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ELECTRICAL-I NSPECTOR RECORD a no n'7 ?n,t r: APPROVALS DATE ID/S!G.COMMENTS Site-Work l- Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm I Dampers Communications Cable Buildins Under Slab /f,loq Bonding / Groundiiu) UFER t/-Dtq lLC:Tr, Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Roush Ceilinss (T-Bar Roush) Meter Release Rough Service Meter ////-19 k?r 9^/e @ 4/r7 FINAL .'lltql-,o DAr-r/lau*7/ Notes, Remarks, Etc.I I tt a I tu'I o\!'Nlill I heeby affirm undr pcnalty of pojury that I an crempt from thc Contracto6' Licw Law for thc following reen (Se.?031,5 Busins and Profsion Code): Any City or County which rcquirs a ponit to congruct. alto. improve dmolish or rcpair uy structre, prior to its istrilcc. also rcquic the applicot for such pcrmit to filc a signcd staanot that hc or shc b lic@ed plmail lo the provisioG of the Contrrctor's Liccnred Law (Chapter 9. Commcncing with Sstion 7000 of Division 3 of the Busin6s ed Prcfe$ioN Codc) or that hc or shc h cxmpt thEcftom ad thc basis for thc allegcd cxmption. Any violation of Sec{ion 7011.5 by 8ny applicanlforspennitsubjetsthe .pplicilttoacivilpenaltyofnotmorethefivehundrcddolltrs($500). __ -1. as owner of the progterly. or my ernployees with rvages as their sole compensation. will do the rvork and the structure is not intended or offered for sale (Sec.7044. Business and Professions Code: 'I'he Contractor's License [-arv does not apply to an orvner of the propo'ty who builds or improves thereon. and who does such u,ork himself or herself or through his or her own employees. provided that such imp,rovanents are not intendetl or offersJ for sale. Il. howe\,€r. the building or improvement is sold rvithin one )€ar of cornpletion. the Owner Builder will have the burden of proving tha he or she did not build or improve the propo1y for the purposeof sale). _1. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4. Business and Profession Code: 'l'he Contractor's License [.arv does not apply to an orvner of property rvho builds or itnproves thcreon. and rvho contracts for such projects rvith a Contracto(s) licensed purcuant to the Contractor's License [.arv). _l arn exempt under Section_I'.C. for this o* DECLARAI'ION I hereby alTirm under penalty of perjury one of the follorving declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for u'orkcrs' compensation. as provided for by Section 3700 of the I-abor Codc. ftrr the performance of the u'ork for rvhich the pcrrnit is issued. -l have and will rnaintain rvorkers' compensation insurance. as requiretl by Section -1700 of the l-abor Code, for the performance of the w'ork for rvhich this pennit is issued. My workers' compensation insurance carrier and policy number are: Carrier:_ Policy Number:__Expires: _-_l certify that in the performance of thc rvork for rvhich this pcnnit is issued. I shall not employ any person in any manner so as to become subject to the workers' cornpensation larvs of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Lahrr Code. I shall, forthrvith comply rvith those provisions.. a WARNING: Failure to sL\cure rvorkers' compcnsation covcrage is unlarv[ul. and shall subject an onployer to crirninalfenalties and addition to the cost of compensation. damages as provided for thecivil lines up to one hundred thousand dollars ($100.000). of the Labor Code. interest and attorney's fees. I hereby affirm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Busine.ss and Professions Code. and my license is in full force and effect. License Class:License Nurnbcr: Date:_Contraclor:_ W I hereby aIlirm unda pcnalty ofpqjury that thft is I @nstruction lctrding agocy f<rr thc pcfonnmcc ofthc work for which this pqmit b hsuc{ (Ss. 3097. Civ. C.). lrnds's Nmc: Lcnder's Address: APPLTCAN'I' DEC LARATION I herdry affinn under penalty of perjury one of the following declarations: Dernolition Perrnits-Asbestos Notification Federal Regulations ('title 40. Pan6) -Required Lctter of Notification -l cqtify that the fcdaal rcgulatiom rcgrding ubctos rmoval uc not applicablc to this prcjcl. ._ | cqtify that I havc ud this application md statc that thc above infomaion is corcct. I agr lo complywth sll Cilyand County ordinance ard Statc Lsws rclaing to building construdiorl ud hcrcby aulhorize repltgtalivs of lhis City md Comty to ot6 upon thc t'I I ffi::ffiffi,v I'ernritee nRnle (print):