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A PP ROV ALS DAT E ID/SIG . <br />Site-Wo rk <br />Undergroun d <br />Po le Bases <br />Li g ht Sta ndards <br />Spas, Poo l, Fountains <br />Siqns (monument) <br />Life Safety /Low V o ltage <br />Fire A larm / Dampers <br />Communications Cable <br />Bu i lding <br />Un der Slab / Floo r <br />Bond ing / Ground ing / UFER <br />T ransforme rs <br />T orqueinq <br />Sub-Panels <br />A ir Conditioners <br />Roof Top Equ ipment <br />Facto ry Wi red Unit <br />Wa ll s (Conduit) <br />Walls (Rouqh) <br />Ce ili ngs (Ha r d & Soffit Rouq h <br />Ce ili nqs (T -Ba r Rouqh) <br />Meter Re lease <br />Roug h <br />Service Meter ' 1 r--. <br />FINAL \ ... \1.'1..\\\, I ~ltA <br />Notes , Rema r ks, Etc. I ----. <br />ELECTRICAL-INSPECTOR RECORD <br />COMMENTS O W NER llUILDE R D ELCARATION <br />I hereby affi rm under penalty ofpe,jury that I run exem pt from the Cont r:ict ors' License Law for the foll owing reason (Sec.703 1.5 <br />Dusiness and Profession Code): Any City or County which requires n pcnn it to cons1nic1. alter, improve. de mol i~h cw repair a•?,y <br />structure. prior to its issuance. also requires the applicanl for such pcm1i1 to file a signed statement that he or she is lin~nscd pursuant <br />to lh e prO\'isions of the Contrnclor·s Licensed L.iw (Chapter 9. Commencing wilh Sect io n 7000 of Division 3 of th e Business mid <br />Professions Code} or thnt he or she is exempt therefrom and the basis for the alleged exemption. Any violat ion or Sect ion 70J 1.5 by any <br />app! for a pcnnit subjects the applica nt to a civi l penall y of no1 more than five hundred dolla rs lS500). <br />_I. as owner o r1hc propc11y. or my employees with wages .is their so le compcnsntio11. will do the w ork and the strnd ure is not <br />in1ended or offc .-ed for sale {Sec.7044 . Business and Pmrcss ions Code: T he Contracto1-·s License L'l w does not apply to nn owner of <br />the pmpc11y who builds or improves thereon, and who docs suc h wofk himselr or hersel f or through his or her own employees. <br />provided 1hm such imp rovements arc not intended or offered for sale. If, howe\'cr. t he bui lding or i111provemen1 is so ld within one year <br />of comp!e1ion. the Owner Builder will hn \'e the burden of pro\'ing lhnt he or sh e did not bui ld or improve the propc11y for the purpose of <br />sa le). <br />_I. <15 owner of the.: prope,,·ty. am exclusively contracting with li<x·nscd contrnctol's to constrn ct lhc project tScc. 7044 , Btisiness <br />and Profession Code: T he Con tractor's License Law does not npply to an owner or propc11y who build s or im pron~s thereon. <br />and who contracts for such p10Jects II nit a Comract m(s) hccnsed pmsuam to the Com,actors/~ense La w) <br />Da l~amcxemptunderSect,on I r.-b ~;iJ~' UJ -vi t!J1{1('. ~ ~VOil~ RS ' r :O ~1PE NsA·1 1O~ / <br /><; ,/...,} ECLAllA I ION <br />I hereby affirm under penalty orperJ ury nc orth fo lo~ <.k·cl1mu1ons <br />_l lmvc and will Jm1.intai11 a Cc11ifil:a1c or Consent to Scl r•lns u rc for \\"Urkcrs' co1npcnsrition, as pro, idcd fo r by Sec tion 3700 oflhe <br />Labor Code. for t he perfo rmance o r the ,vork for wl1ich th e permit is iss ued. <br />_I have and wil l maintain workers· compensat io n insuran ce . .is requi red by Seel ion 3700 of1he Labo r Code, fo r lhc perfonua11ce of <br />the work for which this permit is issuc.'d. My workers' compensation insurance ca1Ticr mid pol icy num ber are: <br />C'nrricr: __________________________ _ <br />Polic y Numbc r: _____________________ E.'<pires: __________ _ <br />_I ce11iry that in t he performan ce or the work for which this permi t is issued. I s ha ll not empl0y any person in ,rny m.nmer <br />so as 10 beco me subject to the workers' co mpcnsmion laws ofCalifo miri. an d agree thai i rl should become s ubj e ct to th e <br />workers' co m pensation provisio ns of Sect ion 3700 or th e Labor Code. I sh.ill. forthwith com p ly with those proYisions .. <br />\VA H..N ING: f nilurc to secure.: workers' compcnsmion LO\·eragc is unlnwfol. nm.I shnat}l sub·ccl nn cmpl0ycr to pena llies n <br />Sectio n 3076 o r the Lnbor Code. intcresl ~1d allorn 's re / I}/) fl r_,,j//4 ~ _ . ci vi l fines up to one hun dred 1ho11sn11.d dollars ($1( .oo~u· in ~dd it icm 10 the C'OSI o r l 'ijc < 11. t1nmngcs as rovided fi 1e <br />Dale: ___________ Al ,ant; f / J _jl/}11} 'f /1(/ff/t, T A <br />. '-.1.1 ,.d,A l!A T ION / <br />CENSIW C O NTRACTOII. - <br />1 <br />~ <br />1 <br />(_,/ <br />I h!.!rcby affirm under penally o r pe1j ury that I am lit·cnsed ml0¢" provision o rClwptt:..T 9 (co11 11 nc11ciug, vith cction 7000) of Division 3 <br />or the llusincss and r m ressions C ode. and my li cense is in'-f.:111 fo rce and cITcct. <br />License Class: ______________ License Nu111ber: ~--------------- <br />Date: ___________ Cont rnC'l or: _____________________ _ <br />C ONSTRUCT I O N LE ND ING AGENC Y <br />I hereby affi rm under pe nal ty o f perjury that there is a construction lending agency for the perfon nancc o f th e wor k for \\"hich this pennit is <br />issued (Sec . 309 7. Civ. C.). <br />Lender·s Name: _________________________ _ <br />Lender·s Address: _________________________ _ <br />A PPLICANT llECLAllATION <br />I hL'febyaffi n n under pena lty or perjury one of the fo llow ing declaration s: <br />Demolit ion Pennits•Asbestos Notifi cation Federn l Reg ulatio ns (Title 40, Part6) <br />_Requi red Leiter of No tifi cation <br />_1 ct.-,·1iry 1ha1 the fcdcrnl regulations regardi ng asl>cslos arc nol app lic.i blc lo this project. <br />I <br />_I cei1i th I ha\'e rend th is applicm ion nd sta te !hat the aOOve i11 fo n nation is cc,rrect. I :ii;ree to c 1 ly wi1h all C'ity and County <br />ordina nces'. Stale Laws rel~ting to r J1ildi co11s.trnt.:1ion, a11d hc.:71re utho~¥ !'epresentalivcs o f ,h' C ty ~nl/J('ounl IO";;ClllCIJiUpo n ,y <br />above men d prope11y for 111spect1 n p ~s}1. (.J, J 1 . J f, <br />:::::i:::·;:gz)~nallorc C ~< e'st1.1 i O -i ifif ?rrm2{__;_J1 I lu ~ ~ ) <br />/............__ V J L