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ELECTRICAL.I NSPECTOR R ECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affum undcr pculty of pcrjury that I m cxcmpt frcm thc Contractom' Liccn* law for thc following rcasn (Ss.7031.5 <br />Busincss and Profcssion Codc): Any City or County which rcquires a lrcrmit to @nstrud. altcr. improvc. demlish or rcpoir any <br />structurc. prirr to its issuffic. also rcquircs th€ rpplicrnt for such lEmit to filc I sigrcd stotcmnt lhal he or slE is liccnsd pumuant <br />to thc prcvisions of thc Contrctor's Liccnsd kw (Chaptcr 9, Comcrcing with Scction ?ofl) of Division 3 of thc Busiress and <br />PmfcssionsCodc)orthathcorsheisexemptttEeftomandthcb6sisforlheallcgcdcxcmption. AnyviolationofS6tionT03l.5byany <br />opplicant for o permit subixts thc spplicant to a civil pcmlty of not mrc than five hundrcd dollus ($500). <br />-1, <br />us owncr of thc propcrty. or my cmployces with wagcs as their solc compensation, will do the work ard thc structurc is not <br />intendcd or offercd for sale (Scc.7044, Business and hofessions Codc: Thc Contractor's Liccnse law does not apply to an owncr of <br />thc propcrty who builds or inrproves thercon. and who docs such work him.sclf or hcrsclf or through his or hcr own employces, <br />provided thut such improvenrcnls arc rtot intcrdcd or offerf,d for sah. lf, howercr, the buiHing or improvenrnl is sold within onc )aar <br />of completion. the Owner Builder will have thc burdcn of proving that hc or she did not build or improve the property for thc purposc of <br />sale). <br />-1. <br />as owncr of the propcrty. am exclusivcly contracting with liccnsed contractors to construct thc proict (Scc. 7W, Business <br />and [tofcssion Codc: Thc Contractor's Liccnse Law docs not apply to an owner of property who builds or improves thercon. <br />and who contracts for such projects with a Contracto(s) liccnsed pursulnl to thc Contractor's Liccnsc kw). <br />-IamexcmptundcrScction-'B.&P.C.forthisreason. <br />f l.rl o'llu'nor. <br />WORKERS' COM PFNSATI()N <br />DECLARATION <br />I hercby aflirm undcr pcnalty of perjury onc of the following dcclarations: <br />-l <br />havc and will maintain a Ccrtificate ofConsent to Sclf-lnsure for workcrs' compensalion. as providcd for by Section 3700 of the <br />[:bor Codc. for thc pedormancc of thc work for which thc pcrmit is issucd. <br />-l <br />havc and will rnaintain workcrs'Scction 3700 of the Labor Codc, filr thc pcrfornuncc of <br />the work for ttts ls carricr and plicy numbcr are: <br />o <br />Policy <br />( <br />_l ccrtify that in thc pcrformance of the work for which this prmit is issucd. I not cnrploy any pcrson in any manner <br />if I should bccome subject to the <br />comply with thosc provisions.. <br />so as to bccomc suhjcct to the workers'comlrcnsation laws of California, <br />workcrs' conrJrcnsation provisions of Scction 3700 of thc [:bor Codc. I <br />and <br />\YARNIN(i:to sccurc compcnsation covcrage is and shall to criminal pcrraltics and <br />civil fincs up to hurrdrcd dollars ($100.000), in <br />and attorncy's fccs. <br />to thc as providcd:'for the <br />Scctiorr <br />O <br />I hcrcby aff'irrn undcr penalty of pcrjury that I am 9 (commcncing with Section 7000) of Division 3 <br />of thc Busincss and Profcssions Codc. and my in l'ull cf fect. <br />Licensc o <br />J }( <br />I hcreby affirm under pcnalty of pcrjury that there is a <br />issued (Sec. 3097, Civ. C.). <br />hnding thc perforrnance of lhc work for which this pcrrnit is <br />[*ndcr's Narnc: <br />I-cnder's Address: <br />APPLICANT DECI ARATION <br />I hoeby affrnnundcr penalty of perjury one of thc following dcclarations: <br />Dcmolition Permits-Ashstos Notification Fcderal Rcgulations (Title 40, Part6) <br />_Rcqu ircd l*ttcr of Notifrcation <br />_l ccrtify that thc fcderal regulations rcgarding renrovalarc not applicablc to this project. <br />_l ccrtify lhat I have rcad this application and with all City and County <br />ordinanccs and State [:ws rclating to building and County <br />above nrcntioncd proprty for inspcction <br />Applicant or Agenl <br />Pcrnrilee nanre <br />atnvc <br />t, <br />cntcr thc <br />( <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under SIab / Floor I -a <br />Bonding I Groundins I UFER (/1 7t l)g-ry'6 1 <br />Transformers l, <br />Torqueinq <br />Sub-Panels <br />Air Conditioners I _r A; <br />Roof Top Equipment () <br />I <br />/7t,DW ry <br />Factory Wired Unit I <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs [-Bar Rouqh)lt ,l , ,?^ <br />lVleter Release - lrL VK{,7 <br />ll <br />Rouqh <br />Service lMeter I <br />FINAL L -l 2.1 bKrr >'/ <br />Notes, Remarks, Etc.v\ I / <br />--.D <br />Or.r na n7 onl tr <br />, <br />)\ <br />a <br />Date:_ <br />t