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ELECTRICAL.INSPECTOR RECORD <br />Bev.08-07-2015 <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DUI,CARATION <br />I hcrcby afltrnr uDdcr p€nalry of Frjury that I m excnpt fioft thc Cbolra.loB' Liccnsc liw for thc followinS rcen (Scc.7031.5 <br />Busincss and Prolbssion Codc): Any Cily or County which rcquircs . pcrmit to construct, alts, irnprove. dcmlish or rcpair my <br />structurc, prior to ils issuancc. Erlso rcquircs thc applicilil for such lEmut lo lile a sigrcd statcmil lhat ha or stE is liccred pusudl <br />to lh( pmvisions of thc Conlracbr's l,iccnscd law (Chapter 9. Co,nmencinS wilh Scction 7000 of Division J of the Busine$ md <br />PrcfessionsCode)orthatltorsheiscxenrptthe.efromandthebasisfortltallegedexenrptbn. ADyviolalionofSeclionT03l.5byany <br />applicnnt for a pcmit subjects the {pplicunt to a civil pcnalty of not mrc than fivc hundred dollars ($500). <br />_1. o owncr olthc proFrcny, or my cmployecs with wagcs as thcir solc coml*nsation, will do thc work and thc sttudm is mt <br />iDterr.l,al or oflcrad for $lc (S6.7(X4. Business and Prcfcssions Codc: The Contractor's Liccn* bw d@s nol apply lo e owrcr of <br />the profuly wlF builds or itrprovus lhermn, and wlm d@s such work hiNelf or lErself or throuBh his or her own enrployes. <br />provided that such improwrcnts re mt iilcnded or olle[{ for slc. lt, howcver, 0E buiHitrg or itrprewmil is $H within orc ,ed <br />ofcomplclio[ lhc Owmr Builder will luve thc bunlen ofpmving tha hc or shc did fttr buill or irpNvc fr pntpdly for lhc purpo* of <br />sde). <br />_1, as owner ofthe prpefly, am exclusivcly conlracting with licensed conlraclors to conslruct lhc project (Scc. 7(X4. Business <br />ad f'rctssboCode:TheContrachr'sLicenseLawdcsilolapplytoailownerofpropcnywhobuildsorimproveslhereon. <br />and who conuacts for such projccls with a Conlractor(s) liccNd pursuMl to thc Contraclor's Liccnsc trw). <br />-l <br />mrcxemp( und{ S.crion-, B. & P.C. for this ENn. <br />Dsac:- <br />WORKT]RS' COM I'f,,NSATION <br />PEC!,ABAUgN <br />I hercby aftirm undcr pcnalty ofpcrjury onc oftlrc fdlowing dccl&atio6: <br />_lhavatrdwill nDintainuCenilicatcofconscnttoSclf-l[sureforworkcrs'coDrpensation,as pmvid€dforbyScction3T0Oofth€ <br />Labor Code, for thc lrrfonurcc of thc work for which thc petmit is issucd. <br />_l havc atrd will nEintain workcrs' conlpcrsation insurance, as rcquircd by Sation 3700 of lhc libor Codc, for lhc fErfomurcc of <br />the work for which lhis Frnut is issued. My workers' corp!'nsation insutscc cmicr afil policy rumbcr ue: <br />cmicr: Et€tt$f vvA-l(d,r/4 ( (NS r/lLANc€ co <br />'7 bO OO tq @2 MPolicy _lixpircs: <br />_l ccflili that in thc lErfornunce ol'rhc work for which this pcrmi! is issucd, I shall not cnrploy my 1rcrun rn any manncr <br />s astobccotrEsuhjccttolhcworkch'coilrpcnsationlawsofcalifonlia,anda8rccthatiflshouldbecorrcsubjecttothc <br />sorkers' compensatioD prolisiotrs of Section 3700 of the l-abor Code, I shall, fonhwith corilply with thos provi$ions.. <br />WARNING: Failurc to scurc workcrs'mmpensation covcfrg. is unlawful, md $hall subjcct m crplorcr to oiminal pcmltics und <br />civil titrcs up b one hundred thousand rlollars ($100.01J0). iI addition to the ol cornpensatiul, danuges as l)rovided tbr the <br />lccs. <br />I <br />I hcrcby affrrl undcr penalty of pcrjury that I anr liccnsl undcr prcvision of Chaplc] 9 (conlrcreing with Scctbn ?000) ofDivision 3 <br />of thc Busincss and Pmfcssions Codc, anl mv licens is in full forcc a8l effcct. <br />'Z 67e I <br />Liccose <br />zo, <br />W <br />I hcrcby al lirm undcr ff,nalty of pcrjury lh^t thcrc is a construction bnding agcrcy frrr thc pcrl-oflnarcc of thc work lt r which lhis pcrmit is <br />issued (Scc. :1097. Civ. ('.). <br />Lcnder's Nadrc: <br />lrndcr's Addrcss: <br />APPI,ICANT DECI,ARATION <br />I hrebyaflimr undcL pcDalty ofpcrjury onc ofthc tbllowif,g dcclrations: <br />DenDlition Pcrnrits-Ashcsk)s Nolification Fcderal Rcgulutions (Titlc 40, Pm6) <br />_Rcquircd kttcr of Notification <br />-l <br />cdily lhd thc federal reguhtions rcguding abcstos rcmval rc not applicable lo lhis pmirt.rsL_lLl cdify tlut I luvc rcad this applicalion dd state tlut lhc above informtion is coffi. I aSreto @nply with aU Cily End County <br />ordinmces md Statc llws rela(in8 kr building construction, and hcrehy authorizc rcprcscntalivcs oI this City and County to <br />rbovc mcntioncd pmpc(y for <br />Applic{nt 0r Agent <br />I'cmilcc nonrc <br />purF)ses. <br />upon thc <br />Site-Work <br />Underground <br />Pole Bases <br />Light 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 />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 (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />N/eter Release <br />Rouqh <br />Service lVleter /\ <br />FINAL 6'10.ll t+"t4-l[,) <br />Notes, Remarks, Etc.