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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,('ARATION <br />I hreby allirrn under pnalty of pqjury that I an exenlpt friln the Contrado6' License Law for the folkrrving re.$n (56.7031.5 <br />Business and Profession Codc): Any City or County which requirs a pornil 1o constnlct. alta. irnprove, dernolish or repair any <br />structue. prior lo its i$uece. also requirB the applicanl for such pennil lo file a signed slatenrent lhat he or she is licensed pmumt <br />lo the Fovisions of the Conlraclor's l-icensed Law (Chapts 9. Commcncing wilh Scction 7000 of Division ]t of the Busins md <br />PrcfesionsCode)orlhalhcorsheiscremptrhtrefiomandthcbasisforlhcallcgedcxonption. Anyviolat'rrnofsstioilT0-3l.5byany <br />applicantforapmritsubjtrlsthe applicanttoacivilpcnaltyofnolrnorethmfivehundrcddollds($500). <br />I. o orvner oflhe progrny. or my employs with wage s their mle conrpensation. rvill do the work md lhe stnrdue is not <br />intoded or oflered for slc (Sa.7044. Busine and Profesions Code: Thc Conlraclor's Licosc Larv do6 not apply lo sn omq of <br />the propeny u'ho builds or irnpove thqon. ed \\'ho do6 such No* himself or hmelf or through his or her orrn empkry-ec. <br />provided that such improvonmts ue not intmdqi orofToed for sle. lf. horvo's. the building or improvement is wld rvithin one yw <br />ofcomplelion. the O\rncr Builds will have thc burdm ofproving that he or she did not build or irnprove the propdly for the pur[nse of <br />sle). <br />_1. ro orvnm of the propoly. am exclusi\ ely contracting \\'ith licosed conlr.cloE lo coilslrucl the preifr1 (s('. 70.1.1. Uusins <br />and ProfssionCode:lhe('ontractor'sLicenseLawdo6notapplytoanorvnerofproJrny$hobuildsoriilprolesthcreon. <br />and who conlracts for such projecls with a Conlractor(s) licensed pursuanl b the Coillrnclor's License l,nN ). <br />I an ereillpl under S<tion I] &l'C forlhisrcason <br />Drte:__-. _ Owrer: <br />WORKERS' COTIPI]NSA'I'ION <br />DECLARA'TION <br />I hercby afiirm undo penalty ofpojury one ofthe follorving d*luations: <br />_l have md rvill mainlain a Certificate of Consflt to Self-lnsure for rvorkos' compensalion. as pnvided for by S(tion :1700 of the <br />Labor Codc. for the pofonnmce ofthc work for which thc pfinil is issued. <br />I have antl s ill nrainlain srrrkers'irsurance. as requirecl by Section .1?(X) otlhe Labor (i)(le. [or lhc ps linrnance of <br />lhe Nork for \\'hich this pcnnit is isued. My cornpmsation insurance caria ad policy numbcr are: <br />Cmiq:- t O <br />Policy t'lurnbcr,-9 Expircs <br />_l ccdify lhat in the perforrnance of the $ork for $hich this pqmil is issued. I shall nol eilrploy ailr pcrson in an)'fiailnq <br />m mtobccornesubjatlotheworkm'compqs.lionla\\'sof('alifomia.andagrccthatiflshouldbcconlesubi(ttothe <br />workqs' composation provisions ofSetion 3700 oflhe t-ah)r Code. I shall. fonh\\'ith conrply with lhosc provisions.. <br />WARNINC: Failure to scurc workers'conlpenstion covqage is unlas'ful. and shall subiect an onplolo to oirninal perBlti6 ild <br />civil linesuptoonehundredthousanddollffi($100.000).inadditiontothecosto[cornpensatior.darnagesasprovidedforthc <br />S(lion 1076 ofthe t bor Code. intsGt and attomef'\f*)r <br />Date:---L- Appllcnnt: \ <br />LICENSED CONl'RAClOR <br />DECLARATION <br />I hmby affirrn undo pmahy of perjury lhd I m licosa.l under prcvision of Chaptr 9 (conrmqcing \rith Selion 7000) of Division J <br />of the Busins ild Profcssions Code. md rny license is in full lorce md cffet.,- <br />ti"rrt ctut"t C-l O <br />Dsre: y</ //6_-r\ <br />License N ",,,r*, <br />qf I -\/f2 - <br />t "*."${44LO4tu1 p-7 rcrdn 4 <br />CONS'TRUCTION LENDING ACENCY <br />I hoeby aflirm undo pcnalty ofpojury that thoe is a construction loding atsency for (he pdfoonance ofthe rrork for $tich this pqrnil b <br />issued (Sa. 3097, Civ. C.). <br />findq s Narne: <br />lsds's Addres: _ <br />APPLICANT DECLARA'TION <br />I harby alfinn under poalty of pejury one ofthe following decluationsl <br />Demolition Pennits-AsbGtos Notification l:ederal Regulations ('l'ille 40. l'ar16) <br />-Required <br />Lats olNolifi cation <br />-l <br />c6tify that th€ federal regulations reguding asbestos rcrnoval are nol npplicable kr lhis proiect <br />I cfiify lhal I have read this application and stale lhal the atx)ve infornflli()D is colr$1. I agre <br />orrjirrancs and State [:s s rclot ing,1p builtling cory'n/tion. and heteb) aulh,riTe reprsenlali\ 6 o <br />::_ : , T::1.:l"T'"**IZnADolicrnt or Agent Sienrlurt: -tt <br />----j" <br />::J <br />to conrply s'ilh all Cily and County <br />fthis ('ity and Count) lo eDlq upon lhe <br />lhlc t,tz/rc <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 />Buildins <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 (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL <br />Notes, Remarks, Etc.