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ELECTRICAL.INSPECTOR RECORD <br />)n <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby rftlrm undcr Fnalry of Frjury that I m excmpt fR m the Contraclos' Liccn$ Law for thc following rcamn (Scc.70l 1.5 <br />Busincss anl Protbssk n Cqlc): Any City or County which rcquircs a Jrrnit to @nsruct. altcr. inprovc, dcflolirh'iir Epair anyr <br />structurc. lrior lo its Lssurrec. aL$ rcquircs the applicanl for such Fmit lo frk a si8rcd stalcmnt lhat hc or shc is liccnsd punuant <br />to rhc pruvisions of thc Conlraotor's Liccnsd trw (Chapter 9. Commcncing with Setion 7U)O of Division J of the Busincss anrl' <br />PrulcssionsCille)orlhathcorsheiscrcmprthcrclrumedthcbasislirrthcalhgcdcxempion. AnyviolationofScctionT03l 5byany <br />applicant for a Frmit subjels the applicanl k, a civil pcnalty of not m,rc than fivc hurxlrcd do[ds ($500). <br />_1. as owncr of lhc pmlEny. or my cmployccs with wagcs as thcir $le comJrcnstion. sill do ttr wuk arxl lhc stnxtE it not <br />intcnlcd or ollcrcd for salc (S@.?(X4, Busincss mrl Pnrfcssions Cqlc: Thc Gtntractor's Lkrnse Law does not apply lo m owncr of <br />thc pn)Frty who builds or impn ws thcBrn. arl wl$ d(*s smh wlrt himsclf or her$clf or th^tugh his or hcr own employecs, <br />pnrvidcd that such imlmrcmtrts e mt intcnlql or()lfcrcd for slc. ll. howerci the buihling or impnrrcmnt is sll within orc )c{ <br />ofuurpletion, thc Owner Buildcr will harc thc burdo ofpR,ving that hc or shc did nol buill or improrc thc In lsly for th€ puryrrs of <br />sh). <br />_1. as owncr of thc prupcdy, amcxclusively contracting wilh lienscd conlracktF kt qrnstruct thc lrrjst (Se. 7O44, Busincss <br />anl PDf6sbn Codc: The Contnctor's Liccnsc Law d(rcs not apply lo & owncr of prolEny who builds or improrcs lhcrcon, <br />and who c$trtBcts for such lroFcts with . Crntmctor(s) liccn*d Pursuant to lhc Conlraclo.'s Liccn* [lw). <br />_l ant cxcnlpl undcr B. & P.C. litr lhis rcason. <br />Owner:rvonxnffilon <br />DECLARATTON <br />I hercby alTirm undcr penalty of perjury one of the fillklwing dcclaratitlns: <br />_l havc arxl will maintain a Certiticate of Consent to Self'-lnsurc fbr workers' comlrcnsation, as provided tilr hy Section 3700 of thc <br />Latxrr C<xJe, tbr thc pcrlbrmance of thc work tbr which the Jrcrmit is Lssued. <br />_l havc alrtl will as rcquircd hy Scction 17fi) of thc l-ahor Codc, tbr thc Jrcrtirrmancc of <br />anl prlicy numhcr arc:thc work lirr lllsuranL:c catTrcr <br />I unc 14C <br />-c) I - IPolicy <br />_l certily that in thc pcrlilrrnancc ol'thc work tirr which this prmit is issued, I shall not enrpkry any frcrson in any manncr <br />s6 as to bccomc suhjc.ct to the workcrs' conrpcnsation laws ol'Calitilrnia, antl agrcc lhat if l slxruld bccome subjcct to the <br />w6rkcrs' conrJrcnsation pnlvisions ol'scctiolr J700 of the Lahrr Ctxlc, I shall, lirrthwith comply with ttrlsc prtlvisitlns.. <br />WARNING: Failure to sccurc wrlrkers'comJrcnsation covcragc is unlawtirl. and shall subjcct an cmpltlycr to criminal pcnaltics anrl <br />civil l-rncs up to onc hundrcd thousand dollars (SlU),Uru), in addition ttr damagcs as providcd firr tlte <br />Seclion -1076 o[ thc htcrcst antl attorrrcy's t'ecs. <br />o <br />I)},('LARATI0N <br />I hcrcby allirrn unrlcr penalty ot'pc{ury that I arn liccnsed untlcr provision ol'Chaptcr 9 (commcncing with Scction 7U)0) ol'Division .l <br />ol' thc Busincss and Prot'cssions Codc, arxl my liccnsc is in t'ull torcc imd el'l'cct. <br />C(o -,q1 31 s6Licc-nsc <br />/a <br />CONSTRUCTION LENDTNG AGENCY <br />I hcrchy allirm undcr Fnally of lErjury that lhcrc is a construct ion bnding aScncy lbr lhe lrcriomancc of lhc work for which this Frmil is <br />issucd (Scc. 3097, Civ. C.). <br />[rntlcr's Nantc: <br />lrndcr's Address: <br />APPLTCANT DECLARATION <br />I trcrcby allirnr undcr pcnalty of perjury one of the tollowing dcclaratiotts: <br />Dcnr1llition Pcrmits-Asbcstos Notil'ication Fedcral Rcgulations (Tillc 40, Part6) <br />-Requ <br />ircd [*t tcr ttf Notifrcatitln <br />_l certil'y that thc t'cdcral rcgulations rcgarding ashcslos rcnrovalarc nol applicablc to this pnrjcct. <br />-l <br />ccrtily that I have read this application arxl statc that thc ahlve iltlirrmatiort is con'cct. I agrce to ctlmply with all City and County <br />orrlinanccs and Statc laws relaling trl <br />atxlve nrcntiorrcrl propcrty tirr insJrccl <br />arxl herchy authrlriz.c rcprcscntativcs of this City and County to cntcr uJxrn thc <br />Applicant or Agenl <br />Penrritee nanre <br />o k <br />Site-Work <br />Underoround <br />Pole Bases <br />Liqht Standards <br />Spas. Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor <br />Bondinq I Groundinq / UFER <br />Transformers <br />Torqueing t -* nr/ <br />Sub-Panels tl \rz 1l)rI\Ylt \/W61 <br />Air Conditioners II v \ur <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinss (T-Bar Rouqh) <br />Nleter Release <br />Rough <br />Service lVleter I J -O'l <br />FINAL ,{ hq 1t)PfYt Y) o L +Yo I <br />TTT lrNotes, Remarks, Etc.