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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/S!G COMMENTS Oms-Buildcr Deluation <br />I hercby affirm unde pcnalty of p.rjury that I m qcmpt fiorm thc Conraciors' Lienrc Law for thc following ruon (w.703 1.5 Busincss <br />md Profcssion Code): Any City or Couty which rcquircs a pcrmit to @Nhd, rltcr, imprcvc, dcmolish or rcpair my strucue, prior to it <br />isumc, also require thc Epplimt for such permit to filc a signcd ststmcnt thst he or rhe is liccnrcd pursuut to thc prcvisions of thc <br />Conraaor's Liered Law (Chaptcr 9, Comcncing with Setion 7000 of Division 3 of thc Business md Profesioos Codc) or that hc s <br />shc is excmpt thercfrom ud thc buis for thc rllcgcd excmption .Any violuion of Scrion 7031.5 by my appliwt for E pcmit subjeds rhc <br />applicant to a civil pctrilty ofnot morc Ihe fivc hundrcd dollrs (3500). <br />-1, <br />ro omer of the popcny, or my employes with wrgcs rs their sole @mpctrsaiorl will do thc work and the st uct[G is not intsdcd <br />or olfrcd for slc ( Src.7(X4, Bwincss ud Profcssions Codc: Thc Conrmor's Liccns Law doq not rpply to m oma of rhc propcny <br />who buildE or improvs thcr@r! ud who dos such work himsclf or harclf or through his or hcr om cmploy€, provided that luch <br />imProvemcnts ac not intcndcd or offrcd for salc. l4 howfls, thc building or improvcmcnt is $ld within onc y6 of @mplctio4 thc <br />Owner-Builder will have thc budcn ofproving that hc or shc not build or imprcve for the purposc ofsalc). <br />I, s owner of the propcny, am cxclusively @nrading with li@nsd contradors to @nltruct thc proicd ( Sc. 7044, Businqs ud <br />Profcssion Code: Thc Contraci.or's Li@ns Law d@s not apply to u omc of proprcny who builds or improvw thqcon , md who <br />onrrcts for such prcjccts with a Cotrhctor(s) liccnsed pursuant to thc Contrt€tor's LiEns. Lsw.). <br />_l arn exempt undcr Section <br />Date: <br />& P.C. for this reason. <br />WORKERS COM PENSATION DECLARATION <br />I hcrcby aflirm undr pcmlty of perjury onc of thc following delmtions: <br />-l <br />havc md *ill msintrin s C€nificatc of Comnt to SclfJNurc for workcrs' compeGatioq a providcd for by Sslioo 37OO of thc <br />Labor Codc, for the pcrfomue of thc work for which thc psmir is isscd. <br />1 76iud will naintain workers' @mpcmtioo in$ruc.q u rcquired by Section lToo of thc labor codq for rlrc pcrforrru@ of rhc <br />Srork for which this pcrmit is iscd. My workcrs' ompcnstion inme uicr ud policy uumbo uc: <br />d <br />Policy <br />(This section need <br />_l certify that in <br />One hundred dollars {$100} or less) <br />the performance of the work for which this permit <br />of California, and <br />is issued, I shall not <br />became subject to the workers ' @mpensation laws agree that if I should to the workers' <br />provisions of Section 3700 of the Labor Code, I provisions. <br />Failure to secure workers' compensation is and shall subject an employer to criminal penalties and civil <br />fines up to one hundred thousand dollars ($100,000),in <br />the Labor Code, interest and attorney's fees. <br />to the cost of compensatior\ damages as provided for the Section 3076 of <br />LICENSED CONTRACTORS DECI"ARATION <br />I hcreiy rlftm unde pcmlty of psjury thrt I m liensd unda prcvision of Ch.prq 9 (omcncing wirh Sccrion ?000) of Division 3 of <br />the Busincss and Profcssioro Code, ud my licens is in full for@ ed cffwt. <br />License <br />Date. <br />I hereby alfirm under penalty of perjury that there <br />issued (Sec. 3097, Civ. C.). <br />Lender's Name: <br />a 88ency perfbrmance of the work for which this permit is <br />Lender's Addrcss: <br />APP LICA N'T'S DECLARATION <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part 6) <br />_ Required Letter of Notification <br />asbestos removal ile not applicable to this project. <br />state that the above information is correct. I agree to comply with all City and County <br />above mentioned property <br />and hereby authorize representatives of this City and County to enter upon the <br />Applicant or agent sig. <br />Permittee name (print): <br />} <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 I Dampers <br />Communications Cable <br />Building <br />Under Slab I Floor <br />Bonding / Grounding / UFER 32 <br />Transformers <br />Torquing 6 -# <br />Sub-Panels o/ 7/rt J* <br />Air Conditioners .,L <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough)l.JrrJ -,2@ <br />Ceilings (Hard & Soffit Rough /4,1@ <br />Ceilings (T-Bar Rough)*J*a^t4/W <br />l\Ieter Release <br />Rough .22*xZ ".€?Service Meter I I -/ <br />F!NAL /0lhl-l D[Wb 1fulda-?b/PAI. <br />Notes, Remarks, Etc 11 <br />/-rl4 r/ 4-7Ce -b.Y <br />r'F,,3 3t I / w-- <br />@ =&t/tsz.5b <br />a <br />Carrier: <br />in any manner so as to <br />-LiccnseNumber <br />5 6 f <t Z P <br />contraoo'' -T -E r <br />and <br />Date:_ <br />3t.