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APPROVALS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<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 (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Release
<br />Rough
<br />Service Meter
<br />FINAL
<br />Notes, Remarks, Etc.
<br />DATE ID/SIG.
<br />I I ' v ~/l\
<br />V V
<br />ELECTRICAL-INSPECTOR RECORD
<br />COMMENTS
<br />,.........,,
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<br />OWNER BUILDER DELCARATION
<br />I h ereby affirm u nde r penally of pe1j my that I run e:,;:e rn pt from t he Contrnctors· License Law for the fo ll owing reaso n (Sec.7031.5 •
<br />Busi11 css and Pro fession Code): Any C ity or County which n:quircs ,1 p<.11nil to constrncl. nlter. im pro\'e, d~1.i10lish or r<.-p.1ir an y ..
<br />s tructure, prior to its issuance. also requires the applicant for such permit to file a sig ned s tateme nt that he or she is licensed pursuant
<br />to the provisions of the Contrn cto r·s Licensed Law (Chnpter 9. Commencing w ith Sectio n 7000 of D iv is ion 3 o f lhe Business and
<br />Pro fessions Code) or that he or she is exempt therefrom and the basis for the a ll eged e xemption . Any violation of Section 703,1 .5 by any
<br />applicant for a pen ni t subjec1s the applicant 10 a civil penalt y of not more than f1,1e hund red doll ars ($500).
<br />~I. as owm:r of the prope1ty. or my employees with wagc-s as th eir sole compensation. will do the work and the structure is not
<br />int ended or offe red for sa le (Sec. 7044. Business and Professions Code: The Co111rnclor 's Li cense Law docs nol apply to an cnvncr o f
<br />the property who builds or im pro\'es thereon. and who does such wOl'k him self or hersel f or th rough his or her own employees.
<br />provided th.it such improvemcnis are no! intended or offered for sale. ff. however. the building or impr0\·cmen 1 is so ld within 011 e year
<br />of complet io n. the Owner Bui lder will have the burden of provi11g that he or she did not buil d or im prove the property for 1hc puq,ose of
<br />sale).
<br />_I. as owner of the prc•pe1ty. am cxd usi,·cly contracting with li censed contractors to construct the project (Sec. 7044. Busirn:ss
<br />and l'mfession Code: The Contrnctor ·s Li cense Law docs not apply lo ;m owner o f propert y who builds or im pro \"es !hereon.
<br />and who contmc1s fo r such projects with a Co111m cto r(s) licensed pursu.rnt to the C'ot11 rac1or"s Li cense Law).
<br />_I Ml e xe m pt under Sec tion ________ . B. & P .C. fo r this reason.
<br />Dn te: __________ Owo c.-: _______________________ _
<br />WORKEllS' C O~ll'ENSATION
<br />UEC LAllATl()N
<br />I hereby affi rm under pc11alty o f pt.-rjury one of the fol lowing d eclaralions:
<br />_I have and wi ll mai ntain a Cc11ilirntc o f Consent to Sel f-Insure for work1...,·s· co mpensation, as prov ided for by ScrtiC'ln .HOO of the
<br />Lalx.lr Code. fo r the pl.1-fonn.ince o f the work for which th e pL'llnit is issued.
<br />_1 h.ivc and w ill ma intain workers· compensation insurance. as requil'ed b y Sect ion 3700 o f the L.ibor Code. for the JX-,·fonnance of
<br />lhe wo rk for which th is penni t is issued. My workers· co m pensatio n insurance carrier and policy nu mber me:
<br />Carrier: __________________________ _
<br />Policy Numbcr: _____________________ Expircs: __________ _
<br />_I cer1 ify that in the per fonnance C'l f the wor k for which th is permi1 is issued. I shall no1 employ any person in :my m:mner
<br />so a.., to become subject to the workers' compcnsa1ion l.lws of Califo rnia. Md .igree th.it if I should become su bject to the
<br />workers' compensation prov isions of Sect ion 3700 of the Labor Code. I shall. for1hwith compl y with those provisions ..
<br />WARNING: f ai lure lo secure workers' compensalion coverage is unlawfu l, and sh.ill subject an emp loyer to c1iminal penalties and
<br />c:iv1\ li nes up to one hund1l.-d thousand doll,,rs (jl 00.000). m add1t1on lo the-cost of compensation. damages as prov1dd for the
<br />Scct1011 3076 o r t?t..: L.il.x:,r Code. mte 1cst nd altrcy's fees _ -7
<br />1 I / , ,, , -/ -i --7 I '"7 ,,-, /
<br />l>ule: ! 1 / 1 /( l icant: / , ., · / ~, ·
<br />LICENSED CQNTll'ACToil I
<br />I -' DllCLARA'I ION '
<br />1 he1eby affirm under pcnaltyc;i)crjury l 1at I am hcc ed unde r pro,11s1on of Chapter 9 (commencmg with Sect ion 7000) of D1v1s1on J
<br />of t he Business and Pro:~<le. and my hccnse 1s m full fo,ce ~~ \ ..---7
<br />L,ccnsc Class _) I LJCCJ!SC N~~---1 ~_:=) / / rt:lor'~---_::-_y -~' . i ; , >/") J',/' O,1tc /I /
<br />-_I , ,,. ~--./ ) • ;>
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<br />TRI ,r·nnN LENDING AGENl'Y
<br />~ hereby affirm undc~ pem1lty of perjury th at there is a ~!ruction le nding agency fo r the 1x1·fonmmcc o f the work for which this permit is
<br />,ssucd (Sec . 3097. C,v. C.).
<br />Lcndcr ·s Na me: _________________________ _
<br />Lcndcr·s Address: _________________________ _
<br />A PPLICANT DEC LARATION
<br />I herebyaffi1m under penalty of perjury one of tht: fol lowing dec larations:
<br />Demolit ion Pe nnit s-Asbestos Notification Federa l Regulations (Title 40. Prut6)
<br />_Required LettcrofNotili calion
<br />_I ccrt ifY,,(h at 11\e federa l regula tions regarding asbcs10s removal are not applicable to 1his project.
<br />I cet1 i that I h~wc read this applicat ion and state th at the abo ve informat ion is com.:ct. I ag ree lo comply with al l City a nd County
<br />or an sand State Laws reklting to bu ild ing constrnction. and hereby authorize represen tatives o f th is City and Co urlly to enter upo n the
<br />above 1tioncd property for inspeclion purposes. ,
<br />-· :-::..-• -; ,,,;f /i/ ,,,/ / , .. 1/.
<br />App ic;ml o:zA: nt S ignnture~._-____ _,,~_,-,'--c7,'/'----,_,,_/_,,..._--,-'-,,-'--~--IJ 111c•_._1~/-~,:~··,r'-/~/_; __
<br />r ,-{,>,
<br />Pcrn~.U: 1c(print): 1 .(/.., / 7 1/•1
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