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