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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Ow-BuildsDclmtbn . - <br />I hmby aftirm unda pcmhy of perjury thrt I m qcmpt form thc CootndoB' Lie@ Irw for thc following raon (se7031.5 BBin63 <br />ud Proforion Codc): Atry City or Couty which rcquira a pcrmit to oBtsuct, rlts, improw, dcmolth or repoir rny srudug prior to iB <br />isuncq rlso rcquira the rpplieat for ruch pcrmit o filc r rigncd strtemat that hc or rhc ir li@ed pmumt to thc provisioro of the <br />Contractor's Lierocd hw (Chptq 9, Comencing whh Scc'tion 7000 of Divisior 3 of tlrc Buins rnd ProfqrbN Codc) or rhlt hc or <br />shc is qcmpt dHefrom rnd the basis br thc tllcgcd qcmption .Any violetion of Scction ?031.5 by roy +pliotrt for r pdrit subjccts th€ <br />sppliont to I civil pmlty of not morc thrn fivc huodrcd doll& (t500). <br />_1, u owncr of thc prcpcty, or my cmployo with mgc ar thcir $lc @mpcutiot1 will do dE mrk rnd lhc ltnrclue it mt iilqdcd <br />or ofrcrcd for $lc ( S6.7X4, BusiHs rnd Profc$io$ Codc Thc ContEctor't Li€e hw doB mt appb to m ow of thc prcpcrty <br />who boil& or improu tlroq ud who doe such mrk hifficlf or hmlf or rhrough his or her om cmployc, provilcd thet such <br />improrcmcnts arc not htcndcd or offcrcd for $la If, horcs, thc building or improwretrt i! $ld within orc yar of omplaio4 the <br />Oma-Builds will h.vc thc burdcn of proving thrt hc or lhc mt build or improw for the purpsc of $le). <br />\-pd oma of rhc propcny, rm cxclusivcly @ntncdrtg with li@E€d @ilnmn ro @Etrucr th€ Fojrrt ( se 7044, BBitre md <br />PrEfcsion Codc: Thc Contnclor'r Liesc I:w do6 not rpply to u ow of propsty who buildt or improvct thcrcon , rnd who <br />@ntocts for $ch projets with a Contncor(s) lierucd puEunr !o rhs Cotrtnctor'! Licc*c lrw.). <br />I am exempt under Section - - .B. & <br />I <br />I hereby affirm under penshy ofperjury one <br />_l hrw ud will msintrin r Ccnifigrc of CoNnt to Sclf-IE[rc for rcrka' ompcrrtion, r providcd for by Scrion 3700 of thc <br />L:bor Codc, for tlrc prformane of thc rcrk for which thc pcrmil is isrucd. <br />I have and will maintain workers' compemation insurance, es <br />work for which this permit is issued. My workers' compensation <br />required by Seaion 3700 of the l-abor Code, for the performrnce of the <br />insurancc carrier and poliry numht are: <br />Policy Number: Expites: <br />(This section ne oi hss) <br />ydirythat in the performancc of thc work for <br />bccame subjcct to the workers ' @mpcnsstion laws <br />which this pcrmit is issued, I shall not employ any in any msnner so as to <br />of California, and agree ttut if I should to the workers' <br />compcnsation provisions of Seaion 3700 of the kbor CodC I <br />WARNING: Failure to secure workers' <br />frnes up to one hundred thousand dollars <br />comPensation <br />($lo0,ooo),in <br />coverage is and shall subject an <br />addition to cost of compensation, &mages <br />thc lrbor Codg intsGt and anomey's fs. <br />@ <br />I hcrcbqr aflm undr pmlry of pgjury $!r I rm liercd uda prcvbion of Chrpts 9 (@mnciag with Scaion 7000) of Diviiiotr 3 of <br />thc Buircs and Profcsioro Codc, ud my liccre ir in full fore rnd cffcct <br />License Class: Liccnse Number <br />Date: Contractor: <br />CONSTRUCTION LENDING AGENCY <br />I hooby affrm undcr pcilhy of pcrjury thrt thcrc ir . @Gtruction lcnding agcmy for thc pqfomn@ of rho wotk for which tltis pomt is <br />irsucd (S*. 3097, Civ. C.). <br />kndq's Namc <br />Lender's Address: <br />APPLICANT'S DECLARATION <br />Demolition Permits-Asbestos Notification Fcderal Rcgulations (Title 40, Part 6) <br />_ Required Letter of Notification <br />I certi! that <br />-6n*,*, <br />the federal regulstions regarding asbestos remot alare not applicable to this proFct. <br />I havc read this application and statc that the above information with all City and County <br />ordinances and State laws relating to and county to enter uPon the <br />abovs mentioned prop€rty for <br />Applicant or agent <br />Permittee name <br />- l-- <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage I <br />Fire Alarm / Dampers l/.X bn t )bth <br />Communications Cable I '/ <br />Building <br />Under Slab / Floor <br />Bonding I Grounding I UFER 'lb/Y/ntl .lN41 <br />Transformers '/(-/-\r'J' - \ <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter ^ l_ / ,ll /-3FINAL'41-// trl W6r{rl7,w <br />Notes, Remarks, Etc.I <br />Ou" wner: