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ELECTRICAL-INSPECTOR RECORD <br />f)zrr n(l fi7 .)fii ( <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <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 SIab / Floor <br />Bonding I Grounding 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 (Rouqh) <br />Ceilings (Hard & Soffit Rouqh ,/ <br />7t-Att4euCeilings (T-Bar Rough)44/20 a <br />Meter Release (/ (, <br />, <br />Tt-*n<go,Rough >/+/It'o i {T)) <br />Service Meter V <br />lah&tiFINALarVl"D',De) <br />Notes Re Etc. <br />OWNER BUILDER DELCARATTON <br />I hcrchy allirm undcr pcnalty of Frjury that I m cxcmpl tiom lhc Contracto6' Licen$ Law for the tbllowing rcason (Scc.70-1 1.5 <br />Busincss arxl Prolcssiotr Culc): Any Cily or County which rcquircs a Jrrmit kr crnstruct. allcr. improvc. dcnrclish or rcpair any <br />slruclurc. pri(rr lo its issuancc, also rcquircs thc applicant lor such lEmit b lile a signcd slalcnEnt that hc or shc is licnsd pgNuant <br />kr lhc provisk)ns o[ thc Conlrack r's Liccn$d Law (Chaptcr 9. Commncing with Section ?m0 of Division 3 of thc Busircis and <br />PnrtcssionsCodc)orthathcorshciscxemptthcrcfromandthcbasisforthcallcgcdcxcmption. AnyviolationofSetionTO3l.5byany <br />applicant for a pcmil srhjr-ts thc applicant lo a civil penahy of nol morc lhan tivc hundrcd dolles ($500). <br />_1. as owncr of thc propcrty. or my cnrpklyccs with wagcs as their solc comJrcnsation, will do thc work and the structure ls not <br />inlcndctl oroll'crcd lirr sale (Scc.7044, Busincss and Prol'cssions CtxJc:'flrc Contractor's License Law does not apply to an owner of <br />thc pnrpcrly who builds or inrprovcs thcrcrln, antl who drrcs such wod< himsclf or hcrsclf or lhrough his or hcr own employees, <br />providcd that such impnrvcnrnts arc not intcndcd orollbrcd tirr salc. If, howcvcr, thc huikling or impruverncnt is sold within one year <br />ol'conrplction, lhe Owncr Builder will havc thc burden of proving that he or shc did not build or improvc thc prcpcrty tbr the purpose of <br />salc). <br />_1, asowncrol'thc proJ-^*rty, anrcxclusivelycontracting with liccnsetlcontractorstoconstruct the projcct (Scc. 7(X4, Busincss <br />and Pnltbssion Code: T'he Contractor's License Law docs not apply to an owner of proJrerty who builds or improves thereon, <br />and who conlracls ltlr such pnrjccts with a Conlractor(s) liccnscrl pursuant to thc Contractor's License Law). <br />-IamcxcmptundcrSectitln-'B.&P.C.forthisrcastrn' <br />Date: <br />TVORKERS' COI\ I PENSATION <br />DECLARATION <br />I hcrchy allirnr untlcr p^-nalty ol pr'rjury onc' ot'thc tolkrwinc dcclaratiotrs: <br />_l havc and will maintain a Ccrtiticatc of Consent to Sclf-lnsurc tor workcrs' compcnsation. as provided for by Section 3700 of the <br />Latxlr Crxle, lilr the grcrtbrmancc of the wrlrk for which the prmit is issuctl. <br />_lhavcantlwill nraintainwrlrkcrs'compcnsationinsurancc.as rcquircdbyScctionSTfi)oftheLahorCode.tbrthe;rcrtrlrmanccof <br />thc work lbr which this permit is issucd. My workcrs' conrlrcnsation insurancc carricr aml Jxrlicy numbcr are: <br />Policv Number: Exoires: - u <br />_l certily thal in thc pcrlilrmancc of thc work tbr which this Jrcrmit is issued. I shall not employ any pcrson in any manncr <br />so as lo hccomc subjcct to thc workers' compcnsation taws of Calitilrnia, and agrce that if I should becornc subject to tttc <br />workcrs' compcnsation pnrvisions of Section 1700 of thc Lahrr Ctxlc, I shall, lorthwith comply provlsions.. <br />WARNTN(i: Failurc lo sccure workers' conrpcnsation covcratlc is unlawtirl, and shall <br />civil lincs up l() onc hundrcd thousand rlollars ($l00.Un), in addition to the cost of <br />to criminal Jrcnaltics antl <br />as provirled tirr the <br />attorney's f'ccs. <br />l)F.('1.,\R,\'l'l()N <br />I hcrc-hy al'lirnr undcr Jrcnalty of Jrcrjury that I am liccnscd undcr pruvision 9 Section 7m0) of Division J <br />ot' tlrc Busincss antl Prol'cssions Codc, and my liccnsc is in l'ull tirrcc and cffcct <br />Liccnsc Numht'r: <br />I hcrcby alfrm utrdcr lrmlty of Jrcrjury lhat thcrc is a @nstructhn bnlin8 agcrcy for thc [rcrfomre of the Mrrk for which this lrcmit is <br />issucd (Se. -1097, Civ. C.). <br />knrlcr's Namc: <br />l-cnder's Addrcss: <br />APPLICANT DECLARATION <br />I hcrcby all-rrn unrlcr pnalty of Jrcrjury onc of thc lblkrwing dcclarations: <br />Dcmolition Pcrmits-Asbcstos Notification Fedcral Regulations (Titlc 40, Pafl6) <br />_Requircd lrt tcr ol' Notil-rcation <br />_l ccrtiti that the I'cdcral rcgulations renxrvalarc not applicahlc to this projcct. <br />_l certity that I havc rcad this application and inlirrmation is correct. I agrce to comply <br />rcprcscntatives of this City <br />with all City and County <br />anrl County lo entcr uJxln thcordinanccs anrl Statc l-aws rclaling to building <br />abovc nrcnlioncd proJrcrty lilr inspcction <br />Applicnnt or Agent <br />Permitee nanre <br />aulh<lrizc <br />C)o 2n/f -