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ELECTRICAL-INSPECTOR RECORD
<br /> APPROVALS DATE ID/SIG. COMMENTS °
<br /> I natty affirm under penalty of perjury that I am exempt form the Contractor:License law for the following reason(sat 7031 5 Business
<br /> Site-Work and Profession Code) Any City or Cowry which requva a permit to consuuq Sher,dmmove,demolish or repair my,tor tmq prior Wits
<br /> wartce,a1w requha the apPltnm for wet permit.file a sigad,aterr m dust he or she is bearded guratmt w the pmmsluw of the
<br /> Underground Com.Wr,L.-Wed Law(Clapt.9,Commero,d,with 5«tion IOW cfDimsd"n3of the business,and Prafesomis Code)or that he or
<br /> 9 she is exam,,therefrom and the tarn for the aleed examlionn Any violation of Section 7031 5 by any apphoml for a permit mbjecta,hc
<br /> Pole Bases applicarm to a civil penalty of nor more than five hundred dollars($500)
<br /> Light Standards _I,as owner ofth<pmp ny,or my employees with wages as their mic compensation,will do the work surd the struamc is muntended
<br /> 9 r offered for We(Sm90Ca,Business and Prof<asions Code The Contractor's License Law does not apply m an owner nfthe progeny
<br /> Spas, Pool, Fountains who builds or improvers,hire.,and who does such work himself or herself or Punish his or her own employa.provided that such
<br /> improvements arc not intended or offered for nit 1(however,the Intotbne or improvement it sold within one y...ofwmpl.loq the
<br /> Signs (monument) Owner-Builder will have the burden of proving that he or she rot build or Improve for the purpose crWe).
<br /> 1,downer of the property,am exclusively comoddiing wish licemd contractors to comma the molar(Sm 7044,Busmen and
<br /> prostration Code The Contractor's lieanse Law does nor apply to m owner of mop.y who builds or improve,thereon,sit who
<br /> Life Safety/Low Voltage wntraaa for cod projects,with a Connm,m(s)licensed pursuant to the C"nti.m,s Lieanae"w)
<br /> Fire Alarm / Dampers —I.tm.,1 veers oo B &P C for this reason
<br /> Communications Cable Date
<br /> —D"'"r
<br /> WORKERS COMPENSATION D' -s RATION
<br /> I hereby aRtam under peiWry of penury one ofNe following dcdenriom.
<br /> Building _I iuve and will maim.in.Cmifma of connm to stlf-Insure for worker$wmpenntion a providd for by Sion 31W ant Nc
<br /> Under Slab / Floor fubor Code,for the performance ofNc work for which the pamd is hued
<br /> Bonding / Grounding / UFER _I have and will m.intiln workers compenntion lnwrance,as re,qulyd by Section 37W ofthe V�r Code for the pafonnmwuflha
<br /> work for which his tarred,us awed My workers'compensation msourrce carrier and policy number ire.
<br /> Transformers Car
<br /> Torquing Policy Number Expres
<br /> Sub-Panels Ths aon adrob wmpined ift permit is ro�oeh ddAollu,(slw)orle.)
<br /> Air Conditioners _i i ably that m the'dirro umcc ofthc work for which this peamu is laud,I thall inn employ my person in any mama w a to
<br /> baame subject to the workers'compensation I�sws OfC5ilfiorrda,and aga that if I should become,subject to the cookery
<br /> Roof Top Equipment mmpenamon,ocr fSec,on33WofthK-sr
<br /> ormail.rn ith comply with those proisions
<br /> Factory Wired Unit Data 3 Walls (Conduit) WAR 9LYC Failurem a rcwmrkerrwog fur, dshall wbj.anemployamo criminal penalties and civil
<br /> fines up to one hundred thousand dollars(sl W,000),in addition m di n of compen.aamq damages a gmvided for the Section 3016 of
<br /> Walls (Rough) Ne Labor Code,imeati andmomayr fact
<br /> Ceilings (Hard & Soffit Rough eby LICENSED CONT CfO1LC DECUKATION
<br /> _ 1 her aff rn under drafty of perjury that I am liccnsd..it.Drovismn or Chapter 9(mmmencing widh Section 10[q)of Division 3 of
<br /> Ceilings (T-Bar Rough) the Bulkiness and professions Code,and my license 1sin bill foraandaffDo
<br /> Meter Release License Class- 'License NumberL—
<br /> Dater or".�hlLF N�A E Rough I herebymundopenalty ofperury that V
<br /> _
<br /> is a m,mdolon ng agency for the performance of the work for which this permit is
<br /> Service Meter issued(Sac.1091,Civ C)
<br /> Lender'a Name
<br /> FINAL 3 /2 /2 y Lmder',Addras, -- - -- __ -
<br /> Notes, Remarks, Etc.
<br /> APPLICANT'S D'C A aT10N
<br /> Demolitmn lttrom -Asbcaws Notification Federal Rcl,I.Wna(Title 40.Pm 6)
<br /> Required]-.tar of NMfiwlon
<br /> _I anify Nat the/federal mild Wioos r<gardin,aabastos removal me pre,aFWiuble w this pooh,
<br /> 1 certify that a red this application ad sum slut Ne above iM ornoto o a con. 1 ages to wmp1Y whh all Ca'and Coumy
<br /> — ---_ ordi w<taws Maine ro building constructor,and hereby ruib tore rc,o ntatives of thy,City ad Cwmy m min upon the
<br /> above and property for iiupseu..pmpo
<br /> Appliun enuig.. Date 7 I Z
<br /> Perminee
<br /> M.\WP51\Permit-Inspection Fams\ElepnuaHospeamn Record.aloc 03 31 06 _
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