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ELECTRICAL.! NSPECTOR RECORD no n7 1n{,l APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards I Spas, Pool, Fountains rzl Signs (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Buildins Under SIab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment a Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rouqh) Meter Release Rough Service Meter FINAL l?.' (3'rg arWto? Notes, Remarks, Etc. --ai1 ()\!' N Ii lt ll tt I t.t ) l,.lt l) 1,. l,('A t{,\'t' t( ) N I hrcby afiim undc pcnalty of ffiury that I m cxcmpt from thc Conlraclor' Licffi law for rhe fotlowing rcua (5â‚¬.7031.5 BNin6s dd Prof*ion Code): Any City or County which rcquirs a pcrmit to coctruct. altc. improvc, &molish or 'rtpair uy struclurc prior to its isumcc. also requirc thc applicmt for such pcmit to lilc a signcd statilfit tha hc or shc b licoscd pimuut to the provisioru of thc Contactor's Licosed taw (Chaptr 9. Commocing rvilh Setion 7000 of Division 3 of lhc BNinN ild Prcfwions Codc) or that hc or shc is cxmpt thqcfrom md thc basis for thc allcgcd ampion. Any violation of Sdbn 703 |.5 by any applicantforapcmhsubjctsthc applicanttoacivilpmltyofnotmorcthmfivchundrcddollm($500). kownef, of the property. or my employecs rvith wages as their sole compensation. will do the work md the structue is not or offered for sale (Sec.7M4. Business and hofessions Code: I'he Contractor's License [au,does not apply to an orvner of the propc'rty rvho builds or improves thereon. and u,ho does such rvork himself or herself or through his or her own employees. provided that such improvonents are not intended or offered for sale. lf. however. the building or improvernent is sold rvithin one year of cornplaion, the Orvner Builder will have the burden of proving tha he or she did not build or improve the property for the purposc of sale). ---1. as owner of the propoly. am exclusively contracting with licensed contractos to construct the project (Sec. 7044, Business and Profession Code: 'I'he Contractor's License Larv does not apply lo an owner of property rvho builds or improves thereon. and rvho contracts for such projcrts rvith a Contractor(s) licensed pursuant to the Contractor's License Larv). _l an lbr this reason. I)nte: 'Orvner: DECLARATION I hereby affirm under penalty of perjury one of the follos'ing declarations: _l have and rvill maintain a Certificate of Consent to Self-lnsure for s'orkers' cornpensation. as provided for by Section 3700 of the Labor Code. for thc po'formance of the work for rvhich the pei'rnit is issued. -l have and u'ill rnaintain u'orkers' compensation insurance. as required by Section ,3700 of the Labor Code. for the perfonnance of the rvork for which this permit is issued. My workers' compensation insurance carier and policy number are: Carrier: Policy Number:-Expires: that in the perforrnance of the work for rvhich this permit is issued. I shall not ernploy any person in any manner so as to become subject to the workers'compensation laws of California. and agree that if I should becorne subject to the rvorkers' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvith comply rvith those provisions..a WARNING: Failure to secure workers' compensation coverage is unlarvful. and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section -1076 of the l-abor Code. interest and attorney's fees. a ll /r. DECI,ARATTON I hereby affrrm 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 Class:-Nurnbcr: l)nte:Contractor: CONSTRUCTION LENDING ACENCY I hcby affnn undo pcnslty of pdury thal th@ is a @nstruclion hnding agacy for thc pqfomcc of thc work fur which this pqmh b issued (Se. 3097, Civ. C.). l:nds's Nmc: [.ender's Address: APPLICANT DEC LARA'TION I herdry affirm under penalty of perjury one of the follorving declarations: Demolition Perrnits-Asbcstos Notification Federal Regulations (Title 40. Part6) __Required Lctter of Notification _l certify that the federal regulations regarding asbestos rernoval are not applicable to this project. I have read this application and state that the above inforrnation is con'ect. I agree to comply rrepresentatives of this City with all City and County and County to enter uJxln theand State Laws relating to building construction. and above nrentioned properly for Applicrnt or Agent ( IPernritee name (print): authorize I