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ELECTRICAL.I NSPECTOR RECORD <br />'/ql <br />APPROVALS DATE !D/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hoeby alfirm unda pmalty of pcrjury that I m cxcmpt from the Contractom' Licmc law for thc following rcmn {Sc.703 1.5 <br />Businas ud Profcssion Codc): Any City or County which requirB a pGrnit to construct. alt6, imprcve. dernolish or rcpairtny <br />structue. prior to its isumcc. also rcquirB thc applicilt for such pemil lo filc a sigocd stalomt that hc or shc is lic@srd pllts@t <br />to th€ FovisioN of thc Contmctor's Licmscd Law (Chaflq 9, Comocing lvilh Sclion 7000 of Division 3 of thc Busine ud <br />ProfsionsCodc)orthathe orshciscrmptthqefromudthcbasisforthcallegcdcxmption. AnyviolationofS6lionT03l.5by.any <br />applicanrforapqmitsubjdtsthe applicanttoacivilp€naltyofnotmorethilfivchundrcddollus($500). ) <br />l. r o*q of thc prcperty, or my cmploye with wag6I their ele smpcnsation. rvill do thework ud the stnrrw is not <br />intqrdcd or oftacd for slc (Sa.7044. Busins ud Profcssioro Codc: Thc Contraclor's Licre llw do6 not pply to u oMs of <br />thc prcpcty who huilds or imfrove thmn. and who doc uch *prk himsclf or hmclf or thrcugh his or hc om cmploye. <br />providcd that such imp.ov@ts ilc nol intqdcd or offq€d for salc. If. howffi. the building or improv@dt is 9H wilhin onc )@ <br />ofcomplaion. the Ownq Builda will havc the turdm ofprcving that hc or shc did mt build or improve thc propety for thc pupos of <br />slc). <br />-1. <br />as owner of the p,roperly. am exclusively contracting s,ith licensed contractors to construct the project (Sec. 7044. Business <br />and t\ofession Code: The Contraclor's l,icense Larv does not apply lo an ou'ner of property rvho builds or improves thereon. <br />and \\,ho contracts for such projects rvith a Contracto(s) licersed pursuant to the Contractor's License Law). <br />-l <br />am exempt under Section-B.&P reason. <br />,,,., il-? - 14 <br />DECLARATION <br />I hereby affirm under penalty of pojury one ofthe ftrllorving declarations: <br />__l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the <br />Labor Code, for the performance of the rvork for which the perrnit is issued. <br />_ I have and rvill maintain rvorkers' compensation insurance. as required by Section -1700 of the [-abor Code. for the perfionnance of <br />the rvork for rvhich this permit is issued. My workos' conrpensation insurance carrier and policy nutnber are: <br />Carrier:_ <br />Policy Number:-I:rpircs: <br />_l cerrify that in thc performance of the rvork for rvhich this perrnit is issued. I shall not enrploy any person in any manner <br />so urs to become subject to the workers'compensation laws of Celifornia. and agree that if I should become subject to the <br />rvorkers' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvith comply with those provisions.. <br />a <br />WARNING: Failure to sure workss'compeGation coverage is unlarvful. and shall suhjat m mployer to siminal pqaltiq ani <br />civil fines up to one hundred thouwd dollare ($100.000). in addition to thc cost of compeMtion, danaga r providcd for the <br />Section -1076 of the Labor Code. interest and attorney's fees. <br />,^r", I l'1- 14 L <br />I hereby affrm under penalty of perjury that I arn licensed 9 (commencing rvith Section 7000)3 <br />of the Business and Professions Code. and rny license is in full force and effect. <br />License Class:__License Number: <br />('onl rRclor:l)alc: <br />W <br />I hmby affm undo pcr, alty of pEjury that th@ is a mnstruction knding agacy for thc pcfomucc of thc work fur which this pamit b <br />issucd (Sc. 3097. Civ. C.). <br />[rnd6's Nmc: <br />- <br />Lender's Address: <br />APPLICANT DECLARATION <br />I hereby aflirm under penalty of po'jury one of the follorving declarations: <br />Dcmolition Permits-Asbcstos Notification Federal Regulations (Titlc 40. Parl6) <br />_Required Letter of Notification <br />--l <br />cqtifythat thc fcdqalregulatiom rcgrding rbclos rqnovalrc not applicablc to this prcjet. <br />-l <br />cstify thar I havc ud this application {d statc that the abovc infomation is cor$t. I sgrc to comply with all Citysnd County <br />ordinancc md Statc taws rclalhg to building construciion. dd h6eby authorire rcprmtativs of this City ud Coutrty to 6t6 upon thc <br />{(* <br />Date:)l-)- lq <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltase <br />Fire Alarm 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 />Rough /Crr ) <br />Service Meter 7/)4',4 flq//-) <br />FINAL t,4.2t'b*t' ,WM ! <br />Notes, Remarks, Etc. t <br />z -,/ I I <br />f)a', nO n7 ')fi'lfi., <br />T