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ELECTRICAL-!NSPECTOR RECORD <br />Rev.08-07-2015 <br />APPROVALS DATE !D/S!G.COMMENTS OWNIiR BUIT,DER DEI,CARATION <br />I hercby affrur uilcr pcDalty of FrJury llral I arl exenlpt frcD thc ContretoB' Liccnse l:w for thc followinS rcasn (Sir.7031.5 <br />Busincss and Profcssion Codc): Any City or County which tcquircs a lumil to construcl, alts, improve, dcmlish or rcpair my <br />slructure, prior b ils issuancc. also rcquires the applicail for such pcmrit lo fila s sigDed statcmnl that lE or shc is licensd pursanl <br />to lhc pmvisions of thc Contractor's l,icen*d liw (Chaptcr 9, Commencing with Section 7000 of Division 3 of thc Blsircss and <br />ProfessionsCode)orthatheorsheiscxemfttherefromaodtlEbasistbrtlEallesedexenlption. AnyviolalionofSectionT03l.5byany <br />applicrnt for a pcnnit subjects the .pplicunt lo r civil pcnalty of not mrc than fivc hundrcd dollars ($500). <br />_1. a\ owner ol th( prolEiy. or my cmployccs wilh wages as thcir mlc compensation, willdo thc wo* ard the stmuc i\ mt <br />imcnlerl or offcred for sle (Sa.70.!{. Busincss and Prcfcssions Codc: Thc Contraclor's Licens law d@s not apply to sn owncr of <br />thepoltrly whobuild$orinDrovesllEre[ddwlDdoessuchworkhimselforlErselforthroughhisorherownemployecs, <br />providcd that such irnpmvcmnls dc ret inlcdcd or ollc&rd for slc. l[ hoscwi tlrc building or ifipmrcmil is $H wilhin orc yed <br />ofconpl.lio[ thc OwrEr Buildcr will have the burdef, ofpNving that lE or shc did nd build or iftprcvc t]rc prcpcny lor lhc purF)* of <br />Mle). <br />_1. as owner oflhe propefly, am cxclusively contraclinS with licensd conlractors to constuct lhc prcject (Scc. 7l}14, Busincss <br />axl PrrltsionCode:TheContracbr'sLiccDseLawd(tsnotapplytooownerofpropedywhobuildsoriDprovesthereol <br />and who conlracts for such proiccts with a Contractor(s) liccnsd pursumt to thc Coilrador's Liccnsc kw). <br />-lanrexemptundqsecti0[-,B,&P,c.tb.tIrisreason, <br />WORKI'RS' COMPE,NSATION <br />DECLARATION <br />I hcrcby affirm undcr pcnalt), ofperjury one ofthe li,llowing dcclilaliotr: <br />_lhavcardwillltsintainaCenil'icatcofconsentloSclf-l[surcforworkcrs'conrperoalion,as prcvidedfo,byScction3T00oftlE <br />tnhor Code, for the pcrfofl)lee of thc work for which thc pcrmit is issued. <br />_l have ard will nlairilain workers'S(l(n 3700 of thc kbor Codc, for thc Jrcdomume of <br />I cffiicr iuxl plicy nunficr uc:thc work rhix ltrnit is <br />)t'olicy <br />_l ccnity lhat ill thc ltrfornuncc of the work for which this pcrnril is issucd, I slull not cnlploy my lErson in uy manncr <br />so as to hccorrc subjccl to thc workcrs' con)pcNalion laws ofcalifonlia. and agrcc lhrt if I slnuld hccorrc subjec( to thc <br />workers'conrlED\atioDprovisionsofSectioD3T00oftheLaborCoJe,tslull,fonhwithcorDplywiththosprcvisions.. <br />WARNTNG: Irailxre k) securc worker\'compcnsalioh covcmSc is unlawful, and shall <br />dollars ($100.000). in additio[ to tlt cost of <br />subjcct an cmployer to qimindl pemhiqs and <br />comp€[salion, dmugcs as providcd for lhccivil fincs up lo onc llundr.d thousand <br />atlorncy's lecs. <br />l <br />) <br />I)I]CLARATION <br />I hcrcby affrnr under lEnxhy of perjury that I anr liccrrsed under pruvision ofChapter 9 (corntrEncinB with Section 7000) of Division 3 <br />of thc Busincs\ and <br />ff*'* <br />Codc. afii my liccns is in full fore drxl cffcct. <br />Licansc 1,1 A ( <br />CONSTRUCTION LENDING AGENCY <br />I hcreby allirm undcr Frnalty of pcrjury (hd thcre is a coostruction bnding sgercy for the pcrfonnarce of thc work lor which this pcrmir is <br />issued (S.c. 3097. Civ. C.). <br />[Jndd s NanE. <br />[.nder'" Addrcss: <br />APPI,ICANT DECI,ARATION <br />I lmby allirm umlcr 1--nalty of pcrjury one of the folkrwing decldatbns: <br />Dcmlition Pcrnits-Asttstos Notificati()n Fcdcral Rcgulations (Tillc 40. Pd6) <br />_Rcquired httcr of Notification <br />_l ccrtity that lhc lcdcral rcSulations rcSilding asbcstos rcrmval dc not applicablc to this pmjcct. <br />abovc rrcnlfuncd pmpcny for inspcction <br />Applicant or A[enl <br />Pcrnrilc( trrnrc I <br />stalc lhal the <br />Site-Work <br />Underqround <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 />Buildinq <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Translormers <br />Torqueinq <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 />Itrleter Release <br />Rouqh <br />Service lrleter /a\ <br />FINAL )0-7A }}.lL\t) <br />Remarks Etc.