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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG. COMMENTS O WN ER llUILDElt DliLCA RATION .
<br />I hereby affirm un der penally of perjury that I am e.,empt fro m the Contrn ctors· License Law for the following n!ason {Scc.7v.H .5
<br />Site-Work Business and Professi on C'o<le): Any Cily or Co un ty which req uires a pc:,,,nit to constnu.:t. altc:r. imp rtwc. dem olish or repair any -st111 cturc. prio r to its issuance. also requires the a pplicant fo r s uch permi t 10 file a s igned statement that he or she is licensed purs"..<Zri t
<br />Underground !/v ll-17 f lt, {.,,.;i, /41& __,/ to the provisions of the C'ontrnctor·s Licensed Law l Clrnpter 9. Commencing with Scc1ion 7000 of Division 3 of the Businc'ss and
<br />Pole Bases z;<,/ A ✓/1,,J-,,,,,? ( If.ta..., Professions Code) or that he or she is ext::mpl therdrnm ,md lht": b;tSis for 1hc alleged c:mnption. Any violation of Section 7031 .5 by any
<br />applicant for .i pcnn it subjects the ap pl icant to a ci vil penalty of not more than fi ve hundred dC'l llms ($500).
<br />Light Standards nY }A f,:;_-.,J_ ~ ,J _I, ,15 owner of the prope11y, or my employees with wages n5 their_ le compensation. will do the work and the slnKture is not
<br />~
<br />Spas , Pool, Fountains intended or offered for sa le (Sec. 7044. Busi ness and Professions Code: he Contractor's License Law does not ;1 pply to an owner of
<br />the propt.-rly who bu ilds or impmves tht,,-re<.111. ;md who does such work hin ·elf or herself or throl1g_h his or her own employees.
<br />Signs (monument) provided that such improvements are not inlcndcd or olTert.'d for sale. If. ho ·ever. the bui lding or im provement is sold within one year
<br />of compld ion. the Owner Builder will have the burden of proving that he or sh did not build or improve the proper1y for the purpose of
<br />sale).
<br />Life Safety /Low Voltage _I. as owner of th e property. run exclusively contracting wilh licensed contrncto to cons1ruct the project (Sec. 70-l4. l3usim.-ss
<br />and Profession Code: The Co111rnctor"s License Law does t apply to an owner o properly who bu ilds or improves thereon.
<br />Fire Alarm / Dampers and who conlrads fo r such prnjects with a Contractor ) h ·ensed pursuant to th Contract or·s Ucc11sc La\\').
<br />Communications Cable _I on,J/97/cct ion I B. & P.C. for this rcaso
<br />Ih le: I { . 'It. o~'k '«i,_ -----Building t I ,_,. WORKERS' COMPEN SAT IO N
<br />D ECL A RATION
<br />Under S lab I Fl oor
<br />I hereby affirm under penalty or p(ijury one or the fo llowing declarat io ns:
<br />Bonding / Grounding / UFER _I ha ve and will mai nta in a Ce11ifica1e or Co nsent to Sclr-lnsure for workers · compensmion. as provided fo r by Scc1iM .HOO o r the
<br />Labor Code. for the perfonnance or the wOl'k for wl,ich the permit is issued.
<br />Transformers _I hm·e rmd will ma intain workers· compe nsat io n insuran ce , as required by Section 3700 oftl1e Labo r Code. fo r the perfonnance of
<br />T orq ueing the work for which this pen11it is issued. My workers· co mpensatio n insuranc e cm,·ier and po licy number arc:
<br />Sub-Pane ls Call'icr:
<br />Air Conditioners Policy Number; E:~pires:
<br />Roof Top Equipment _1 ccrt iry that in t he per forman ce of the work for whic h 1his permit is i sued. I sha ll not emp loy any person in any maim er
<br />Factory Wired Unit so as to become subject to the workers' co mpe nsat ion laws ofCalifomia. a 1d agree that if! shou ld become subject to 1hc
<br />work ers' compensation provisions of Section 3 700 of the Labor Code. I sh II. forthw ith comply with those provisions ..
<br />Wa ll s (Conduit) '""'""' ,.;, ... '" _,_, .. .,-, mm,-;..,t. """"" ' ~ '"" .. ,., "" """'~" rn,.;m, -·~ '" W a ll s (Rough) civil fi nes U(J lo o ne hun dred thousand dollars ($109-, 0). in ilddition to ,c cost of compensat ion. dam<1ges as provided for the
<br />Ceilinqs (Hard & Soffit Rough Section .107~ of:7 L:;;C~dc, interest and alt o ncxfs cs. t?;
<br />Cei lin qs (T-B ar Rouqh) Date: .J / -Z.. '/ 'f// I Appl\, t: I I -· IC ENS ED C O NTRACT OR
<br />Meter Release DECLA RATION
<br />I hereby affirm un der penally o f pe1jury that I am licensed under prnvision o f Chapter g (commencing with Section 7000) of Division 3
<br />of the Business and Professions Code. and my license is in ful l fo rce :md effect.
<br />Rough
<br />License Class: License Number:
<br />Service Meter • I
<br />l~/X/17 ~ . Date: Contra ctor ; FINAL ..... .,;::w '\
<br />Notes , Remarks , Etc.
<br />, C -..... C O NS TRUCTION I.ENDI NG AGENCY
<br />I here by anirm under pena lt y o f perjury that there is a constniction lending a£cncy for th e performance of the work for which this permit is
<br />issued (Sec. 3097. Civ. C.).
<br />Lender's Name:
<br />\ Lende r·s Address:
<br />I A PPLI CANT llEC I.AIU T ION
<br />I hereby affinn undt.·:r penalty of perjury one of t he fo llo\ing declarations:
<br />Dcmoli1 ion Permits-Asbestos No1ificatio11 Federa l Reg liations lTitle 40. P~u16)
<br />_Required Len er of Not ification
<br />_I Ct,,'rlify that the federa l regulations gar ing asbcst s remova l arc not app licable to th is pl'Cljcct.
<br />_I certify thm I ha ve read this ap pli , li on and state that th · above inform ati on is co1Tect. 1 agree to co mply wit h all City and County
<br />ordinam:es and Stale Laws relating to . uilding constmcti on.: ":"''"'""~""'""""';=•':"'"':~-above mentioned prope1ty fo';i.tio rnrposcs.
<br />Appli cant or Agent Sigm,ll 1 c: --· -Dale:_l _ { {(
<br />Pc-rm it ce nam e (pri,11 ): I
<br />{._1,..,,, PO r ~ ( 17 'J \ I.I.
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