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ELECTRICAL.INSPECTOH RECORD <br />Hev.08-07-2015 <br />APPROVALS DATE ID/SIG.COMMENTS OWNITR BUII,DIiR I)t:l-CARATION <br />I hcrcby affrnr undcr penaky of perjury that I atrl exctrrpl fronr thc Contraclos' License law for the followilg rcason (Se.7031.5 <br />Businc$s arxl Prolcssion Codc): Any Cily or Counly which rcquircs a prmit to construct, allq. improlc, dcrmlish or rcparr my <br />struclure, Irior to its issuance. aLso requircs lh. applicaot for such p€mrit k) Iile a signcd statcmnl that lE or shc is liccNed pursant <br />lo the pmvisions of llE Contractor's l-iccnscd lrw (Chapter 9. Commcncing wilh Scclion 7000 of Division 3 of thc Busincss and <br />PrcfessioDsCode)orthatheorsheiscxernpl(herefronlandllPbasisfortlEallegedexenlpltm. AnyviolaliurofsecrionT03l.5byilry <br />ilpplicxntfornpenniltubjeclslhe applicant(oilcivilpcmltyoInolmorethrnfivehundreddollars($5m). <br />_1. ar owncr ol thc prolErly, or my cmployecs with wa8es as their Mlc co,npcnsation, will do thc work and Lhc stmtue is mt <br />ine[led or offcred for Mlc (Se.70.1.1. Busincss and Prcfcssions Code: Thc CoDlractor's Liccn* kw d@s not apply to u owncr of <br />thc propcny who builds or in{roves lhsdnr ild who does such work hinrself or lrrscl f or tlmruglr his or hcr own enlployees, <br />providcd that such irnprovtrrcnts rc mt intcnded or olfcrcd for salc. ll, howevci OE boMing or irprovcmnt is $ld within one yco <br />ofcompletio[ the OwEr BuiLler will have thc burdcn ofpnrving tlu hc or she did rct boikl or inrprcvc thc pmpqty for (h. purpo* of <br />*rlc). <br />_1. ns ()wner ofthe prrrperty, am cxclusivcly contracting with liccnsed contraclors to construcl thc prcject (Sec. 7044. Business <br />aryl PnrlissirCode;TheContraclor'sLicenseLawd(xsnotapplytoanownerofproFnywhobuildsorinprovesthercon. <br />and who contracls for such p(lt'cts with a Conlracktr(s) liccNd pursuml to thc Contracbr's Liccn$c Law). <br />-l <br />ereiempt uoder Sectiur , B. & P.C. lbrthis Eason. <br />E9E[EB!!;QMT-!]N!AII9N <br />DECLARATION <br />I hercby aflirnr undcr pcnalty ofpcrjury onc ofthc lollowing dcclua(ions: <br />_IhavcardwillnuintainaCenificateofC'onsnttoSclHnsucforworkers'comlrrsation,s prcvidcdforbySetion3T00oftlE <br />lahor Codc, for (hc pcrfonmrce ofrhc *ork for which lhc permit is irsucd- <br />_lhaverndwillnHirillinworkers conrpensali(nriilsurrtrce,as requiredbyScclion3T0OofthebhorCodc,forthcpcrfomumeof <br />(hc work for which this rroit is issucd. My workcrs' con4rcnsatio[ insurmcc cuicr ilxl lDlicy Dun$er uel <br />n Cer . <br />Policy <br />_l cc(ify that ir lhc lErfornuncc o[llrc work for which this Frmit is issucd, I shall mt cnrploy any in dy manncr <br />so as lo becorrc subjcct to thc workcrs' coillpcnsation laws of Crlilomia, and agrce that if I should bccorrc subject to the <br />worters' conrlrnsationprorisioNof Sec(ion1700of thc LaborCode, I shall, fonhwith@mplywilhlho*prcvisioru.. <br />WARNING: Failure lo *cura worlers'compcnsstion covcragc is unlawful. trd shall subjcct d cmploycr to oiminal pcmhLs and <br />civil I'lres up lo onc lrundred tlDusand dollars ($ I 00,000). in additiur to thc danuges as provided for the <br />dbrN)"s lccs.K <br />I lfrcby affirnr under lxnaltyofperjury that I anr licen*d '("')?2ry5Y""'o[ thc Busincss and Professions Codc. and my license is in full fore rnd effect. <br />LieeDsc Nutrrber: <br />CONSTRUCTION LENDING AGENCY <br />I hercby al-llrm undcr Fnahy of pcrjury that thcrc is a conslruction bnding a8crcy for thc pcrl'ormrcc of thc sork lor which this fErmit i\ <br />issuerl lScc. 1097, Civ. C.). <br />Iruler's Nanrc: <br />tJndcy's Addrcss: <br />APPI,ICANT DECI,ARATION <br />I hrcby irffrmundcr 1^-nalty of pcrjury onc of thc following dEluations: <br />Dcmolilion Pcrnits-Asbcslos Notification ltderal Rcgulalions (Titlc 40, Part6) <br />_Rcquilcd Lcttcr of N(nificrtion <br />_[ ccrtily that lhc Itdcral rcgulations rcguding asbcsk)s rcrfr)valdc nol applicablc to this projcct. <br />fil ""nity rtrrr I luvc rcad this application uxi statc thal lhc ahovc infortrHliotr <br />ordinanccs and Statc Laws relnting to building <br />above mntioncd prcpcny for inspcction <br />ApplimDl or Agent <br />I'cmlil(c nanrc <br />Site-Work <br />Underqround <br />Pole Bases <br />Lioht 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 />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Wdls (Conduit) <br />Walls (Rouoh) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />ltleter Release <br />Rough <br />Service lVleter <br />F!NAL h-$-a U 1I \[, <br />Notes, Remarks, Etc.U