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ELEGTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I haehy affm undq p@alty of pcrjury that I m cxcmpt ftom thc Contracloc' Licere trw for thc following roSn 13*.;O:lS <br />Businss od Profesion Codc): Any City or County which require a pamit to omtruct, altc, imprcvq dcmolish or rcpoir my <br />struclrc prior to its issuucc. also rcquirs thc 4lplicot for such pcrnit to filc a signcd statmot that hc or shc is licoscd pwmr <br />to thc provisiorc of thc Contractor's Licmscd trw (Chspro 9. Comocing with Setion 7000 of Division 3 of thc Buin* 8d <br />Prcfeions Codc) or that hc or shc is crmpt thocfrom dd thc bosb for thc sllcged crmption. Any violation of Sdion 7031 ,5 try oy <br />applicant for I pmit subjcts thc applicsnt to a civil p€mlty of not morc tho five hun&cd dollm ($500). <br />illA o*o of ,n"propcrty. or my mplolc with wag6 6 their slc compcnsation, will do thc wq* snd thc $ructrc b rct <br />' inqrded or offscd for ele (Sc.7044. Busin6 md Prcf*iom Codq Thc Contmctor's Lictrc kw do6 trot apply to m owna of <br />thc ptoFrty who tuil& or itrlFo6 thq@n. ild who dc suh *ork himsclf or hmlf or thrcugh his or ho om mploycc. <br />providcd rhar such improvmB e mt intsrdod or oflirod for slc. If, howq. thc hrilding or inprovorurt is mH within onc )a <br />of rcmpl:tiol thc o\rnq Buildq will havc thc h[&n of Foving tha hc or shc dkl rct tuild or inFovc thc propsly for the pupoe of <br />sale). <br />_1. re omo of thc prcpsty. m qclusivcly coilracting with licmed contractoE to coEtruct thc projet (56. 7044. BEinN <br />ard Proftsim Codc: Thc Contrclor's Licosc Law do6 not apply to m ownd of propqly who builds or imprcv6 thqan. <br />and who corilBds for such Fojtrls with a Cotrtncto(s) lictrcd pu6wt to the Cootrsctor's Licerc hw). <br />-l <br />mcxmpt mds Setion--' B. & P.c. forthis rwn. <br />o*",' o I' 7-. ) 6 o,n",,VuL( a.l t c. .?t e li .t q <br />YOE6EEEIAUPINSAIIA! <br />DECI.AEAUqN <br />I hrcby aflim unda pcnalty of pqjuryoncof thc following dclaratioro: <br />_l havc md will maintain I Cgtificatc of CoMt to SelfJNurc for workm' compeuation. s prcvidcd for by S*tion 3?00 of thc <br />t bor Codc. for thc pqfomcc of thc wort for *hich thc pqmit b isucd. <br />_l havc and will maintain workm' comperoation isurancc. 6 rcquircd by Sction 3700 of thc kbor Codc, for thc psfollmcc of <br />the wrk for which this pemit b iscd. My workm' comp@tion imuracc cuiq md policy numba uc: <br />Carrier:_-- <br />Policy Nurnber: ExPires: <br />AlL(enify that in the perflormance of the work for which rhis permit is issued. I shall not etnploy any person in any manner <br />' so us to become subject to the workers'compensation laws of California. and agree that if I should becomc subject to the <br />workers' compensation provisions of Section -3700 of the l-abor Code. I shall. forthrvith comply with those provisions.. <br />WARNING: Failure to secure workers' compensation coverage is unlau,ful. and shall subject an employer to criminal penahics and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. diunages as provided for the <br />Section .1076 of the Labor Codc. interest and attorney's fees. <br />o o( <br />I hereby affirm under penalty of perjury 3 <br />of the Business and Professions Code. and my license is in full force and effect. <br />Liccnsc ('lass: <br />Dalc: <br />License Number: <br />Contrrctor:_ <br />CONSI'RUCTION LENDING AGENCY <br />I hwby aflim undr pcralty of psjury that thsc is a coretruclion lending agocy for thc pqfomilce of the work for which lhis pcrmh b <br />issued (Sec. 3097. Civ. C.). <br />Lender's Nanre: <br />Lender's Address: <br />- <br />APPLICANT DECLAIIA'TTON <br />I herelry affirm under penalty of perjury one of the following declarations: <br />Demolition Permils-Asbestos Notification Fcderal Regulations (Title 40. Part6) <br />-Required <br />Later of Notification <br />_l certify that the federal regulations regarding asbestos removalare not applicable to this project. <br />ceflify that I havc read this application and state that the above infonnation is correct. I agrec to comply <br />f this City <br />with all City and County <br />and County to ertcr upon,the <br />. o( 2'7o <br />ordinances and State l.arvs relating to building construction. <br />above mentioned property for inspection purposes. <br />and hereby authorize representatives o <br />Applicn:rt or Agent a1 icl 2,4 e, I; vr c< <br />permiree name lprinty: DLzOI Ct 't t Ci .u'l r t i ,< q <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltase <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinss (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter ^-FINAL cilv"{?e 1 lPrvL-cr '/29 ) <br />N Rema Etc. <br />r-)> <br />ng n7