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IDiSIG COMMENTSAPPROVALSDATE <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safetv /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rough) <br />Meter Release <br />XJ/b-'-l'l .lL IRouqh <br />tl U I J-nService Meter <br />+l D"lFINALam <br />Notes, Remarks, Etc.l,:Tl <br />OWNER BUILDER DELCARATION <br />I herchy aflirm un,Jer pcnalty of Frjury that I m cxcmpt from thc Conlracl)rs Liccnsc Law lbr thc ti)llowitlS rcason (Scc.70-] 1 .5 <br />Busincss ail P(rlassion C(xlc)i Any City or Counly which requircs il lrmlrl k) con$lrucl, altcr. improvc. dcm(]lish or rcPair any <br />stnrcturc,priork)ils issunnce.alsorequiresthcapplicantli)rsuchlrcrmittotilcasiSncdslalcmcnl lhathcorshcirlicensed pursuant <br />to thc provisi{)ns of lhc Contrack,r's Liccnscd Law (Chaplcr 9. CommcncinS wilh Scction 7(}00 ol Division .l of lhc Busincss and <br />PrultssionsCodc)orthatlrcorshciscxcmptlhcretionandlhcbasisti)rthcallcScdcxcmption. AnyviolationofScctionT0]l.5byany <br />applicanttirralErnlitsuhjectslhc apPlicantk)acivilpenallyofnotmorclhallilchuildrcddollils(S5U)) <br />_1. as owncr of thc proFdy. or my cmployccs wilh wagcs as thcir s()lc conlpcnsati([. will do lhc work ud lhc slructw is not <br />intcnlcd orolltrcdl'('rsalc(Se.?(X4,BusinessedPnrfessrrnsCrxlc:'fhcCuilracbr'sLiccnscljwdoesnotapplybanowncrof <br />thepn)fre(y whobuildsorimpr)vcsthcre\)n,iltdwhodocssuchworkhimsclforhcrsellorthrouShhisorhcrownemployees. <br />providcd lhat such improvcmnts e ton intcnlcd orollcrcd lirr slc. It: h()wcvcr. lhe huihlinc or improrcrrcnt is soll wilhin ilnc y('e <br />ofconrpleli{)n, thc Owncr Buildcr will have thc hurdcn of proving that hc or she did not bttild or intprovc lhc pn)FErty lhr tlE purJbsc ol <br />sah). <br />_1. as owncr of thc propciy, tm cxclusivcly contrae(in8 with liccnscd coilracl(n's lo conslrucl lhc pF)iccl (Scc. 7M4. Busincss <br />aml PnrtissilrCorlc:ThcContracbr's[,iccnscLawdoesnolalplyk)anowncrofproPcrtywhohuildsorimprovcslhclcon. <br />and who conlracts li)r such lrojccts wilh a G)ntraclo(s) liccnscd pursuant k' lhc Conlrack)r's [,iccnsc Law). <br />_l rtrr c\rnrpl u,xlcr Scel Il. & P.( . li)r lhr\ rcrsrnr. <br />Drte:- <br />WORKERS'COMPENSATION <br />DECLARATION <br />I hcrchy all irm undcr penalty of pcrjury onc of {hc tbll)wing dccldations: <br />_l havc and wiLl mainlain a Ccdilicatc of Consenl to Scl[lnsure lbr workcrs compcnsation, as provided ti)r by Scction .]7U) of the <br />lntx)r C(xtc. ti)r thc pcrlbrmncc of lhc work ti)r which thc JEmit is issueil. <br />_l havc and will maiDttin workcrs compcnsalion insurancc, as rcquircJ hy Scclion .\7U) ot thc Lahor C(ldc, for lhe perfbmancc of <br />lhc work lor which this Frmil is isscd. My workers compcnsation insurance cffiicr and F)licy numhcr trc: <br />Policy Numhcr: E\Pircs: <br />_l ccflil.v that in thc pcrlbrmxncc ol thc work tbr which lhis pcrnil is issucJ. I shall nol enrpk)y any pcrson ir any ilanncr <br />so {s to trccorc suhjcct k) the workers compcnsatx)n laws (,1 Caliti)rnia. and agrcc lhat tl I sh()uld hccorc suhjcct k) thc <br />workcrr'c()nrpcnsationprrvisionsofScction.lTmofthcLah)rCode.lshall,ti)nhwithcrlmplywiththoscprovisi(rrs.. <br />IVARNIN(i: Failurc k) sccure workers'compcnsation covcragc is unhwful. anrJ shall suhjcct rn cnrpkryct kt criminal Fnallies and <br />civil lines !p (o onc hundrcd thousand dollars (Slm,o&D. in addit(trr k) thc cosl ol cotrrt--nsatt)n. tlamagcs as providcd li)r lhc <br />Sccr()n -1076 ofthc Lalx)r Codc.rDd l'ccs. <br />l,lcENst.:D ('()Nt RA("1'oR <br />t)t,t( t,,\t{,\1't()N <br />I hocby allir m undcr pcnally ()l l^-rjury I anr under prrrvisirn ofChap(cr 9 (eomnrcncilrS Bilh Scclion 7000) ol Divisi()n -1 <br />of lhc Busincss and Pnrlcssrrns Codc, and my liccnsc is in lill lirrcc aml cllcct <br />Licr'nsc Class:Nunrhcr: <br />J 1r1 <br />I hercby al lrm undcr frcnally of pcrjury lhal lhcre is a conslruction lcndhg agcncy tbr lhc perli)rmancc r)f lhc w()rk ti)r which this [tmit is <br />issuc,l (Scc. 1097. Civ. C.). <br />[-cn(id"s Ninlc <br />lrndcr's Atldrcssr <br />APPLICANT DECLARATTON <br />I hcre-by allimundcr Jrcnally ol lrcrjury onc ol thc titllowinS dcclaralions: <br />f)cnx)lition Pcrmils-Asbcslos Notitlcalion Fcdcral Rcgulati(rns ('I illc 40, Pan6) <br />-Rcquircd <br />lrncr ol Nolif icattrn <br />cc(ily thxt thc tcdcral rc8ulation( rcgddinS flshuslos rcmovll drc nol applicxblc kr lhis projcct <br />hrvc lhis rpplicdti()n drl stale lhat thc atx)vc intomation is corcct. I agrec h comply wilh all City and County <br />'cs rnd rclatinS lo md hcrchy aulh{}rizc rcprescnlativcs of this City rnd County b cnter uflm lhc <br />Applicnnt or <br />Pemritcc nam\lpri <br />lor <br />,,",",sq - \0-tcl <br />ELECTRICAL.INSPECTOR RECORD