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ELEC TRICAL.I NSPECTOR RECORD ()^', f\Q f\^7 ?n4t:, APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire Alarm I Dampers Communications Cable Building Under Slab / Floor Bonding I Grounding / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Rough)I ,/ Meter Release Dftnrt e 1-r17 I Rough Service Meter I FINAL lz El rq b*n oaL Lfl Notes, Remarks, Etc.,l I hqeby affim undo panalty of pa'jury that I m cxmpt from thc Coilmctos' Licoe t:w for thc following rwn'1sc.2031.5' Businss and Profcssion Codc): Any City or County which rcquiro a permit to costruct. altc. improvc, dorclish or rcpair my structuq prior to its isumcc. also rcquirc thc eplicilt for such pcmit to file a signed statmot thal hc or shc is lic@sâ‚¬d p$uilt to thc provisiom of thc Contractor's Liccnsed [:w (Chapt6 9. Commocing with Setion 7000 of Division 3 of thc Busincs ud Professions Codc) or that he or shc is excmpt thqefrom od thc bsis for the allcged er@ption. Any violation ofsetion 703 I .5 by any applicantforapmitsubjetsthc applicanttoacivilpenaltyofnotmorcthaolivchundreddollus($500). __ l. as owner of the property. or my employees rvith wages as their sole cornpensation. will do the rvork and the structure is not intendcd or offered for sale (Sec,7044. Business and hofessions Code: The Contractor's License Law does not apply to an owner of the property rvho builds or improves thereon. and who does such rvort himself or herself or through his or her own employees. provided that such improvanents are not intended or offerod for sale. lf. horvever. the building or improvement is sold wilhin one year of complaion. the Orvner Builder rvill have the hrden of proring tha he or she did not build or improve the propaty for the purposc of sale). _1. as owner of the propâ‚¬rty. arn exclusively contracting rvith licensed contractors to construct the project (Sec. 7044. Business and Profession Code: The Contractor's License Larv does not apply to an owner of property rvho builds or improves thereon. and who contracts for such projerts rvith a Contracto(s) licensed pursuant to the Contractor's License Law). I arn cxcrnpt under Sectiott , B. & P.C. for this reason. ( )rr nrr: WORKERS' COI}IPENSA'I'ION DECLARATTON I hereby affinn under penalty of pa'jury one of the follorving derlarations: _l have and will maintain a Certificate of Consent to Self-lnsure for rvorkers' compensation. as provided for by Section 3700 of the Labor Code. for the pei'formancc of the work for which the p,errnit is issued. -l have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the performance of thc rvork for which this permit is issued. My workers' compensation insurance carrier and policy number are:' S/ot+<Carrier:_ Policy -Exp',,, //3or/us __l certify that in the performancc of the work for which this permit is issued. I shall not anploy any person in any manner so as to become subject to the rvorkers' compensation lau's of California. and agree that if I should become subject to the rvorkers' compensation provisions of Section -1700 of the Labor Code. I shall. fonhs'ilh comply rvith thosc provisions.. WARNING: Failure to secure workers' compensation , is unlarvful. and shall subject an anployer to criminal penalties and addition to the cost of compensation, damages as provided for thecivil fines up to one hundred thousand dollars Ill Section -1076 of the Labor Code. interest and l)alc:./t/4/rq L D[-('l.AR,t t'lON I hereby alTirm under penalty of perjury that I arn licensed under provision of Chapter 9 (commencing rvith Sectkrn 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. l.icense C c l)nlc:tt/s/ r *l- CONSTRUCTION LENDING AGENCY I hereby affrrm under penalty of perjury that there is a construcrion lending agency for the po'formance of the work for issue<l (Sec. 3097. Civ. C.). p,ermit is [rnder's Name: Lender's Address: APPLICANT DECLARATION I ho'eby aflinn under penalty of perjury one of the following declarations: Dernolition Pennits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notification -l certify that the federal regulations regarding asbestos removal are nol applicable to this projcct. _l certifu that I have read this the ahrve infcrnnation is corred. I agree to comply representatives of this City a with all City and County and County to erter upon theordinances and State Larvs relating to above rnentioned property for Applicnnt or Agent l'errrrilr:c nanle and state that and hereby authorize l ll /,^l / tl tzl <l t9 l)ate:_ /