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ELECTRICAL.INSPECTOR RECORD <br />Rev.08-07-2015 <br />APPROVALS DATE ID/SIG.COMMENTS 0WNI'R BUII,DER I)I.]I,CARATTON <br />I hcrcby aflrm under penalty of perjury thal I anr cxenpt froD thc CbntractoN' Lic.nrc Law for thc followinB rcaetr (Sec.7031.5 <br />Busincss and Prolbssion Code): Any City or Counly which rcquircs a permit lo cons(ruct. altcr, irnprovc. dcmolish or rcpair my <br />struclurc, pri()r lo ils issuance. also rcquires thc applicatr for such lEnlil lo file a sigilcd slalclEnt that lE or shc is liccn*d pusuant <br />to lhc pmvisiom of thc Conlractor's Liccnscd Irw (Chaptcr 9. Commcncing with Scction 7000 of Division J of thc Business dd <br />Professions Code) or thal lE or slE is erempt therefrom and tlE b&sis tbr dE alleBed exenqairn. Any violation ofSrcrion 7031.5 by any <br />applicantforapcril[subjetsthe npplicrnlloncivilpennltvofrctrmrcthantivchundrcddollars($500). <br />_1. as owncr ol'th(' propny. or nry c rnphyces wilh wagcs as thcir solc cornfrcnsation, will do thc work ard thc stMtwc is not <br />irilended or offered for salc (Se,7044. Busincss and Prcfcssious Codc: The Contmctor's Liccnsc Law dres nol apply to ao owner of <br />thepropeny whohuildsorinDrovesllErqntuldwl$doessuchwo*.hirnselforlErselfortluoughhisorherownenDhy@s, <br />providcd that such improvsmnts dc iln inlcndcd or olTcred fo, salc. Il, howcvq. trc huildin8 or irprovcmnt is eld within onc ycd <br />of completio[ tlE Owmr Buikler will havc thc burrlen of pmving tlut lr or shc rlid rct buil] or impmve 0E pmpdty for th. puqrcs of <br />s1e). <br />_1. as owner o[the prol*fly, am exclusit'€ly contrarting with liccnsd contraclos to conslruct th€ pmjact (Scc. ?(X4. Busincss <br />aril ProfksionCode:TheContractor'sLicenseLawdoesnotapplyk)anownerofpropenywhobuildsorinrprovesthereon. <br />and who contracls for such pro.iccts wilh a Contracto(s) liccnscd pursuet !o lhc Contraclor's Liccnsc [aw). <br />_l anr excnlft under Scctiotr-, B. & P.C. tor tllis reason. <br />WORKI'RS' COMPENSATION <br />DECLARATION <br />I hcreby afllrm undcr pcnaltyofpcrjuryonc ofthc lbllowinS decl{ations: <br />_lhavemdwill nrutiluiDaCeflilicateofC(nNcntk)Selll[suref(rr*orkers'conrpensation,as providedforbyScction3?00ofthe <br />lrhor Codc. tor thc pcrfornrancc ofthc work lbr which thc pernit is issucd. <br />_l have and will rMinlain workeB cotrfcnsalion insura!rec. as requircd by Scclion 3700 of thc lrbor Codc, for thc Frfoffie of <br />thc work lbr which this is My inrurmce cmier :url grlicy numbcr de:y\(e ?oI <br />l'olicy L( <br />_l ccnify lhal in lhc l{rlornuncc ot tlr work for which tlris pcrmil is issucd, I shall nd cnrploy my Frson in aoy manncr <br />e astotrccom$ubjccltothcworkers'compcnsationlawsofcalifomia,andagrcethatiflslDuldbecorcsubjectlothc <br />workers' conrlEnrlioo provisions of Section 3700 of the bbor Codc, I shall. fonhwith comply wilh lho* prcvisioN.. <br />WARNING: Failure lo secure workers'comFnsation coveruge is unlnwful, and shall subjcct An employer to friminrl p€nalties and <br />civil lines up rr one lunrlrerl thousand dollnrs (S100.0$0). iIl of compensaliur, danuges as provided for the <br />Scclion intcrcsl and rlk,rncv s ltcs. <br />LICENSED CONTRACTOR <br />t)ECl,ARAl tON <br />I hcrcby affirnr undcr Fnalty of pcrjury thlt I 8nr liccnsd undcr povision ofchapter 9 (cotnnEncing with Srction 70m) of Division 3 <br />o[ the Busincss and l'refersions Codc, rrrd rny liccnse is in full force and cffcct. <br />qL6-7 6 <br />CONSTRUCTTON LENDING AGENCY <br />I hcrcby allirm undcr rtnalty of pcrjury that thcrc is a construction lcnding agcrcy for thc perlbflnarce ofthe work lt r which this pcrmit is <br />issucd (Sec. 309?. Civ. C.). <br />Lender's Nanlc: <br />knder's Addrcss: <br />APPI,ICANT DECI,ARATION <br />I h*cby ttftimrundcr p.nalty ofperjury onc of thc following decl4f,ti()ns: <br />Demolition Pcrnits-Ashcsk)s Notification Fcdcral Rcgulations (Titlc 40, Pm6) <br />_Rcquired Lrttcr oI Norifi olion <br />_l cffify thal lhc fcdcral rcgulalioN rcgudinS asbcstos rcrreval {c not applicablc to this pmiEt.rT <br />lll ccnity tlut I luvc rcad this application axl statc tlHt thc abovc informaliotr is corcct. I sgre b conply wilh all City and County <br />ordinanccs md Statc lnws rclaling to buildinB construction, and hcrcby authorizc rcprcscntativcs ofthis <br />ab()ve nentioned propeny ft)r iDspection <br />Applicsilt or Agmt <br /><bl <br />l'cmrilcc nanr(t\cL <br />tlrc <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / 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 (Roush) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Roush) <br />I/eter Release <br />Rouoh <br />Service lrleter <br />FINAL {^-lo -ad \Y-r <br />"\JLtNotes, Remarks, Etc. <br />tr