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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE lD/stG.COMMENTS OWNER BUILDER DELCARATION <br />I hscby afllril undq pmalty o[ pojury lh.l I m exeilpt from the Conlracto6 Licosc liw for thc following remn (Sec.?03 1.5 <br />Businas and Profxion Code): Any City or Counly which rcquira a pcnnit to construcl. all6. improve. doalisl or rerl.l any <br />sltuclurc. prior to its isumcc. also rcquirB the applicant for such pmnit to file a signed stalolol thal he or she is licosed pursuanl <br />ro the provisions oflhe Conlraclor's Liccnsed larv (Chapls 9. Commcncing with Section 7000 ofDivision J ofthe Busirress and <br />ProfesionsCode)orthath€orshciseiempttherefiomandthebasisforthcallegedexmplion. Anyviolationofs(tion?0-1l.5byan! <br />applicantforapemitsubjatsthe applicanttoacivilpenaltyofnotmorclhmfivehundreddollus($500). <br />_1. as owno ofthe prop€rty, or rny cmployeB with wag6 d lheir sle conpmsation. will do the work ald the structuc is nol <br />intodql oroflsedlorsle(Ss.T044.BusinesandProGssionsCodc:'l'heConlractor'sLicmse[-awdoesnotapplytoanouncrof <br />the prepgty rvho builds or improve thson. md who do6 such wo* hirnself or hmelf or through his or her own employeB. <br />provitled lhat such improvsnenls de nol intmded oroflqed for sle. lf. howw6. lhe buildinS or improvemmt is mld within one 1m <br />ofcomplaion. the Orvns Builde rvill have the burdo ofproring thal hc or she did not build or irnprove the prepqty for lhe purlx)s of <br />sle). <br />- l. o orvns ofthe prcperty. dn e\clusively conlracling with licm€al contractoE to conslruct lhe prejd (Sa. 7044. tsusins <br />ard ProfasionCode:TheConlractor'sLicenseLawdo6notapplyloanownsofpropmywhobuildsorirnproveslhseon. <br />and who contracts for such prejets rvith a Contracto(s) licosed pursuilt to lhe Contractor's l-icmse law). <br />-l <br />tun cxenlpt under Sectt)n U. & P.C. for lhis re6on <br />Dalr:()rrncr: <br />\\ oI{Kl)ts' ( ()lIPl,.Ns,\'l loN <br />Dl:( t.,\lt,\ l loN <br />I hocby aflinn undcr poalty of ;rjury one of the follorving delrations: <br />I havc md will maintain a Cmillcate of Comot to Self-lnsure for workqs' compmsation, o povided for by Setion 3700 of lhe <br />Labor Code. for the pqfommce of thc wotk for which the pmnit is issued. <br />I have anrl rvill maintain workeN' compensalion insurance. as required by Setion 3700 ofthc t.ahor Code. for the psfonnance of <br />the rvork for rvhich this pennit is issued. My rvorkos' conrpensation ins[rance can'ier md policy numbet uc: <br />Canicr: <br />Policy Numbs:-_Expires: <br />I cmify lhat in the poforrnance ofthe rvork ftrr rvhich this pennit is issued, I shall not ernploy any p6son if, any manntr <br />s stobscorne subjcttotheNorks'compensationlarvsofCalifomia.andaSrethatiflshouldbecornesubjecttothe <br />wo*ss'compnsationprovisionsofSstienlT00ofthetaborCode,lshall,forthwithconplywiththosprovisions.. <br />WARNIN(;: I,ailure (o secure workcrs'cornpensation coveragc is unlarvful. and shall subjecl an crnpkryer Io oirniiral pLlrahics nnd <br />civil fincs up lo one hundred thousand dollars ($100.000). in addition lo the of conrpnsation. damages as providecl for the <br />Section lhc Code. ints6t and atlomsy's <br />I)atc: <br />DECLARATION <br />I hqeby amril undq penahy of psjury lhal I an licens€d undq Frovision ofchaptc 9 (commmcing wilh Scction 7000) of Division -1 <br />of the Business and Profcssiom Code. md rny licase is in full force md eff(t. <br />l.iccnsc ( lass:Nunr[rl <br />rrll)rl r:llit contrsctor:+ <br />CONSTRUCTION LENDING AGENCY <br />I hrcby allirm undo penally of pejury lhal lh6e is a comlruc(ion l€nding agmcy for the pcfonnmce of the rvork for lvhich lhis fEflnit is <br />issued (S(. 3097. Civ. C.). <br />Lends's Name: <br />l-endcr's Addras: <br />APPLICANT DECLARATION <br />I hotby affinn unds penalty ofpojury one ofthe following delaations: <br />Demolition Psmils-Asbetos Notilication Fcdsal Regulations (Tillc 40. Pa(6) <br />Required Late of Notification <br />I corify that the federal regulalions rcgading obckrs remlval are nd applicable to this preject. <br />I colily that I have read this applicaliof, and stale that the at{vc infomralion is corecl. I a8r@ lo comply with all City and (hunly <br />ordinancs and Stalc lnrvs relating to building conslruclion.hqeby authorize reprsenlativ$ oflhis City and Counly to enlo u[x)n lhc <br />above mmtioned property for inspection <br />Applicrnt or Agcrt Sigtrsture: <br />Permile name (print): <br />l)rlc lt bln <br />Site-Work z(\ <br />Underground 6'2r-v V.#AL I <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildins <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 (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL -7J -Zlt \.NI,lL\ <br />Notes, Remarks, Etc.\V <br />IA