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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCA&ATIJN <br />I hseby afnm undq peoalty of psjury lhat I m exempl from the Conlractors' l-icense Law for thc follou'ing rwn (56.7031.5 <br />Busines md Profssion Code): Any City or County which requira a pmit to construcl, alto. improvc, dmolish or rcpair my <br />structue, prior to its issumce. also requirB the applicat for such permil to file a signed statmmt that hc or shc is licffed pusumt <br />to lhc frovisioN of the Contraclor's Licenscd law (Chapta 9. Commencing rvith Setion 7000 of Division 3 of lhe Busins ild <br />Profe$ionsCode)orthatheorshcisexcrnptthgefromadtheb6isfortheallegedcxonption. AnyviolationofsectionT0-ll.5byany' <br />applicantforapsrnitsubjslsthe applicanttoacivilpenalt)'ofnotmorethmfivehundrcddollus($500). <br />_1. r owno oflhe propefly. or my mployc with wags c thcir sle compengion. will do the wo* md the stnElrc b not <br />intmded or offqed for ele (Ss.7044. Busine md Prcfessions Codc: The Conlractot's Licry Law doc nol apply Io il owns of <br />the prcperty who builds or improve thoon, md who do6 such wort himself or hosclf or through his or ho om employee. <br />provided that such improvmts dc mt intqded or offq€d for sle. lf. how*<. the building or improvmot is sH within onc )q <br />ofcomplaion, the Orvnq Buildq will havc thc hrdo ofproving tha he or shc did not build or improvc the prcpqly for the purpo*of <br />sle). <br />_1. I oms of thc prop6ty. m exclusivcly coilracting wilh licmsed contractoE to coNtruct the projcct (Ss. 7044. Businm <br />md Profosion Codc: The Contractor's Licctrse Law dos trot apply to il owntr ofproperty who builds or improvB thssn, <br />and who contmcts for such prcjccts with 8 Contmdo(s) licmed puNu&l to the Conlraclor's LiccN Law). <br />I m exemDt unds S(tion-. B. & P.C- for this rmon. <br />Da(e:_- __Owilcr: <br />DECLARATION <br />I hcreby a{Iinn under penalty ofpojury one ofthe following declarations: <br />_l havc md will maintain a Cffificate of CoN6t to Self-lNure for workers' conrpensation, 6 provided for by Sation 3700 of thc <br />tabor Codc. for lhc pofommce of thc wor.k for which the pomit is issued. <br />_lhaveandwillmaintainworkerc'compcNationinsurancc,o requiredbySrction3T00oftheLaborCodc.forthcpqfonnmceof <br />de: <br />q- ltq <br />T ;t_l cdify that in lhe pofomance of the work for which this psrnit is issued. I shall not mploy any pmon in any <br />s 6 to berome subiet to the sarkm'cornpssalion laws of Califomia. md agre that if I should bocome subjst to the <br />work6s'compqvlionprovisiouofSectionlT00oftheLaborCode. Ishall. lonhwilhcomplywiththosprovisions-- <br />WARNINC: Failure lo secure work6s' cotnpensation coverage <br />civil lines up to one hundred thouwd dollm ($100.000), in r <br />S6tion 3076 of lhe Labor Code. intsBt ed attorney's fm. <br />is unlarvful. and shall subjet an qnployer to oiminal pqultio md <br />conrp€Nalion. danag* c provided for thecosl of <br />L+lzsl toI)atc:r\ <br />I h6eby affirm unds penahy ofpdjury that I m licosed undo provision ofChapls 9 (contnmcins with Scction 7000) of Division 3 <br />ol lhe Businas and Profsions Code. md rny liceme is in full force ad effect. <br />Liccnse Nurnlrr: <br />I hoeby affirm under penalty of pqjury that thqe is a conslruction lending agocy <br />issued (Se. 3097. Cir. C.). <br />po'fonnmcc of the rvork for which this pqilil is <br />Lender's Nanre <br />Lender's Ad&s: <br />APPI,ICANT DECLARATION <br />t luebyallim unde pmalty ofperjury one ofthe lollowinS decloationsl <br />Dernolition Psmits-Asbeslos Notification Fedsal Regulations (Tille 40. Pd6) <br />-Required <br />trtter of Notification <br />-l <br />csrify that the Hsd regulatioN rcgsding cbstos rmoval ae not applicable to this prcjet. <br />-l <br />cdiry that I have r€d this application od above infomation is co[ec1. I agre to comply with all Cily and Counly <br />ordinance md State [,aws relating to building hreby authorizc reFrrcotativ6 of this Cily ild County to flt6 upon thc <br />above rnqrtioned proptrty for inspstion purpos6. <br />Applicant or Ageil(o ArA--lhlr: <br />Pern!ite nime (print):4 fr71+-/4 <br />,(14t, <br />Site-Work <br />Underground <br />Pole Bases <br />Lisht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <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 />Ceilings (Hard & Soffit Rough <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rouqh ff a,l\l CZ'T <br />Service Meter i tl - A, <br />FINAL 5YW 4 t 7A \)trrn'Pry5"1 <br />Notes, Remarks, Etc.'l 't ut <br />n-,, <br />I <br />? <br />_ Contraclor: