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ELECTRICAL.!NSPECTOR RECORD <br />()^r na n7 ?n,t A <br />APPROVALS DATE ID/S!G,COMMENTS OWNER BUILDER DELCARATION <br />I haeby aflirm undq pcmlty of pgjury lhat I m cxcmpl from lhe ConiractoE' Lic6s Law for thc following rcen (5{.7031.5 <br />Businas and Profeion Code): Any City or County rvhich rcquirG a pcrnit to congruct. allq, improvq dmolish or rcpab my <br />structuq prior to its isumce. also requiB the applicilt for such pcrmit lo file a sigocd stdmal that hc or shc b licilscd plNet <br />to the prcvisions of the Conlmtor's Licosed taw (Chaptq 9. Commencing with S{tion 7000 of Divisiotr 3 of thc Buincs u( <br />PrcfcsionsCode)orthathcorshcisompthocfromildthebasisforthcallegedcxmption. AnyviolatiotrofSedbnT03l.5byany <br />applicantforapqmitsubjntsthe applicanttoacivilpmaltyofnotmorcthmfivchundrcddollas($500). <br />_1. as owner of the properly.or my employees with wages as their sole compensation. rvilldo the rvork and the struclure is not <br />intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Larv does not apply to an orvner of <br />the property u,ho builds or improves thereon. and rvho does such u'o* himself or herself or through his or her own employees. <br />provided that such irnprovanents are not intended or offered for sale. l[, horvcl'er. the building or irnpnovement is sold within one year <br />of cornplaion. the Orvner Builder rvill have the burden of proving thal he or she did not build or improve the properry for the purpose of <br />sale). <br />_1. as owner of the property. am exclusively contracting rvith licersed contractors to construct the project (Sec. 7044. Business <br />and Pnoftssion Code: The Contractor's License Law does not apply to an orvner of property rvho builds or improves thereon. <br />and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's l,icense Law). <br />-l <br />am exempt under Section-. B. & P.C. for this reason. <br />l)alc ()u rtcr: <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hereby affrnn under pcnalty of perjury one of the following declarations: <br />-l <br />have and will maintain a Ceitificate of Consent to Self-lnsure for workcrs' compensatio[ as provided for by Section 3700 of the <br />Labor Code. for the performance of the work for which the permit is issued. <br />-l <br />have and will maintain workers' compensation insurance. as required by Section -3700 of the Labor Code. for the pcrformance of <br />the rvork for which this permit is issued. My workers' compcnsation insurance carrier and policy number are: <br />i] hluc ri ca,a, ? v ri c t"Carrier: <br />Policy N..*k-. '\^,c;oquotg Expires:rr> <br />_l cerrify that in the performance of the work for rvhich this perrnit is issued. I shall not employ any person in any manner <br />so as to be<ome subject to the rvorkers' compensation larvs of California. and agre€ 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 />WARNIN(i: Failure to secure workers' compensation coverage is unlarvfiul. and shall subject an onployer to criminal penalties and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the <br />Section 3076 of Labor <br />o <br />I hereby affrrrn under penalty of perjury -3 <br />of the Business and Profcssions Code. and my license is in full force and effect.I <br />Licensc <br />a C Nurnrrcr: , cl) 5l ta <br />c tt L ('ontraclor:D( \p ormt C t lAt-gcJ <br />W <br />I hrcby aflirrn undo pcnalty of pgjury that thtr b a construction hnding agmcy for thc pgfommce of the work for which this Fmit b <br />issucd (Se. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPLICANT DECLARATION <br />I hereby affinn under poralty of perjury one of the following declarations: <br />Dernolition Permits-Asbestos Notification Fcderal Regulations (Title 40. Part6) <br />-Required <br />Letter of Notification <br />-l <br />cgtiry that the fcdqal regulatiom rcgading rebstos rqnoval se not applicablc to this prcj€t. <br />'D!{ csriry tUt I havc rod rhis application and statc that thc abovc infomation is coret. I agre to comply rvith all City dd County <br />ordinsncG od State tas relating to building coNtruc,tior\ atrd hreby authorize reF6fftativs of this City md County to ot6 upon tlE <br />above rnentioned property for inspection purposes. <br />L9Applicant or Agent * <br />pernrireenan,c(pri,r): rL D 4 n i C I V Cl(qqt <br />,^,",- \fzf f q <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 lDampers <br />Communications Cable <br />Building <br />Under Slab / Floor R <br />Bonding I Grounding / UFER 12-2o.l"l klwl <br />Transformers \./ <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />,4\ <br />Rough |a,:/t ,7-fu-['t)rlLVc) <br />Service Meter \A <br />/t\ <br />FINAL {2.-u-ls l*rYWtl <br />Notes, Remarks, Etc.lv <br />_+