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ELECTRICAL.INSPECTOR RECORD <br />Rev.08-07-2015 <br />APPROVALS DATE ID/SIG COMMENTS OWNI'R BI.'TI,DIiR DEI,CARATI0N <br />IhercbyaffirnrunrlerpenallyofFrjurythatIumexemplfromtheContractoN LicenscLawforthefollowilgrcasn(Scc.70]l.5 <br />Busincss nnd Proltssion C()dc): Any City or County which rcqutcs a lErrnit lo construct. altcr, improvc. dcrmlish or rcpair my <br />structurc, prior to its issuance. also rcquires the applicdrl for such lEnuil to fil€ a si8rcd slatcnEnl lhat lE or she is liccnEd pusumt <br />lo thc povisions of 0r Contractor's l,iccnscd Ilw (Chapter 9, Commcncing with Scction 7UD ol Division 3 of thc Busincss and <br />ProfessionsCode)orthalltorslEisexenlpttherefromandtlEbasisfb(tlEallegedexemptiotr. Anyviolationofseclion?03l.5byarry <br />rpplicrntforapernritsubjectsthe dpplicrntlo!civilpenaltyofnotnlorethanfivehundrcddollars($5m). <br />_1, a\ owncr ol-thc prolrny. or my cmPloyccs with wagcs as thcir $lc comfEngion, will do the work ard thc stmtw is mt <br />irlerxlcd or ollcrcrl ftrr salc (Se.7(X,{. Busincss anrl PrcfcrsioDs Codc: Thc Contrnclor's Liccnsc Liw dcs not apply to an owncr of <br />the pfi)p€ny wlrc huilds or inlnoves lheren, and wlD d(Es such work himself or lEr*lf or tluough his or her own enrpkryees, <br />provided thar such irnprovcrrcnts dc not intcndcd or ollcrcd for sle. ll, howcvcf, 0E building or irprovcrent is mld withh one ,r4 <br />of conplclio[ thc OwrEr Builtr will luve the burdcn of proving lhd hc or she did mt build or inprcvc rhe pml$y for lh. purlD$ of <br />sle). <br />_1, as owncr ofthe propc(y, rm cxclusi\cly contructing with lican*d con(ractos (o conslruct thc pmjcct (Scc. 7Ot4, Businc$ <br />arrl ProlbssionCode:TheContractor'sLiccDseLawd(Esnotapplytoilownerofptopenywhobuildsorimproveslhereon. <br />and who contracts for such projccts with a Contrachr(s) liccNd pursumt to thc Conuactor's Licensc lrw). <br />-I <br />anrerempt undcr Secliol-, B. & P.C. lbr (his rcatoil. <br />]y!^lBrg&:l;QllrENsArI9N <br />DECLARATION <br />I lrcrchy afllrm undcr penalty of pciurv onc ol thc l'()ll()wing dcclralions: <br />_l have and will nuinlail a Ccnilicate of Consctrl k) Sclf-lflruc for *ork6s' cotrpeNation, as frovided for by Scclion J700 of th€ <br />tabor Code, for thc pcrfoflllme o[lhc work for which lhc pcrmit is isslcd. <br />_l have afil will nrairnain workers'insuft[ce, as hy Section 3700 oflhe t bor C'ode, for lhe Frcrfornurrce of <br />cuicr anl grlicy nunrbcr ucrthc work lbr wlich lhis is i\rucd. <br />I <br />Policy <br />_l ccnify Ihat in thc lrcrfornrancc of thc work for which this pcrmit is issuL'd. I shall not cmploy uny pcrson in any nunnc'r <br />s as to bccorrc subjcct to lhc workcrs' cotrrpcnsation laws of Calilbmia, and agree lhat if I srould becorre subjcct lo thc <br />worlers' comlEnstrion pruvisions of Scction 3700 of the tabor Code, I slull, fonhwith corr)ply with tho* prcvisiors.. <br />WARNING: Failure to rccurc workcrs'compensaliorr coveruSc is unlawful, and shall subject an amploycr to simindl pcnalias snd <br />crvil llncs up k) one hundred thousrnd dollars ($100.U)0). iil additiul danuges as providcd for lhc <br />Sccli(,n :1076 Cfilc, intcrcst and altorrcy s ltcs. <br />DECI,ARATION <br />I hercby nffirnr u[der ltnnlty of pcrjury that I anr liceosd under pruvision ofChaptcr 9 (conlnEDcinS wilh Scclion 7000) of Division 3 <br />ol the tsusiness and Codc. nnd nly license is in llll for€ and eflect. <br />License Number: <br />W <br />I hercby alllrm undcr Fnally ofpcrjury lhd thcrc is a conslruction lending agcrcy for thc pcrlonnarce ofthc work lbr which this psrnil i\ <br />issucd (Scc. 3097. Civ. C.). <br />[-eNler's Nanre: <br />landcr's Addrcsr: <br />APPI,ICANT DECT,ARA'I'ION <br />I Imhy afiirnr undcr Nnalty of pcljury onc of the ti)llowing dccluations: <br />Dcnx)lition Pcrnrits-Astx'stos Notification Fedcral Rcguldtions (Tillc 40, Ptn(, <br />-Rcquired <br />trllcr (,f Notificaliur <br />-l <br />cc(ili thar thc IcdcralrcSulations rcgildinS asbcstos rcmvaldc not applicablc to lhis pn)jctt. <br />Itcmils nonrc <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht 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 />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Roush <br />Ceilinqs (T-Bar Rouqh) <br />ltleter Release <br />Rough <br />Service l\Ieter n\ <br />FINAL 6-10.A <br />Notes Remarks Etc <br />abovc rEntioncd popany for inspcclion purpo*s.