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ELECTRICAL.I NSPECTOR RECORD <br />f)*. <br />APPROVALS DATE ID/S!G COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm I Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor '6)lLcL?{5.,e 2'( L)- o - <br />Bonding I Grounding / UFER I <br />Transformers <br />Torqueing <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 />-rl ,JCeilings (T-Bar Rough)I \n <br />lvleter Release Ptl lt X)r LYfU / <br />I <br />rv <br />Rough /7tl Af <br />Service Mete(l /17 //q f,C{t 0K -l)si 'kf,/ lDlt/ . 2r{S lt,(tu <br />a//FINAL I ru '7,Dfnt\')rrzWW <br />Notes, Rgmarks, Etc,1tI <br />-' htlf-l{I <br />I hqeb,y affm unda poalty of pcrjury thaf I m cxmpt from the ContractoB' Liccnse [:w for thc following r@n (Ss.7031.5 <br />Buincs md Profeion Code): Any City or County which rcquim a pannit to coNtruct, alt6, improvq &mglish or rcpair uy <br />strucluc Fbr to its isuilcc, aho rcquic thc applicst for such permit to filc 8 sigtrcd statmt that hc or she b licaE d plNattr <br />to thc provisioE of thc Contractor'! Liccn*d taw (Chaptq 9. Comechg with SEtion 7000 of Division 3 of thc Bui!6 ud . <br />PrcfcsioNCodc)orthathcorshciscxcmptthqcfromudthcbosisforthcallegcdcroption. AnyviolationofSrlionT03l.5byany <br />applicantforapcmitsubjctsth€ 8ppticettoacivilpffiltyofnotmorcthilfivchundrcddollus($500). <br />-1. <br />a owno of thc prcpcrty, or my cmployG with wag6 a their elc compcmation, will do thc work ad the stnrc1rc is not <br />intdded or ofrqcd fq slc (Se.7044, Buiae od Profeioro Codc: Thc Conlrrclor's Licce taw doc not apply to m omq of <br />rhc propqty who builds or improve tt@n. atd who do6 sch wrt himsclf or hc8lf or thrcugh his or ho om oployc. <br />providcd that such imprcv@dts rc not itrtqdcd or olfqcd for salc. If, howm. thc building or imprcvqnq|t b sld within onc ]6 <br />of conpliiorL thc Own6 Buikkr will havc thc h[do of prcving thd hc or she dll rct build or impovc thc popoty 6r thc Ftrpocc of <br />sb). <br />-1. <br />a omo of thc propqty, m qclBivcly contraaing with licansed contractoE to conslruc{ thc projd (Sa. 7044. Bwins <br />and Prphsbn Codc: Thc Coilnctor's Licmc Law doc not apply to u owna of prcpcny who builds or imprcvG th6@tr. <br />and who antncts for such prcjE{s with 8 ContEcto(s) licas€d puE@t to thc Contractor's Liccffi l6w). <br />I m cxmDt undq S(tioo-. B. & P.C. for this reon. <br />Orvner:_ <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hereby affrrm under penalty of perjury one of the following dectarations: <br />_l have and will maintain a Certificate of Consent to Self-lnsure for workers' contpensation, as provided for by Section 3700 of the <br />l-abor Codc. for the performance of the work for which the perrnit is issued. <br />-l <br />have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the pcrformance of <br />the work for which this permit is issucd. My workers' compensation insurance carrier and policy number are: <br />Policy 1/24 '/M <br />-l <br />cerrify that in the of the work for which this perrnit is issued. I shall not <br />,/ <br />employ any person in any tnanner <br />should become subject to thcso as to bccome subject to the workers' compensation laws of California. and agree that if I <br />workas' compensation provisions of Section 3700 of the labor Code. I shall, forthwith comply with those provisions.. <br />WARNING: Failure to secure rvorkers' compensation coverage is unlarvful.and <br />civil fines up to one hundred thousand dollars ($100.000), in the <br />Section 3076 of the Code. interest and attorney's fees. <br />0 <br />I hereby affirm under penalty of perjury that I am licensed provision of Chapter 9 (commencing with Sesion 7000)of Division 3 <br />of the Business and Professions Code, and rny license is in full force and cffect. <br /><-.L <br />1tl toT'r <br />I hereby alTirm under penalty of perjury that there is a <br />issued (Sec. -i097. Civ. C.). <br />agency for the performance of the work for which this p,errnil is <br />Lender's Name: <br />APPLICANT DECI {RATION <br />I herety affirm under penalty of perjury one of the following declarations: <br />Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Pat16) <br />-Required <br />Lettcr of Notification <br />-l <br />ccrlify that the federal regulations regarding asbestos removal are not applicable to this project. <br />-l <br />cerrify that I have read this application rvith all City and ('ounty <br />ordinances and State l.arvs relating to and County lo enter uF)n the <br />above mentioned property for <br />Applicant or Agent <br />I'crlrtitec nanre ( glrinl ): <br />that <br />Onr, \h ++ <br />zt) <br />"' NIGT){A F/{D,oc/, <br />Z <br />re <br />---t-