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ELECTRICAL.!NSPECTOR 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 Safetv /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 (Roush) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinos (T-Bar Rouqh) <br />It/eter Release <br />Rouqh A IService Meter vwvFINAL6-10-% <br />Notes, Remarks, Etc. <br />BI III,I}I:R I)EI,(--ARA'I'I()N <br />IhercbyaflirnruDderpennllyofFrjurythalIaDexcnrptfroDrlheContractoN Liccnselawforthcfollowingr.ason(Sec.7031.5 <br />Business an Prolcssion Codc): Any Ci(y or County which rcquircs a ;rcrrnit to construct, altcr, improvc, derrclish or rcpair ily <br />structurc, prior k, its issuailce. xlso requircs lhe afplicul for such penril to file a signed slalemnl lhat lE or shc is licced pursuanl <br />to the provisions of th.' Contrackr's l-iccnscd hw (Chaptcr 9, Cornhcncing with Scction 7000 ol Division 3 of thc Busincss and <br />ProfessiolsCode)orlhatleorsht'iscrenuttherefronlandtlEbasisfortlEalle8edexenlplion. AnyviolationofSectionT0Sl.5byany <br />npplicnntfor0prnnilsubjeclslhe npplicanlloacivilpenaltyofnotmorethrnfivehundreddollars($50$). <br />_1. &\ owncr ol'thc proJrnv. or rny crnployccs with wages as thcir $lc comfEnsdion. will do thc work ard lhc stMue i\ mt <br />iilcrxlcd or offcrcd for slc (Sa.7U!1, Busincss and Prcfcssions Cqle: The Conlractor's Liccn* Law d@s nol apply lo an owncr of <br />thc pmFdy wln toilds or inrprows thdrsnl uxl wlb dH such work himself or lxrslf or tkouSlr his or her own enlployes, <br />providcd that such improverrcnts dc not irtc.dcd or ollcrcd for salc. lll howcvci tlrc building or h{rrowrrcnt is $H within onc ycu <br />ofcompleliou the Owrcr Buildcr will havc th. burdcn ofpmvin8 lhd he or shc did rut buill or inrprcvc tlE pmpsly for th. purpos of <br />Mh). <br />_1. as owncr of the prcpcrly, um cxclusirely contracting with licenrd contrscloa to conslrucl tha prcjcct (Se. 7Og. Business <br />afil ftutessblCoderTheContraclor'sLicenseLawdoesno(applykranownerofpropenywhobuildsoriorprovesthereon. <br />and who contracls for such projccts wilh a Cof,(mchr(s) licen$d purslml lo thc Contrador's Lhcnsc llw). <br />-Imrcxert1rtuudersrcti()tr-'B'&P.c'1brtIisrcasn'Dele:- <br />WORKI;RS' COM PI'NSATION <br />pECIA8AIION <br />I hcrcby alfirm undcr pcnalty ofpcrjury onc oIIbc lollowing dccleations: <br />_l have arr-J will nrainlair a Cenil'icatc of Consent b Self-lnsurc for workcrs' cuuFnsalion, as prcvidcd for by Sotion 3700 of the <br />Labor Codc, for thc pcrforrmncc ofthe work lor which thc lcrtlit L\ issucd. <br />_lhaveaudwillnrain(ainworkers'cotr[ensationinsurance,as requiredbyScctrrn3T00oflhetabK)aCodc,fortheperfornEh-eof <br />thc work for wlich this lrcrnrit is i$sucd. My vorkcrs' con4rcnsation imurdcc cuicr dxl Jnlicy oumbcr ue:€v€CC)N ts,4 c-O <br />Policy o 2 <br />_l cenify tlut in thc l)crfornHncc o[thc work firr which thig pcrnrit is issucd, I shall not cmploy any pcrson in any muncr <br />I a to trccom subjecl to thc workcrs' compcnsation laqs of Califomia. and agrcc that if I slnuld bccom subject to thc <br />workers' conrpensation provisions of Section l7U) of the Labor Code, I shall, fonhwith ronDly wilh thos prcvisioos.. <br />WARNING: Failure lo scura workcrs'mmpensalion coverage is unlawful. dd shall subjcct m and <br />civil lines ul) to otr€ hutrdrcd thrusand dollars ($100.UU0). iI additi(trI rhe <br />Scction 3076 intcresl aod dtorrcy's l'es.e <br />Ir,r't.,\t{}\'il( )N <br />I hcrcby affirnr under lEilalty of pcrjury that I rnr licerurl under pruvision ofChaptcr I (cotrurrncing with Scction 7000) ofDivision 3 <br />of thc liusincss aild Profcssions Code. and my license is in lull force and cltcct. <br />Liccnsc Nunlber:L7b <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby alnrm undcr pcnalty of pcrjury lhat thsc is a construction lcnding agcrcy for thc pcrlormarce of thc work lor which this pcrmit is <br />issucd (Sec. 3097. Civ. C.). <br />Irnder's Addrcssr <br />APPI,ICANT DECI,ARATION <br />I lxrchy iillirnl undrr INnalty of pcljury onc of lhe Ii)llowing dccldalions: <br />Dcnrlitkrn Pcrnrits-r\slrstos Ndrfica(()n Fedcral Rcgulati(,ns (Tilc 40. Pu6) <br />_Rcquircd [xllcr of Nolilicati(,n <br />_l ccrtili that lhc lcderal rcgulilions regddinS asbcshs rcmoval{c not applicable to this pmjcct. <br />6t ccnity ttror I havc rcad tlils application url statc tlul lhc uh)ve infornulion is corecl. I agree to cotuply willr all Ciry and County <br />ordinanccs and Sta(c lrws rchtiog to buildinS <br />ak)rc rncntioned property for inspection <br />Appli(sDt or Agenl <br />I'crnrilcc nanlc <br />hcrcby authorizc reFe*ntativcs ofthis Cily md County to entq upon Or <br />\ <br />l:ndcr's Nare: