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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNEN BUILDER DELCARATION <br />I hcrcby alfrm undcr Fnslty of pcrjury that I m excmpt from thc Crntmdo6' Liccn$ law for thc following rcNn (5(.7031.5 <br />Busincss ard Profcssion Codc): Any City or County which requircs a pcrmit lo construct, alts, imprcvc, dcmlish or rc;uir ony <br />structurc. Itrior to its issuarce. also rcquires thc applicot for such |Emit to file a sigrcd stalenrcnt lhlt hc or drc is liccnsd puNsnt <br />to Ihc pmvisions of thc Contrrctor's Lbcnsd Lrw (Chapts 9, Comrcing with Sstion 7000 of Division 3 of thc Busircss rnd <br />PrcfcssionsCodc)orlhathcorsheiscxcmptthcrcfromandthcbasisforthcollcgedcxcmption. AnyviolationofSsthnT03l.5hyany <br />applicanl for 8 trrmit subjcls $c rpplic.nt to a civil pcnahy of not mre than fivc hundrcd dollds (S50O). <br />_1. as owncr of thc profrcrty, or my employecs with wagcs as thcir sole compensation. will do the work and thc structurc is not <br />intcnded or offered for sale (Soc.70l4. Busincss and hofessions Code: The Conlractor's License law docs not apply to an owncr of <br />thc propcrty wtrl builds or in{rroves thcrcon, and who docs such work himself or hersclf or through his or her own cmployecs, <br />provided that such improvcnrcnts arc not intcnded oroffered for sale. If, howcvcr, thc building or improvcnrcnt is sold within onc )aar <br />of completion. the Owner BuiHer will have thc burden of proving that hc or shc did not build or improve the propoty for the purFnsc of <br />salc). <br />-1, <br />as owncr of thc property, &m exclusively contracting wilh licenscd contraclors lo construct thc projcct (Scc. 7W, Busincss <br />and Profcssion Codc: The Contractor's Licensc Law docs not apply to an owner of propcrty who builds or improves thercon, <br />and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's Licensc kw). <br />-Iamcxcmr}tundcrSection-.B'&P.C.forthisrcason.ll..r^. <br />WORKE' RS' COMPENSA TION <br />DECLAITATION <br />I hcreby affirm undcr penalty of perjury one of the following declarations: <br />-l <br />havc and will maintain a Certificate of Conscnt to Self-lnsure for workcrs' compcnsation, as providcd for by Section 37fi) of the <br />Labor Code, for the performancc of thc work for which the permit Ls issued. <br />-l <br />have and will maintain workers' compensation insurancc, as required by Section 3700 of the L:bor Codc, for the perforrnance of <br />the work for which this permit is iszucd. My workers' compensation insurance carrier and policy number are: <br />.*.,, - 2'Li1 r9-- rL(^JA a 1 t <br />poricy*"^o",, q0lqLEq r*p'i,"r, /6*/o* L'{ <br />_l certify that in thc performancc of thc work for which this permit is issucd, I shall not employ any pcrson in any manner <br />so as to bccome subjcct to the workers'compcnsation laws of California, and agree that if I should bccome subject to the <br />workers' compensation provisions of Section 37fi) of the l-abor Codc. I shall. forthwith comply with those provisions.. <br />WARNING: Failurc to sccurc workcrs'compcnsation covcragc is unlawlul. and shall subjcct an cmploycr to crirninal Jrcnaltics and <br />civil fines up to onc hundrcd thousand dollars ($100.0m), in addition to the cosl of compcnsation. damages as Itrr lhc <br />and attorncy's ?-1n <br />NECLARATION <br />t hcrcby affrm under penalty of pcrjury that I am liccnsed under provision of Chaptcr 9 (commcncing with Section 7m0) of Division 3 <br />of the Business and Professions Code, ard my liccnse is in full forcc and cffcct. <br />Liccnsc <br />. L49 <br />Nunrbcr:4 D+ ci <br />o**ffi-)e, - Ll 4 tV,t-L/h/ <br />W <br />I hercby affirm undcr pemlty of perjury that tlrcre is a construction lcnding agcrcy for lhe psfomrce of lhc work for which this permit is <br />issued (Sa. 3097, Civ. C.). <br />knder's Namc: <br />[.cnder's Addrcss: <br />APPLICANT DFCLARATION <br />I ffiy aflirm undcr pcnalty of prjury onc of thc following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Titlc 40, Part6) <br />_Rcquircd lrttcr of Notification <br />-l <br />certily that thc fcdcral rcgulations regarding asbcstos rcmoval arc not applicablc lo this projcct. <br />_l certify that I havc read this application and statc that thc above informatiort is correct. I agrec lo with all City and County <br />and County to cnlcr upon thcordinances and Statc Laws rclating construction. and hcreby authorizc <br />atxrvc mcntioncd propcrty for <br />Aglplicant or Agent <br />I'ermitee n$me <br />). <br />k< <br />> -Ze-a <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq I Groundinq / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factorv Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />N/eter Release <br />Rouqh <br />Service Nleter t <br />FINAL B v I '1r(fufffit / <br />Notes, Remarks, Etc.I <br />[Jn., nO n7 On{ tr <br />( )u,rtt'r': <br />Scction 3076-of thc l-abor Code, intercst <br />o,r".,.lt-/6 -)f <br />U4-C <br />t Ap \^f