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ELECTRICAL-INSPECTOR RECORD 201 5 APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under SIab / Floor Bonding I Grounding / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush) Ceilinss (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) lVleter Release Rouqh Service N/eter FINAL Notes, Remarks, Etc. OWN I.:R BI.'ILDER DIiI,CA RATION I hereby affirnr under penalty of prjury that I arn exerrpt fnrnr the Contractoru' l.icense L:w for the following rea$n (Sec'.7031.5 Busincss and Prol'cssion Codc): Any City or County which requircs a Jrcrrnit to construct, altcr. irnprovc. dcrmlish or rcpair any slruclure, llrior kl its issuarrce. also requires tlrc applicurt for such penuit t<l file a sigrred stateflEnt that lre or she is licelrscd pursuanl to thc. provisions of th. Contractor's Liccnscd I-rw (Chaptcr 9. Comrncncing with Scction 7000 of Division 3 ol'thc Busincss and Professions Code ) or that lrc or slre is exerr4rt tlrcretnrnr and tlrc basi.s for the alleged cxenrptiort. Any violation of Secti<ln 703 I .5 by any applicant lirr u prrnit subjects the applicunt to l civilpennltyof not rnore thun five hundred tlollars ($5tltt1. _1. a.s owncr ol'tlrc pro[^-rty. or tny crnployccs witlr wagcs as thcir solc cornlxnsation, will drl the work and the structurc is ff)t interxled or offeretl for sule (Sec.7]14. Business and Professions Code: Tlte Conlractor's License Law does not apply to an owner of the pnrprty wlxr builds or inrproves tlrerurrr, and wlxr dtrs such work himself or lrcrself or through his or her own entployees, providc.d that such improvcrncnts arc rx)t intcndcd or olTcrr.'d for sah. ll. howcvcr, thc building or furprovcnrcnt is sold within one )ear of conrpletkrn, tlrc Owner Builder will have the btrrden of proving that he or she did not builJ or improve the pmpcrty for thc purposc of sale). _1. as owncr of the p'()perty, anrexclusively contracting with licensed contraclors t() conslruct tlrc project (Sec. 7014. Busittcss and Prulessiou Code: The Colrtractor's Licerrse l,aw does not apply to an owner of property who buikJs or intproves tltereon. ancl who c()nlr:lcts for such projr'cts with a C()nlractor(s) liccnscd pursuanl to thc Contractor's License taw). _l lrnr cxctnl)t uttrler B. & P.C. lor tlris rc:ts()n. W(IRK I'RS' COIT I'F]NSA'I'ION DECLARATION I lrc'rcby affirrn undcr pcnalt.v of pcrjury onc o[thc lirlkru'ing declarations: _l have and will nuintain a Certiticate of Cornerrt to Sell-lnsure for workers' coruperrsalion. as pnrvided for by Section 3700 of tlte lalxrr Ct>dc, for thc Jrcr[ornrancc of thc work l'or which thc pcrmit is issuetl. _l have arrd will utairrtailr workers'corlllensalion insurauce, as required hy Seclion 3700 of the Lahor Code, filr llrc lrcrftrrnutrce of thc work tirr which this ;rcrnrit is issuc<|. My workcrs' cornprsation insuraltcc caricr iuxl lrulicy nunrbcr:uc: Policy Numbcr: lixpires: _l ccrrify tlrat in thc 1^-rtbrnuncc'of thc work firr which this Jrcrmit is issuctl. I slull n()t cnrploy any lrcrson in any nunncr so as lo bccornc subjcct to thc workcrs' conlpcnsation laws of California. and agrcc that if I slnuld bccome subject to thc workers' conrpensation provisions of Section 3700 of the l-abor Cotle, I slurll, forthwith conrply with those provisions.. WARNING: Failure to secure workers' cornlxnsation coverage is unlaw[ul. rrnd slrall subject an employer to criminal penaltie.s and civil lirres up to ()ne hundred tlxrusand rJollars (S100.m01. in addition to tlrc cost of conrpetnation, danuges as provided for lhe Section 307(r of thc Lalxrr Codc, intcrcst ancl attrlrncy's l'ccs. LICENSED CONTRACTOR DECI,ARATTON I hercby affirrn under ;rnalty of pcrjury that I anr licensed under provision of Chapter 9 (conutrcncing with Section 70m) of Division 1 of the Busine.ss and Professions Code. arxl rny license is in full force arxl effect. License Class: Licensc Number: f L,.,.. CONSTRUCTION LENDING AGENCY I hcrcby al'ljrrn undcr pcnalty of pcrjury that thcrc is a construction lcnding agcncy for thc pcrlbnnance of the work l'or which this pcrrnit is issuetl (Sec. 3097. Civ. C.). [*nder's Nanrc: l-cnder's Addrcss: A PPI,ICA NT DECI,A RATION I h:nc*ry aflirnr undcr pnalty of perjury onc of thc firllowing dcclarations: Dcnxrlition Pcrnrits-Ashcstos Notification Fctlcral Rcgulations (Tille 40, Part6) -Rcquircd Lcttcr of Notifrcation _l ccrtily that the fcdcralrcgulations rcgarding asbcstos rcmoval are not applicablc to this pmjc'ct. _l ccrtify tlrat I havc rcad this application uxl statc tlrat thc above informalion is correct. I agrcc to conply with all Cily antl County ordinances and Statc [aws rclating to building consuuctioru and hcreby auttnrizc represcntatives of this City and County to entcr upon thc ab<lve rncntioned prcpcrty for inspection purposcs. Applicant or Agcnl Pcrmitce nomc (prinl): _ ( larlicr: Contractor: Date:-