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ELECTR!CAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUTLDER DEI.CARATION <br />I hrcby affirm unds penalty of perjury that I m cx@pt ftom thc Conrac{oB' Lic6c Law for thc followiog rwn (Sc.7011.5 <br />Buinss ad Profsion Codc): Any City or County which rcquirs a pannit to construcl, altc, improvc, dmolish or rtpair uy <br />sbuclurc trior to its isuacq also rcquiG thc applicut for such Frmit to filc a signcd stat@ot tha lrc or sltc is ticmscd pwant <br />to thc FovisioG of the Contretor's Licqscd llw (Chapt6 9. Comcnciog with Setiotr 7000 of Division 3 of thc 8uh6 ed <br />PrcfNioN Codc) or that hc or shc i! qmpt thqcftom ed thc basis for thc allcXcd amption. Any violation of Selbn 7031.5 by my <br />appliwtforapcmitsubjetsthc applicanttoacivilpcmltyofnolmorcthefivchundrtddollm($500). <br />_1, c omq of thc propcrty, or my cmploye with waga re thcir mle omperuation, will do 0E wtrk ud thc structrc is mt <br />intsdcd or offcrcd for slc (Sc.7044, BBins md Prcfsiom Codc: Thc Contrrctor's Licce bw do6 not apply to u omq of <br />thc prcpqty who tuilds or impros tltaon, ad who do€ wh wrt himclf or hcrclf or thrcugh his or hc om mploye <br />prcvidcd that such improvffits e mt intcrdcd or ofu for slc. lf. howq, thc buil4ing or improvqEl is sld within onc )ar <br />of compt:tion, thc Ovma Buik'la will havc thc hrdor of prcving tha hc or shc dil mt buiH or irryorc thc popcty br thc purpo* of <br />sh). <br />_1. s om6 of thc pIopqty, m cxclBivcly contracling with licenscd contractoE to @nstruct thc projc{ (S@. 7044, Bahe <br />and Pioftsion Codc: Th€ Contractor's Liccw Law do6 not apply to e own6 ofpropcrty who builds or imprcve thaon, <br />md who conkacts for such projErs with 8 Conlncro(s) liccnscd pum@t to thc Contractor's Licw trw). <br />I m cxmDt utrds Setion-, B. & P.C. for lhis rcen. <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hereby alTirm under penalty of perjury one of the following declarations: <br />-l <br />have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the <br />LabSr Codc, for the perfonnance of the work for which the perrnit is issued. <br />Lllnur"and will maintain workers' co :e. as required by Se,ction 3700 of the Laborff]?#Hx#,*"#ffi' -Code. for the performance of <br />are: <br />lo lnlzctPolicy <br />-l <br />certify that in the performance of the work for which this permit is issued. I shall not ernploy any person in any manner <br />so :rs to becorne subject to thc workers' compensation laws of California, and agree that if I should becomc subject to the <br />workers' compersiltion provisions of Section 3700 of thc tabor Code. I shall, forthwilh comply with thosc provisions.. <br />WARNINC: F-ailure to serurc workers' compensation coverage is and shall subject an onployer to criminal petralties and <br />civil fincs up to one hundred thousand dollars ($100,000), in cost of cornpensation, damages as provided for the I <br />attorney's fees. <br />I hereby affirm under penalty of perjury that I arn licensod under 9 (commencing with Secrion 7000) of Division 3 <br />of the tsusincss and Professions Code. and my license is in full force and effect. <br />License bb "er32 <br />CONSTR,UCTION LENDING AGENCY <br />I h@by affm undr pcmlty of pcrjury thd thft is s consiruclion hnding agocy for thc pqfomcc of thc wo* for which ahis pqmh is <br />issucd (Se. 3097, Civ. C.). <br />Lcrtrlct''s Nirtttc. <br />Lender's Address: <br />APPLICANT DECLARATION <br />I hereby affinn under penalty of perjury one of the following declarations: <br />Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40, Part6) <br />-Required <br />Letter of Notification <br />-l <br />cedify that the federalregulations regarding asbestos removal are not applicable to this project. <br />_l certiff that I have read this that the above infonnation is conect. I agree to comply with all City and County <br />ordinances and State Laws relating to enter upon the <br />above mentioned property for inspection <br />Appticant or Agent I <br />I'ermitee nrnle <br />and hereby authorize representativcs of this City and <br />kl <br />Site-Work <br />Underground <br />Pole Bases <br />Lisht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm I Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq I Groundinq / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinss (Hard & Soffit Roush <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL ll' lz "4,U["YutU\7qJ <br />Notes, Remarks, Etc. <br />Rev. 08-07-2015 <br />Oafe: ?