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ELECTRICAL-I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Omer-Builds Dcluarion <br />I hacby rllim undo pcoslty of pcrjury rh&t I m qcmpt fom the Contractom' Lietrrc LEw for thc following wn (s.70l I . 5 Businc$ <br />ud Prof*sion Codc): Aay City or County which rcquiro r pcrmit to ourruct" altc( improvc, dcmlish or rcpair my stmuq prior to it <br />issure, also requirs thc applimt for ruch pcmit to lilc s signcd ltsremant thrt hc or Ehc is li@nsd purMr to thc provisions of thc <br />Cotrt rctor's Lienscd Law (Chaprer 9, Comcrcing with Scrion 7000 of Division 3 of thc Buritrc$ ad Prof6sioN Codc) or rhlt hc d <br />shc ir cxcmpt thcrcfrom ud thc bqir for thc allcgcd cxcmptioa .Aay violation of Sction 7031.5 by ay Epplimt for ! pcmit subjrcE thc <br />applicmt to a civil pcndty of rct morc thu fivc hurlrcd dollus (t500). <br />_I, s omcr of thc prcpcny, or my cmployco with wrgo as thcL $lc mmpcnstiot\ will do thc work ud thc ltructuc h rct intctrdcd <br />or ofcrcd for sslc ( Se.7044, Buincss md Prof.ssion! Codq Thc Contrrctor's Licre Llw dcs trot spply to u omq of thc propcny <br />who builds or improva rhuoq md who de3 sh work him*lf or harclf or rluough hi3 or hs om cmploycct, providcd rhlt such <br />improvcmcots uc oot intcndcd or offcrcd for rdc. lf, howcvcr, thc building or improvcmcnt is iold withitr onc yu ofomplctioq thc <br />Owner-Builda will hrvc thc budcn ofproving that hc or rhe not build or improvc for thc purpos ofs.lc). <br />_1, u omcr of thc propqty, m cxclusivcly @nrrcting with li@ns€d @ntrrctoE to @6hd fic projer ( S@. 7044, BusiD6s md <br />Profession Codci Thc Contrrctor'E Liesrc kw doca not spply to 6 omcr of propcny who builds or improvca thq@n , ud who <br />conErcts for sch prcj€ts sith I Contrsdor(3) liqs€d pur$ut to rhe Contnctor's LieNc Lrw.). <br />_l arn exempt under Section B. & P.C. for this re&son. <br />Date: <br />WORIGRS COMPENSATION DECT"ARATION <br />I hcrcby alfirm undo pcnalty ofpajury onc ofthc followitrg dclanrioN: <br />_l havc ud will mainoin r Ccnific*c of Corent to Sclf-IMc for rcrkm' ompcnstioq u providcd for by S61ior 3700 of rhc <br />Lsbor Codc, for thc p*fomue of thc work for which thc pmit is imcd. <br />_lhavcedwillmsintainworkqs'ompcmtionin$rue,r rcquircdbyScaion3T00ofthchborCodqforthcpcforrrueofthc <br />work for which rhis pqmit is imcd. My workc' @mpcnsrtion in$ree trid atrd IDlicy numbq [c: <br />Cuis: <br />Policy Number: Expires: <br />(This scction n. oi less) <br />_I ccrtify that in the performancc of the work for which this pcrmit is issucd, I shall not employ any pcrson in any manner so as to <br />became subject to the workers ' compensation laws of Californiq and agrec that if I should becomc subject to the workers! <br />compcnsation provisions of Section 3 700 of thc Labor Code I shall, forthwith comply with thosc provisions. . <br />WARNING: Frilurc b !@rc workss' @mpcnsdon @vorgc is unlawful, ud shall rubjct m cmployq to qimiod pcElti6 rnd civil <br />fina up to one hundrcd thourud dollm (S 100,000),in sddition to thc rcn of ompcnutio4 damagcs u prcvidcd for the Scrion 3076 of <br />rhc Llbor Codq intscst rnd anmcy's fe. <br />LICENSED CONTRACTORS DECI.ARATION <br />I hocby altrrm under pamlay of pcrjury thsl I m li@nlad unds prcvision of Chapto 9 (omcncing with Sctioo 70oo) of Divilion 3 of <br />thc Busiocs ud Profqsiotr Codg ed my liccre is in full fore md cffct. <br />Liccnse Class. Liccnse Numbcr <br />Date: Contractor: <br />CONSTRUCTION LENDING AGENCY <br />I hccby allim uodo p€ndty of psjury ttut thqc is r omtruction lctrdiDg rgcmy for &G pcrfurme of thc wuk for which thir lmit ii <br />issued (S@. 3097, Civ. C.). <br />Lrndcr's Nrmc: <br />Lender's Address: <br />APPLICAN?S DECI,1\RATION <br />Dcmlition Pdmit&Albcstos Notilicarion Fcded Rcgulrtioru (Iitlc /rc, Plrt 6) <br />_ Rcquircd Lttq of Notificrrion <br />I ccrti& thst thc fcdanl rcgulationr rcguditrg .!bqro! movr.l uc not rppliceblc o thir prcjcct. <br />- <br />I cotiS that I havc rod ths lpplicrtiotr ud Eratc that rlE ibovc idomEtiotr i! @rcct. I lgre to @mply with sll City rnd Cmtyqdire rnd Statc Lawr rclrtiog to building ourructioo, md hccby uthoriz rcpreotetivcr of thir City rnd Couoty to 6t6 upoi tbc <br />rbovc mcntioaod propsty for iupetion [ro4ps. <br />Applimt or rgcnt sig.: DEtc:_ <br />Pcrmitre |mc lgrinr) <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 />Building <br />Under SIab / Floor <br />Bonding I Grounding / UFER <br />Transformers <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 b/ff'tr \2 /l 4\zzn ce /(s/) <br />Service Meter I I <br />FINAL t0lblTl D/l,#-Y,'fuJd//t <br />Notes, Remarks, Etc. <br />Forms\Electrical-lnspection Record.doc 03.31 .06