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ELECTRICAL-INSPECTOR RECORD <br />)n.i f <br />APPROVALS DATE ID/SIG COMMENTS OlVN F]R RTiII,I)I.]R I )I.:I,(',\ RA'I'ION <br />I hcrcby affirm under pcnalty of lErjury thal I am cxcmpt fron thc Corlraclo$' Liccnrc kw for thc following rc.sn (Ss.7031.5 <br />Busincss ard Pmfesshn Codc): Any City or County which rcquircs s lEnnit to construct. allcn improvc. dcmlish or rcpair any <br />structurc. prior lo its issuare. als rcquircs thc applicant for such lErnril lo filc a siSncd stalcmnl that hc or shc is liccnscd puNanl <br />lo thc pmvisions of thc Contrack r's Liccnred Law (Chaptcr 9. Comrcrcing wilh Sction 70(n of Division 3 of lhc Busincss and <br />prcfcssionsCodc)orthathcorshciscxcmptthcrcfrommdlhchosisforthcallcgcdexcmption. AnyviolationofSccthnTO3l5byany <br />.afplicanl for o pcrmil subttls thc applicant to a civit pcnalty of nol mrc lhan fivc hundrcd dollsrs ($500). <br />I lr./ <br />!ll. as owncr of thc prolEny. or my cmplo)rccs with wagcs as their $h ompcnsation. will do Ihc wotk {d thc slnr{w is mt <br />intendcrl or offcrcd fq sle (Sa.2044. gusircss and Professions Codc: Thc Contractor's l-iccnsc hw docs nol aPPly to an owncr of <br />lhc pnrFny who huil<ls or improrcs thcNn. and who dms such mrt himsclf or hcr$lf or lhrcugh his or hcl own cmployccs. <br />p..rUca rhor ruch imlmwmnls m mt intcnlc{ or olf$ql for $h. If. lhwercr. lhc boiuing or ifi{rrcrclrcnl is $H within orc }cu <br />;f complction. thc Owncr Buildcr will hrw thc hurdcn of pmving thsr hc or shc did not buiH or iry,rcre thc lreFrry for tlrc PurtD$ of <br />sle). <br />_1. as owncr of the ;nopcny. om exclusivcly controctilg with liccnrcd contractotr lo coNtruct thc pmjst (Ss. 7(X4. Busircss <br />arxl prolbrsion Code: Thc Conlrsctor's Liccnsc Law docs not apply to an owncr of propcny who builds or improvcs lhercon. <br />and who conlmclsforsuchproj.tlswilhaContmclo(s)liccnscdput$unllolhcConlrudor'sLicensckw)' <br />I arrr cxerrtnt <br />"*",-g-! <br />under Section-. B. & P.C <br />t-7 / tg or"n".,\(-- <br />I hcrcby alTirnt undcr pcnahy ol'pcrjury one ol'thc follttwing dcclarations: <br />_l havc a1d will maintain a Ccrlificatcof Consclrt to Self-lnsurc for workcrs'compcnsalion. as provided for byScction -j700of thc <br />Labor Crde. for the pcrformancc of the work l'or which thc pernrit is issuccl. <br />_l havc an4 will maintain workcrs'compcnsation insurance. as rcquircd by Scction -37fi) of thc Lahor Code, for the pcrformance of <br />the work for which this Jrcrmit is issucd. My workers' conrJrensali<ln insurancc carricr and Jnlicy number are: <br />that in thc lrcrfornrance of thc work ltrr which this pcrrnit is issuctl. I shall rxrl crnpkly any pcrson in any matlncr <br />if I should bcconrc subject lo thc <br />cornply with th<lsc provisi<lns.. <br />su as to hecornc subjcct to the workers'cotnpcnsalion laws of Calitirrnia. and agrcc that <br />workcrs' conrpensalion provisions of Sccti<ln 37()0of thc Latxrr Code. I shall. lirrthwith <br />WARNING: lrtilurc lo sccurc workcrs' corrrllcrtsation c()vcrilgc is tttrlts'lul.shall subjcct tn etnployer ttl pcrraltics artd <br />civil fines up lo one hundrcd thousand dollars (Slm'un)' in addition ol' colrtpcnsat ion.as provided for the <br />Scctiort 3076 of thc Lahor Cotlc. intcrcsl and allorncy's l'ccs. <br />,,r",?141 ll9 Applicant: <br />a <br />t hcrchy aflirrn undcr pcnalty of pcrjury lhat I atn licenscd undcr provision of Chaplcr 9 <br />of thc Busincss and Professions Codc. and nty liccnsc is in full fbrcc urxletl'cct. <br />u'ilh Scction 70fi)t of Divisioll 3 <br />Date:-('ottl raclor. <br />CONSTRUCTION LENDING AGENCY <br />I herchy atfirm undcr JEnaltyof Frjury lhat lhm is a @nstruclion hndirrg rgency for lhc pcrfonprcc of lhc work for which this lrcrmit is <br />issucd (sc. 3097. Civ. C.). <br />lrndcr's Nanrc: <br />Lendcr's Adclrcss: <br />APPI ICANT DECLARATION <br />I hcrcby aflirm under pcnalty of perjury onc of the following declarations: <br />Denrolition Permits-Asbestos Notification Fedcral Regulations (Title 40. Part6) <br />-Rcquircd <br />Lcttcr of Notification <br />(8"::,:i'::,". <br />fctlcral rcgulatiorrs rcgarding ashcslos rcnxrvitlflrc nol ap;llicahlc lo lhis project. <br />rcad this applicatiort ald ahrvc intirnttation is with all City and Counly <br />and County l() cnlcr uyrn thcordinanccs and .Statc l.aws rclaling to building and hcrcby aullnrizc <br />ahrvc rrtcntioncd propcrly l'or insJrcctiott <br />Applicnnt or Agenl Signnture:L-Nao <br />,*",gft1 ft! <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Sl ab I Floor <br />Bondinq / 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 Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />lVleter Release <br />Rough <br />Service JVleter I - <br />S.\ <br />FINAL \tl 4 lq -l M g <br />Notes, Remarks, Etc.t U\ <br />--> <br />n{t]' <br />o <br />,