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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor <br />?Bondinq I Groundi no I UFER It tb 7r0 -1 <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilinqs (Hard & Soffit Rouoh <br />Ceilinqs [-Bar Rouqh) <br />-Nleter Release )llt a '/r(f Vw <br />OIt>,DINY 20 AY <br />Rough ,lr ,L ,A <br />'Service [Meter Ir 1 <br />}FINAL Ir a) <br />Notes, Remarks, Etc. <br />I hereby affirnr untler penalty of prjury that I arn exen)pt fronr the Cbntractors' License l-aw for the followirtg reason (Sec,7031.5 <br />Busincss and Prolbssion Code): Any City or County which rcquires a permit to construct, alter. itnprove. demolish or rcpair any <br />slructure, prior to it.s issuance. also requires the applicanl lbr such permit to file a signed statement that lre or she is licerscd pursuant <br />to the provisions of thc Contractor's l-iccnscd law (Chaptcr 9. Commencing with Scction 7000 of Division 3 of thc Busincss and <br />Professions Corle) or that lu or she is exenqrt therefrom and the basis for tlre alleged exenption. Any violation of Section 7031.5 by any <br />applicant for a perrnit subjects the applicant to o civil pcnalty of not more than five hundred dollars ($500). <br />_1. a.s owncr ot'thc. propcrty, or tny ernployecs with wages as their solc comlrcnsation, will do t?rc work and thc stnrcture is not <br />intended or offeretl for sale (Sec'.7(X4. Bu.siness and Professions Code: The Contractor's Licensc Law does not apply to tut owner of <br />thc property wlro builds or inrproves tlrruln, and wlxr does .suclr wort hinself or lrcrself or tluouglt his or her own entployees, <br />provided that such improvcrncnts arc not intcndcd oroffcrcd for salc. Il. howcvcr, thc building or funprovcnrcnt is sold within one )aar <br />of completkrn, the Owner Builtler will have the burden of proving that he or she did not build or improve tlrc properry for thc purposc of <br />s:rh). <br />_1, as owner of the propcrty, am exclusively contracting with liccnsed contraclors to construct thc project (Sec. 7044, Business <br />arxl hol'ession Code: The Contractor's License Law does not apply to an owner of property who builds or improves lhereon. <br />and who contracts for such projects with a Contractor(s) liccnscd pursuant to thc Contrac{or's Liccnse Law). <br />-IantexemptunderSectitltt-,B.&P.C'lbrthisreason. <br />WORKI'RS' COMPT]NSATION <br />DECLARATION <br />I hcreby all'irnr undcr pcnalty of pcrjury onc of thc tirllowing dcclarations: <br />_l have arxl will nuintafur a Certilicate of Consent to Selt'-lnsure for workers' comlrcnsation, as provided for by Scction 3700 of the <br />labor Codc. for the 1rcrfornrance of the work lbr which thc pcrnrit is issucd. <br />arrdI will rnaintuin workers' contpetnalion insurallce, as required by Sectitln <br />which this lrcrnrit is issucd. My workcrs' crytqrcnsation insurartcc can'icr <br />h/t'64ca\ TVVtCn <br />3700 of the labor Code, for the Jrerfornun-e of <br />alxl policy nunrber arc:tlrc work frlr <br />Carrier: <br />^/\ /Policy D5 \\ZO <br />ccrrify that in tlrc 1^-rlirrnrancc of thc work for wlrich tlris pcrmit is issucd, I shall not cnrploy any lrcrson in any ntanncr <br />so astobecorncsubjccttothcworkcrs'conrpctrsationlawsofCalifornia.andagrccthatif lshouldbecomesubjccttothc <br />workers' comlrcnsation provisions of Section 3700 of the Labor Code, I shall, forrhwith conrply with thosc provisions.. <br />WARNING: Failure to secure workers' cornpensation coverage is unlawful, and shall subject an to and <br />civil [ines up to one hundred tlxrusand dollars addition to tlre cost of the <br />Scction 3076 of thc Ldxrr Co<lc. <br />oo,",{ lzzlzO <br />intcrcst and attornc'v's <br />I hercby affrnt under pnalty of perjury tlut I anr licens,ed under provision of Chapter 9 (conunencing with Section 7000) of Division 3 <br />of the Busine.ss and Professions Code. anl rny licensc is in full fiorcc md effect. <br />Licerrse <br />C \O Nunrber:41b16b <br />\,/ \ r.\a"t <br />CONSTRUCTION LEND]NG AGENCY <br />I hcrcby allirm under pcnalty of pcrjury that thcre is a construction lcnding agcncy for thc performancc of the work lbr which this permit is <br />issued (Sec. 3097, Civ. C.). <br />l-ender's Name: <br />APPI,ICANT DEC I,ARATION <br />I hcrctry afl-rnr undcr Jrnalty of pcrjury onc of thc following dcclarations: <br />Denrolition Pcrnrits-Ashcstos Notification Fedcral Regulations (Titlc 40, Part6) <br />-Rcquircd <br />l*ttcr of Notification <br />_l ccrtily that the <br />Ng ccrrify tnar I luvc <br />l'cdcral rcgulations rcgarcling asbestos rcrnoval arc n()t applicablc to this project. <br />rcad this application iuxl stalc llral tlrc ahrvc IS c()rrccl.agrcc t()conrply with City and County <br />ordinances irnd Statc Laws rclating of this City and County to cntcr up0n thc <br />ab<lve lnentioned property <br />Applicant Agent <br />Pcrmitcc nanlc <br />[trr <br />Itl construction,and <br />inlbrrnalion <br />rcprcscntatives <br />*," 1lz-z-lzo <br />Rev. 08-07-201 5 <br />7ftWs <br />-j) <br />t4 tlril DlYtdt <br />D**W ,17-L ZI