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ELECTRICAL-!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq I Groundinq I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouoh) <br />Ceilings (Hard & Soffit Roush <br />Ceilings (T-Bar Roush) <br />l\Ieter Release <br />Rouqh <br />Service lVleter I <br />FINAL tt lfo hn 0ffwd 7 <br />Notes, Remarks, Etc.lt <br />OWNE,R BUTT,DER DIiI,CARATION ! <br />I hereby affirnr untter penatry of perjury that I arn exernpl from the Contractonr'Licensc l-aw for the following reason (S...203t.5' <br />Busincss and Profcssion Code): Any City or County which requircs a pcrmit to conslruct, aller, irnprovc, dcmolish or rcpair any <br />structure, prior to its issuance. also requires the applicant for.such pernril to file a signed staternent that lre or she is licenscd pursuanl <br />to thc pmvisions of thc Contractor's l.iccnscd law (Chapter 9, Commcncing with Scction 7000 ol' Division 3 of thc Business and <br />hofessions Code) or that hc or she is exempt therefronr and the basis for tlre alleged exenption. Any violation of Section 7031.5 by any <br />applicant for u perrnit subjects the applicant to a civilpenaltyof not more than five huntlred dollars ($500). <br />_1. as owncr ol'thc property. or my cmployees with wages as thcir sole compcnsalion, will do thc wcrk and thc structure is rxrt <br />intendcd or offered for sale (Sec.7Ot+, Business and Professions Codc: The Contractor's Licensc l-aw rloes not apply to an owner of <br />the prcperty wlrcr btrilds or improves thereorL and wlro does such work himself or lrcrself or through his or her own entployecs, <br />provided that such improvcrmnts arc not intended or oflcrcd for salc, Il. however, thc building or inprovcrncnt is sold within onc year <br />of completion, the Owner Buikler will have the burtlcn of proving ttrat lre or she did not buikl or improve Orc propaty for thc purposc of <br />nale). <br />_1, as owner of the propefly, um exclusively contracting with licensed contraclors to construct thc projcct (Sec. 7044, Busirrcss <br />arxJ hrofesskxr Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. <br />and who contracts for such projccts with a Contractor(s) licensed pursuant to thc Conuactor's License Law). <br />-IantexernptunderSectit,tt-'B.&P.C.fortlrisreason. <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hercby affirm undcr Srcnalty of perjury one of thc tbllowing de-clarations: <br />I <br />J I hu", and will nuintain a Certiticate of Consent to Self-lnsure for workers' compensation, as prcvidcd for by Se,ction 3700 of thc <br />labor Codc, for the pcrformarce of the work for which thc pennit is issued./ <br />Vli hor. anrJ will nuintain workers' conryrcmalion insurance, as required by Section 3700 of the Laborv- <br />thc work for which this pcrnrit is issucd. My workcrs' conqrcnsation insurancc carricr arxl plicy numbcr <br />fn <br />Code, for lhe perfonnarrce of <br />are: <br />TI osf z=[ z*z r <br />irr thc pcrtirrnunce o[ thc work for which issucd, I shall not employ any pcrson in any manncr <br />and agrce that if I should bccotnc subjcct to thc <br />shall, forthwith comply with thosc provisiotu.. <br />this Jrcrmit is <br />of California.so as to bccornc subjcct to thc workcrs'cornpensation laws <br />workers' conqrcnsation provisiorrs of Sectiott 3700 of the Labor Cbde, I <br />WARNING: Failure to secure workers' compensation coverage is unlaw[ul, and shall subject an employer to criminal penalties and <br />civil firrcs up to one lrundrcd thousand dollars ($100,W0). in addition to lhe cost of compersation, danuges as provided for lhe <br />Section 3076 of thc [:tnr Cotle. intcrcst and attorncy's [cc's. <br />io[tQ[mI)ete: <br />I l- LTcENSEpcoNTRACToR <br />DECLATTATION <br />I hercby affirm under pnalty of pcrjury that I ant licensed undcr provision of Chapter 9 (commencing with Section 7000) of Division 3 <br />of thc Busincss and Professions Code. and my license is in full force and effect. <br />Nunrber: <br />qc(u117 <br />License <br />Dnte:nl?A lbo <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby aflirrn undcr pcnalty ol'pcrjury that thcrc is a construction hnding agcncy for thc pcrl'orrnance of thc work lbr which this pcrrnit is <br />,issued (Sec. 3097, Civ. C.). <br />l.cnder's Name: <br />L.cnder's Address: <br />APPLICANT DECI,A RATION <br />I r-brcby aftirnr under p-nalty of pcrjury onc of thc tbllowing dcclarations: <br />Dcnxrlition Pcrnrits-Asbc'stos Notification Fcdcral Regulations (Title 40. Pan6) <br />-Rcquircd <br />l-cttcr of Notification <br />_l certity that thc fcderal rcgulations rcgarding asbcslos rcmoval arc not applicablc to this project. <br />_l ccrtily tlrat I lurvc rcad this application uxl statc that thc abovc inlornution is corrcct. I agrc'rc to comply with all City and County <br />ordinanccs and State Laws rclating to building construction, and hcrcby authorize representativcs of this City and County to entcr upon ttr <br />above rnenlioned property for <br />Applicant or Agent <br />lrcrnritee trunlc <br />! <br />08-07-2015 <br />ll <br />Dare: Iol2A[l O <br />tt