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A PP ROV ALS DAT E ID/SIG . Site-Wo rk Undergroun d Po le Bases Li g ht Sta ndards Spas, Poo l, Fountains Siqns (monument) Life Safety /Low V o ltage Fire A larm / Dampers Communications Cable Bu i lding Un der Slab / Floo r Bond ing / Ground ing / UFER T ransforme rs T orqueinq Sub-Panels A ir Conditioners Roof Top Equ ipment Facto ry Wi red Unit Wa ll s (Conduit) Walls (Rouqh) Ce ili ngs (Ha r d & Soffit Rouq h Ce ili nqs (T -Ba r Rouqh) Meter Re lease Roug h Service Meter ' 1 r--. FINAL \ ... \1.'1..\\\, I ~ltA Notes , Rema r ks, Etc. I ----. ELECTRICAL-INSPECTOR RECORD COMMENTS O W NER llUILDE R D ELCARATION 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 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 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 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 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 app!ic.int for a pcnnit subjects the applica nt to a civi l penall y of no1 more than five hundred dolla rs lS500). _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 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 the pmpc11y who builds or improves thereon, and who docs suc h wofk himselr or hersel f or through his or her own employees. 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 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 sa le). _I. <15 owner of the.: prope,,·ty. am exclusively contracting with li<x·nscd contrnctol's to constrn ct lhc project tScc. 7044 , Btisiness 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. and who contracts for such p10Jects II nit a Comract m(s) hccnsed pmsuam to the Com,actors/~ense La w) Da l~amcxemptunderSect,on I r.-b ~;iJ~' UJ -vi t!J1{1('. ~ ~VOil~ RS ' r :O ~1PE NsA·1 1O~ / <; ,/...,} ECLAllA I ION I hereby affirm under penalty orperJ ury nc orth fo lo~ <.k·cl1mu1ons _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 Labor Code. for t he perfo rmance o r the ,vork for wl1ich th e permit is iss ued. _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 the work for which this permit is issuc.'d. My workers' compensation insurance ca1Ticr mid pol icy num ber are: C'nrricr: __________________________ _ Polic y Numbc r: _____________________ E.'<pires: __________ _ _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 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 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 .. \VA H..N ING: f nilurc to secure.: workers' compcnsmion LO\·eragc is unlnwfol. nm.I shnat}l sub·ccl nn cmpl0ycr to crimin.il pena llies n 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 Dale: ___________ Al ,ant; f / J _jl/}11} 'f /1(/ff/t, T A . '-.1.1 ,.d,A l!A T ION / CENSIW C O NTRACTOII. - 1 ~ 1 (_,/ 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 or the llusincss and r m ressions C ode. and my li cense is in'-f.:111 fo rce and cITcct. License Class: ______________ License Nu111ber: ~--------------- Date: ___________ Cont rnC'l or: _____________________ _ C ONSTRUCT I O N LE ND ING AGENC Y 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 issued (Sec . 309 7. Civ. C.). Lender·s Name: _________________________ _ Lender·s Address: _________________________ _ A PPLICANT llECLAllATION I hL'febyaffi n n under pena lty or perjury one of the fo llow ing declaration s: Demolit ion Pennits•Asbestos Notifi cation Federn l Reg ulatio ns (Title 40, Part6) _Requi red Leiter of No tifi cation _1 ct.-,·1iry 1ha1 the fcdcrnl regulations regardi ng asl>cslos rcmov.il arc nol app lic.i blc lo this project. I _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 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 above men d prope11y for 111spect1 n p ~s}1. (.J, J 1 . J f, :::::i:::·;:gz)~nallorc C ~< e'st1.1 i O -i ifif ?rrm2{__;_J1 I lu ~ ~ ) /............__ V J L