y!B6E&I-g9TITENSA]IAN <br />DECLARATION <br />I hcrcby ullirm undcr l^.-nalty of pcrjury onc of lhc lilllowi[g dcclarations: <br />_l havc arl will rruiilain a Ccrtilicatc of Conscnt lo SelLlnsurc tbr workcrs' compcnsalion, as provitlctl for hy Scction 1700 of the <br />tlbor Gxlc, lilr thc pcrli)rmancc ol' lhc work fi)r which thc Pcrnrit is issucd. <br />_lhaveandwillmairtainworkcrs compensali([insurancc,as rcquircdhySection]7(nofthcLahorCodc,fbrlhcpcrt(xmanccof <br />thc w(,rk li)r which this pcrmit is issrcJ. My workcrs compcnsltion insurancc cuicr iukl fDlicy numbcr tre: <br />e ("olzrt <br />Policy <br />.L <br />_l ccdili that in thc l--rfornuncc of thc work li)r which lhi( pcrnlil is issilcd, I shall n(il cmpkry any pcrson in any manncr <br />so as lo hccore subjccl k) thc workcrs' compcnsat ion laws of Calilomia, and agrcc that if I should hccomc suhjccl to lhc <br />workers'conlpcnsali([provisionsol'Sccti(]n-17(X)oflhcLrh)rCodc,lshrll,fi)rthwilhcomplywilhthoscp(]visi(rls.. <br />WARNTNG: Failurc k) *curc workcrs'comlEnsation covcragc is and shall suhjcct m cmplrrycr to uiminal lrcnahrcs ud <br />civil IiDcs !p k) onc thousatrd dollilr{ (Sl0t}.UX)). tn addit()n thc cost of compensation. damxges as providcd ti)r the <br />Scct()n.1(17(,Codc, intcrcst And alt)rncy s ftcs. <br />q <br />Applicrnl <br />I hcrchy allirm undcr pcnalty of pcrjury lhat I am liccnrc,l umlcr pnrvisioil ofChapter 9 (comrcncing with Section 7(X[) of Divistrn ] <br />ol lhe Busincss and Pnrfcssions Ctxlc, arxl my liccnsc is in lull t'or@ iurl cffccl. <br />Liccnsc <br />-L{z1( t-f 6 <br />o I <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby allirm undcr frnal(y of Frjury that lhcrc is a construclion hnding rgerrcy firr thc ltrfomrmce of lhc work tirr which lhis lEmit is <br />issucd (Scc. 1097, Civ. C.). <br />Ilnrlcr's Nrnrc: <br />lahder's Address: <br />APPLICANT DECLARATION <br />I lErchy atlimr undcr pcnalty oi pcrjury one of thc li)li)wing dccluations: <br />Dcmolitir)n Pcrmils-Aslrsk)s Notillcalion Fcdcrrl Rcgulations ('lillc 40, Pd6) <br />_Requircd [.tlcr ol Notiliertion <br />_l ccrlily lhat Ihc lillcral rcgulali()ns usbestos rcn$val arc not applicahlc lo lhis prujcct. <br />_t ccnily thal I havc rcad this thc rhrvc inlinmrtion is corccl. I aSre k) comply with all City and <br />ordinaor('s rnd Stalc I-xws rchlirrg l() <br />afx)vc mnli(trlcd propcrty li)r inspccli(,n <br />Appli(anl or Agena <br />I'cniriteo n{De ( <br />urd hcrchy rcprcscnlalivcs {)f lhis City aod <br />rL tt <br />thc <br />Site-Work <br />Underqround <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 />Building <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 (Rouoh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL olfr/ n ,\l<- v-r A Sxltt) <br />Notes, Remarks, Etc <br />.a <br />iu.r.r-[ ,n