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ELECTRICAL-INSPECTOR RECORD <br />t3^,, fl(l'i' '',: /\ .i l': <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Groundins I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Wdls (Conduit) <br />PM*Walls (Rouqh)I x?l?d &ry <br />Ceilinss (Hard & Soffit Rouqh t <br />"/1-1"/) <br />OlWt tA'ry <br />Ceilings (T-Bar Rough) <br />Nleter Release <br />Rough <br />Service N/eter I I <br />FINAL WmlL tr57 <br />Notes, Bemarks, Etc uu- <br />l,A1YLI A (l,/L r171 T0{L*W,7 <br />ll <br />OWNDR BUILDER DELCARATION <br />I hcrcby affirm undcr pcnalty of pcrjury thil I {m cxempl frcN thc Contractors' Licenrc L{w for lhc following rcasm (5(.7031.5 <br />Business ard Profcssion Code): Any City or County which rcquircs a Jrcrmit to snslrucl. ahcr. improvc. dcmolish or rcpair any <br />struclurc. prior to its issuancc. also rcquires lhc npplicant for such lrrmil lo lilc a signcd slalcmnl lhnl hc or shc is liccnscd puNuarl <br />to lhc pmvisions of lhe Contrachr's Liccnscd law (Chaplcr 9. (irmmeming with Scction ?0fl) of Division 3 of lhc Busincss sld <br />ProfessionsCodc)orrhalhcorshciscxcmptthcrcfromandthch{sisforthc{llcgcdcxenftbn. AnyviolalionofsectionT0.ll.5hyany <br />upplicilnt for a permil suhjets the applicant to a civil pcnahy of nol morc thar livc hundrcd <lollars ($5fi)i. I <br />_t. as owner of thc propcrty. or nly ernployccs with wagcs as lhcir solc cornpcnsalion. willdo thc work and thc structurc is nol <br />intcndcd or <lflbrcd for salc (Sec.7(H4. Business and Jtol'cssions Codc: Thc Contraclor's Licensc Law docs nol apply to an owner of <br />thc prrrperty who builds or improvcs lhcrcon. and who d<rcs such work hirnself or hcrsclf or through his or her own cntployecs. <br />providcd that such inrprovcmcnts are mlt intendcd orollcred firr salc. lf. hou'cvcr. tlrc buildirtg or inprovenrcnl is sold within onc )rcar <br />of conrplction. the Owncr Builder will havc the burdcn of proving that hc or shc did not build or inprove the pnrprty for thc purposc of <br />sah). <br />_1. as owncr of thc propcrty. arn cxclusivcly contract ilrg with licclrscd conlraclors lo conslruct thc project (Scc. 7M4. Busincss <br />and Pnltbsskrn Codc: 'f he Contractor's Liccnse Law docs not apply lo an owncr ol'propcrty who builds or intproves thcreon. <br />and who contracts tirr such projccts with a Contraclor(s) liccnscd pursuanl to lhe Contraclor's Liccnsc [:w). <br />-lamcxcmptundcrScction-.B'&P.C.forthisrcason.Date:_()rrnt.r <br />}V( }RK IiRS' CONI PENSA'I'I( }N <br />DECT ARAI'ION <br />I hcrcby alfirrnundcr pcnaltyof pcrjury onc of lhc ltrllowing dccluralions: <br />_l havc and will nuintain a Ccrtilicatcof Conscnt to Self-lnsurc lirr workcrs'cornpensation. as providcd f<lr bySection 37fi)of the <br />Latxrr C<rdc. for thc grcrformance of thc work lbr which the pcrrnit is issued. <br />_l havc alrd will mairrtain workcrs' cornperrsatiolr insurancc. as rcquircd by Scct ion .j7fi) of the l-abor Codc. for the pcrlbrmance of <br />thc work l'or which this ;rcrrnit is issucd. My workcrs' cornperrsalion insurancc carricr and policy nultrbcr arc: <br />Policy Number: Expircs: <br />_l ccrtily that in thc pcrl'ornrancc of the work lbr which this pcrnrit is issucd. I shall not cmploy any pcrson in any manncr <br />so as to hccome subjcct to thc workcrs' compensation laws of Calilbrnia. and agrcc lhat if I should becorrc suhjcct to thc <br />workcrs' c<lmpensation provisions of Scction 37fi) ol'thc labor Crxlc. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failurc lo sccure <br />civil lincs up lo orrc hundrcd <br />rvorkcrs'coverilgc is unlawful. and shall subjcct an cnrploycr lo criminal pcnalties and <br />dollars I t'l to thc cost of comJrcnsation. damages as providcd lbr thc <br />Sccliorr .107(r thc Codc. <br />LtrcI)ate:% <br />I hcrcby al'l'irrn under penalty of pcrjury I artt undcr provision 9 (conrmcncing with .Section 7fin) of Division 3 <br />of thc Business and Profcssions Codc. and nry liccrrsc is in lirll torcc and ct'fcct <br />Liccnsc <br />Date: <br />Nunrhcr:6q57zA <br />6 IA trKc- <br />I hcrcby affinn undcr pcnalty of pcrjury lhat <br />issued (Scc. .3097. Civ. C.). <br />tsa bnding aScncy t'or thc Jrcrfornuncc of thc work for which this Jrcrnrit is <br />l.cnder's Namc: <br />Lcndcr's Acldress: <br />APPLICANT DF'CLARATION <br />I trcrcbyallinnundcr pcnalty of perjury ottc of thc folkrwing dcclarations: <br />Dcnrolition Pcrmits-Asbcstos Notification Fedcral Rcgulations (Title 40. Parl(r) <br />-Rcquircd <br />lrttcr of Notificalion <br />I <br />q <br />_l ccrlily that regulations rcgarding ashcstos rctnovalnrc nol applicahlc to lhis projccl. <br />ccrl ify rcad this application and slatc that the ahrvc inlirrrnatiorr is concct. I agrcc l<l conrply with all City and Coultty <br />conslruction. and hcrcby aulhoriz.c rcprcscntativcs <lI this City and County ltt cnlcr upon lhc <br />abovc <br />,,,.'-g!zJApplicant or Agent 2011 <br />Pernrilce <br />l-aws rclating to <br />M