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ELECTRICAL.I NSPECTOR RECORD <br />f).no n'7 1^"' s, <br />APPROVALS DATE !D/SIG.COMMENTS <br />Site-Work <br />__!UnQerground <br />Pole Bases <br />Light Standards <br />FountainsPoo <br />Life Safety /Low Voltage <br />Fire Alarm lDampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />ipmentRoof Top <br />Wired Unit <br />lffalls (Conduit) <br />)Walls <br />Ceilings (T-Bar Rough) <br />Soffit RoughCeilinqs(Hard & <br />Meter Release <br />Rough -I <br />Service Meter l, t/tTfi w <br />FINAL owpuv {-0 <br />Notes, Remarks, Etc. <br />o\!'Nt.lt <br />I hrcby affim undq pqahy of psjury that I m cxcmpt from thc ContractoE' Licse Law for the following rcen (Se.70]i.5 <br />Businss od Profeion Code): Any City or County which requiro a pqmit to corctruct. altc. improva danolish or rpair uy <br />struclw. prior to its isuucc. alm rcquira the applicmt for such pcmit to file a signcd statmot tha hc,or shc b licmscd prmut <br />to lhe Fovisions of the Contractor's Liccnscd Law (Chapt6 9. Commocing wilh Sstiotr 7000 of Division 3 of thc puinas ad <br />ProfcsionsCode)orthathcorshcisexcmptthscfromandthebasisfortheallegedex@ption. AnyviolationofSsiionT0-1l.5byany <br />applicant for a pcmit subjets thc applicant to a civil pcnalty ofnot morc the fivc hundred dollus ($500). <br />---1, c omq of the prcpcriy. or my cmployG wilh sag6 6 thcir $le comFmation. will do thc rcrt ad thc $nrlrc b not <br />intodod or offercd for sale (Se.7M4. Busin6s ild Prof6siom Codc: Thc Contractor's Licse taw do6 not apply to il ownq of <br />thc poperry who builds or imprcvs thqon. ild who dc such rc* himsclf or hmelf or thrcugh his or ho ow cmploye. <br />provid€d that such improvmdts rc mt intqrded or ollrcd for slc. I[ howdd. thc building or imp(ov@t is pld within onc ]qrofcomplaion, thc Owno Buikts will havc thc huda ofpoving rha hc or she did not buiH or inprorc lhc prcpsry for thc purporof <br />sle). <br />-1. <br />as owncr of the property. am exclusively contracting rvith licensed contractors to construct the project (Sec. 7044. Business <br />and Pmftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon.and rvho contracts for such projects rvith a Contracto(s) licersed pursuant to the Contractor's License l-aw). <br />-lamexemptunderSection-.B'&P'C.forthisreason.l):tle ()n lrer: <br />WORKERS' COI\IPENSA'I'ION <br />DECLAITATION <br />I hereby affinn under penalty of perjury one of the following declarations: <br />-l <br />have and rvill rnaintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section -1700 of the <br />Labor Code. for the performance of the rvork for which the pennit is issued. <br />Code. for the perfonnance of <br />afe: <br />C> <br />-l <br />certi$r that in the performance of the rvork for rvhich this perrnit is issued, I shall not employ any person in any rnanner <br />so as to become subject to the rvorkers' cornpensation laws of California. and agree that if I should bccorne subject to the <br />workers' cornpensation provisions of Section 3700 of the Labor Code. I shall. forrhrvith comply with those provisions.. <br />WARNING: Failure to sccure rvorkers' cornpensation coverage is unlau'ful. and shall subject an onployer to criminal penalties and <br />civil fines up lo one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the <br />Section 3076 of the Lakrr Code. interest and attorney's fecs. <br />I <br />I hereby affirrn under penalty of perjury that I arn licensed under 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code. and rny license is in full force and effect. <br />l.icense cto License Number:afit7 5 CLuL('onlractor: <br />CONSTRUCTION LENDING AGENCY <br />I hwby affrm undr pef,slty of pqjury that th6c is a coNtruc-tior lcnding agocy for thc pqfomoce of the wrk for which this pqmit b <br />bsucd (Sc. 3097. Civ. C.). <br />[rnd6's Nmc: <br />Lender's Address: <br />APPLICANT DECLARATION <br />I her*,y affrm under penalty of perjury one of the following declarations: <br />Demolition Pernrits-Asbestos Notification Federal Regularions (Title 40. Pafi6) <br />_Required l-rtter of Notilication <br />-l <br />certify that the federal regulations regarding asbestos removal are not applicatrlc to this project. <br />that I have read this application and state that the abor.e infonnation is correct. I agree to cornply with all City and Counly <br />ordinances and State Larvs relating to building construction. and to ent€r <br />above mentioned property for inspection purposes. <br />Applicnnt or Agent <br />Permitee nrme (print):- DAr^14 <br />of this City and <br />Z <br />the <br />Signs (monument)