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ELECTRICAL.INSPECTOR RECORD <br />()^'no n7 1n,, q <br />APPROVALS DATE !D/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire AIarm I Dampers <br />Communications Cable <br />Buildins <br />Under Slab / Floor <br />Bondinq I Groundinq / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Roush) <br />Meter Release <br />I <br />Rough l?-l8 ('t Vkft0crt wY( <br />Service Meter t7 'lg (n Dtl\^4 7-+3 '- <br />F!NAL tli ? q{n\ . <br />Notes, Rgmarks, <br />I <br />OWNER BUILDER DELCARATION <br />I hrcby affm unda pcnalty of perjury that I m cxmpt from thc ContracloE' LiceE taw for the following r@$n (5€.70-11.5 <br />Busines and Profsion Codc): Any City or County which rcquiro a pmnit to coNtruct, altc. improvc dcmolish or rcpair uy <br />slruc{ue. prior to its isuocc. also rcquirc the +plicilt for such pcnnit Io filc a signcd statm@t lhd h€ or $c b licoscd pmualn <br />to thc provisioro of thc Contrsctor's Licensed law (Chaptq 9. Commmcing with Setion 7000 of Division 3 of thc Buins od <br />hofsions Codc) or that hc or shc is cxcmpt thqcfrom ed the basis for thc allcged cxmpion. Any violation of Scclion 703 I .5 by any <br />applicantforapetmitsubjEtsthc applicmttoacivilpcnaltyofnotmorethmlivehun&eddollas($500). <br />_1, as owner of the properly. or my employees with wages as their sole compensation. will do the work and the structue is not <br />intended or offered for sale (Sec.7M4. Business and hofessions Code: J'he Contractor's License Law does not apply to an owner of <br />the property who builds or improves thereon. and who does such wort hirnself or herself or through his or her own employees. <br />provided that such irnprovonents are not intended or oflered for sale. lf. however. the btrilding or irnp,rovement is sold rvithin one year <br />of cornplaion. the Orvner Builder will have the burden of proving that he or she did not build or imp,rove the propoty for the purpose of <br />sale). <br />_1. as owner of the property. an exclusively contracting with licensed conlraclors to construct the project (Sec. 7044. Business <br />and Profession Code: The Contractor's License Law does not apply to an orvner of property who builds or improves thereon. <br />and who contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License [arv). <br />_l am exempt under B. & P.C. for this reason. <br />Ilo t o.( lrw n or. <br />WORKERS' COM PENSA'IION <br />DECLARATION <br />I hereby alfirrn 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 3700 of the <br />Labor Code. for thc performance of the work for which the perrnit is issued. <br />-l <br />have and Section -1700 of the l,abor Code. for the performance of <br />and policy number are:the rvork for carrier <br />Ar <br />Policy Nurnber: IAflA IbqP ?tr3:!Expires: <br />'b?r) <br />_l cerli& that in the perforrnance of the rvork for which this permit is issued. I shall not ernploy any person in any manner <br />so as to becorne subject to the workers' compensation larvs of California. and agrec that if I should becomc subject to the . <br />workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failure to scrure u'orkers' cornpensation coverage is unlau'ful. and shall subject an onployer to criminal poralties and <br />civil fines up to one hundre<l thousand dollars ($100.000). in addition to the cost of compensation. damages as pri)vided for the <br />Section 3076 of the Labor Code interest and attorney's fees. <br />DECLARATION <br />I hereby affrm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force and effect. <br />License cuuCJ-D--Nurnber:Z <br />CONSTR,UCTION LENDING AGENCY <br />I h6cby affm unds pcnahy of pcr-jury that th6r is a construction landing agocy for rhe pqfomcc of thc rcrk for which this pqrnit b <br />isucd (Se. 3097, Civ. C.). <br />APPLTCANT DT'CLARATION <br />I herdry affirm under penalty of perjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) <br />_Required Letter of Notification <br />_l certi& that the lderalregulations regarding asbestos rernovalare not applicable to this project. <br />._l certify that I have read this rvith all City and County <br />and County to enter upon theordinances and State Larvs <br />above mentioned property for <br />Applicant or Agent <br />(--1 <br />o,r",/y'q;2o <br />Lender's Address: <br />Permitee nanre (print): <br />Date:,/r