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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DELCARATION <br />I h6eby amrm und6 pmahy of perjury lhat I an cxempl fiorn the Conlracto6 LiceN taw for the follorving ree)n (5(.7011.5 <br />Businss and Profession Codc): Any City or County which requir* a permit to conslrud. alto. irnprove, dmolish or rq*ir illy <br />structue. prior to its issuance. also require the applicmt for such pmnit to file a signed slatement lhal he or shc is licensed pursumt <br />lo the provisions of the Contractor's Licensed taw (Chaptq 9. Commencing wilh Section 7000 of Division 3 of thc Business and <br />ProfessionsCode)orthatheorsheisexernptthsefromandtheb6isforlheallctedcxmption. AnyviolationofSctionT03l.5byany <br />applicantforapmnitsubjststhe applicanttoacivilpenaltyofnotmorethufivehundrcddollars($500). <br />l. as owner ofthe pro;rny. or my employe rvilh rvags as their mle compmsation, will do the work Md lhe structue is not <br />inlmded orofleredforsle(56.T044.BusinmandhofesionsCode: TheContraclor'sl.icmselrwdoesnolapplytoanownerof <br />thcpmperty whobuildsorimlrovoth6on.mdwhodo6suchrvorkhimselforhoselforthroughhisorhsoNnemployeB. <br />provided that such impro\'ffits rc nol intaded or ofiqed for ele. If. howwq. the building or improvonmt is wld rvithin one ;eo <br />ofcunplaion. thc Orvne Buildo will have the hrrdo ofproving that hc or shc did not build or improve the prepdy for the puryrse of <br />ele). <br />_1, m orvner ofthe proptrly. iln exclusively contracting wilh licensed contracloB lo construct the proj*t (Sec. 7044. Busines <br />and Profcssin Code: 'fhe Contractor's l-icense l-arv doe not apply to il ownq ofpropcrly rvho builds or irnproves lhersn. <br />and rvho conlracls for such projffts vilh a Conlraclo(s) licmsed puBuant lo lhe Contr.ctor's LicoE LaN). <br />-l <br />m excmpt und6 Sstion-, Il. & P.C. for this re6on. <br />Dite:_ Owner:____ <br />WORKERS'COMPENSATTON <br />DEC[-ARA'ITON <br />I hoeby affrm undo pmalty ofpojury one ofthe follos ing dclaations: <br />I have ad will maintain a Ccnificatc of Consenl to Selflnsure for work6s' compmation. c provided for by Sfftiof, 1700 of the <br />labor Code. for the pofomilce of (he uo.t lor u,hich the pemit is isucd. <br />_-lhaveandwillmaintainworkqs'compensationinsurance.ro requiredbySeclionlT00oftheLaborCode.fortheptrfonnanceof <br />thc work for which this pemit is isued. My workos' compemlion imur@ce cuic md policy numbo re: <br />Can icr: <br />Policy Number:-Expir6r _ <br />I cffify thal in lhe pqfoflnance of the work for which this prmit is issued. I shall not onploy any person in any nrMns <br />s as to become subjal to lhe work6'compqMtion lass of Califomia. ild agre that if I should become subjsl lo lhe <br />work6' compmsation provisiom of Selion -1700 of the Labr Code. I shall. f<rrthrvith comply wilh thor provisions.. <br />IVARNING: Failure to sue worken conrpssalion cov@gc is unlawful. and shall subjffl an onployo to oiminal poaltis and <br />civil finesuptoonehundredthousanddollss($100.000),inadditiontothecostofcom[Ensation.damagesasprovided[orlhe <br />Smlion 1076 of Code, intsst and attomey's <br />Applicanl: <br />DEC'T.ARATION <br />I hmby affirm undo penahy of perjury that I m licmsed undo provision of Chapto 9 (comrnacing with Section 7000) of Divisfun .l <br />of the Business md Prof6sions Code. md rny licosc is in full iorce ed cffect. <br />License Class: - <br />Ds'e: t I-[Z <br />Nunrltr: <br />CONSTRUCTION LENDINC AGENCY <br />I hmby aflim unde pmalty of pedury lhal lh6c is a construclion loding agmcy for the pofommce of the rvork for rvhich this fmnit is <br />issued (Str. -1097. Civ. C.). <br />Lends s Name: <br />APPLICANT DECLARATION <br />I ho'ebyaffm undr penalty ofpsjury onc ofthe following deloations: <br />Denrolilion Pqmits-Asbestos Notification Fedoal Regulalions (Title 40. Part6) <br />- <br />Required Lelte of Notificalion <br />I cffify lhat the feddal regulations rcgoding Gbeslos rmoval de nol ryplicable to this prejst. <br />_ lcertifythallhavercadthisapplicationedstalelhattheatnveinfonuationiscorecl.lasrEtoconrplywilhallCilyaildCounty <br />ordinancs and State laws rclaling to building md hoeby authorize reprGfllaliv6 of this City and County lo mlfr ufnn lhe <br />aboYc mtrtioned propeny for <br />Applicnnt or Agen( Signrlure: <br />Pcrnril$ ilanlr (prinl): <br />,rrr\Jl4n <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <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 />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />[r/eter Release <br />Rouqh <br />Service Meter <br />FINAL -74*74 VJI <br />Notes, Remarks, Etc.U <br />lb tucr b€ ',Vt <br />('onlrnctor: <br />Lcnrlcr's Atldrcss: <br />3-22-ty Y"\LI.1L <br />tQ-.{- 11 Pytt { a$trbt"rrv( t}f D*dtf4