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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/S!G.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor <br />Bonding I Grounding IUFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Roush <br />Ceilings (T-Bar Rouqh) <br />N/eter Release <br />Rough <br />Service lVleter rl A.l ,Y- <br />FINAL 1 <br />Notes, Remarks, Etc I <br />t <br />e <br />,I'I0N <br />I hcrcby aflirm under Fmlty of Frjury that I m cxctrrpt fmm thc ContractoE' Liccns tie for the following rc&sn (Sc.7031.5 <br />Busincss and Profcssion Codc): Any City or County whbh rcquircs a Jrmit to @nstruct, alts, improw. demlish or rcIBir ily <br />structurc, prior to its ilsumc, dso rcquircs thc applicant for such pcrmit to file . signcd stalcrcnt thal he or shc is liccnsd pusuml <br />to the prcvisions of thc Conrrcbr's Licensd [nw (Chapter 9, Comrcncing with Setion 70OO of Division 3 of thc Busircss md <br />PrufcssionsCodc)orlhathcorshciscxcmptthrcfromedthcbasisforthcalhgcdcxemption. AnyviolationofsslionT03l.5byany <br />;gliet fnr a pmit subiets thc applicant to I civil pemlry of not mrc rhan five hundrcd dollus (5500). <br />$Lt. ,. n**, nf ,hc prcFny. or my cmplo,rces with wagcs as thcL solc comlrcnsalion, will do thc wtrk and tlrc stnEtw is mr- inlcnded or oflcrcd for slc (S6.7(X4. Busiress and Professions Code: Thc Crntnctor's Lhens [rw d@s not apply to an owmr of <br />thc pmFny who boilds or inprcG thc@[ dtd who d6 srch rc* himself or hcrslf or thrcugh his or ho own employccs, <br />Providcd thal such impmwmnts re mt inteid or offcrcd for sb. If. howcw, thc building or imprcwmnt is $U within onc )Ear <br />of strplction. thc Owncr Buik,r will harc the brrdcn of prcving that he or shc dil ret build or imprcw thc prcJrcny for thc purp$ of <br />elc). <br />-1, <br />as owncr of thc propcrty, am exclusivcly contracting with liccnscd contractorc to construct thc projcct (Scc. 7W. Busincss <br />and Profcssion Code: Thc Contractor's License Law docs not apply to an owner of propcrty who builds or improves thcreon. <br />and who contracts for such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's License Lrw). <br />I am cxcmot <br />Dale: <br />eoK Cvnfro <br />woRxn'ts''covprNsd'rrr* - - <br />DECL{RATION <br />I hcrcby affirm undcr pcnalty of pcrjury one of the following declarations: <br />-l <br />have and will mainlain a Certificatc of Consent to Self-lnsure for workcrs' compensalion, as provided for by Section 3700 of the <br />Labor code. for the performance of the work for which the permit is issucd. <br />-l <br />have and will maintain workers' compcnsation insurancc. as requircd by Section 3700 of thc labor Code. for the pcrformarcc of <br />the work for which thls pcrmit is issued. My workers' compensation insurance carrier and plicy number are: <br />Policy Numbcr: Expires: <br />6;[3 enify rhat in thc Jrcrformrcc of the work for which this Jrcrmit is issuc<I. I $hall mt employ any prcn in any manrcr <br />-$ as lo bccorrc subjst to lh€ wo*crs' ompcnsation laws of Califomia. md agrc that if I should bccorc subjcrt to the <br />wo*c6'omlrcnsationprcvisionsofScaion3T0Oofthet2borfuc,lshall.forthwith@mplywiththospmvkions.. <br />WARNING: Failurc to wurc workero' ompensation @vcrage is unlowful, md shall subjet an cmplo,€r to oimind pmfifi and <br />civil fines up ao orc hundrcd thousd dolhs ($100,000), in addition to the cost of compcnsation. damgcs o pDvidcd for thc <br />Scction 3076 of thc labor Code, interest and attorncy's fces. <br />o*"..ofl ?/2o2//*frfr cuMo ; <br />LICENSED CONTRACTOR <br />NF'CII\RATION <br />I hcrcby aftirm undcr pcnalty of perjury that I am licenscd undcr provision of Chapter 9 (commcncing with Section 7m0) of Division 3 <br />of thc Busincss and Profcssions Codc, rurd my license is in futl forcc and cffcct. <br />Liccrtsc Nurnbcr: <br />CONSTRUCTION LNDING AGENCY <br />I hcrcby affrm undcr lEmlty of perjury that thcrc is a omtruction bnding agercy for thc pcrfomc of the rcrk for which this permit is <br />issucd (Sec. 3097. Civ. C.). <br />knder's Name: <br />[.ender's Address: <br />APPI ICANT NT'CLA&ITION <br />I lrcrcby affrrm undcr penalty of pcrjury one of the following dcclarations: <br />Dcmolition Pcrrnits-Asbestos Notification Fcdcral Rcgulations (Title 40, Part6) <br />_Requircd Lrttcr of Notification <br />-l <br />certify that thc fcdcral rcgulations rcgarding asbcstos rcmovalarc not applicablc to this projcct. <br />ccrtify that havc rcad this application and stalc that the atnvc inforrnation is correct. I agree to comply with all City and County <br />reprcscntativcs of this City and County to cntcr uponandStatc[,aws rclating to building constructi<ln.authorizc thc <br />abovc mcntioncd propcrty for inspction purposes. <br />Applicant or Agent <br />Pernrilee nanre <br />aurcl hcrcby <br />cultfo o,r", , og /o? /2021 <br />Dn., nA n7 On1tr <br />, <br />B. & P.C. for this