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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG. Site-Work COMMENTS Underground Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (rnonument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under SIab / Floor I ,^- Bondins lGroundino I UFER lol0l8,('l&ffi1 I Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment / Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rough) [Meter Release Rough ^ l-/Ll ./)o Service N/eter ra r ld,l qrrvt{.4 AUU FINAL tu/0/tu bUf,Afr tr Notes, Remarks, Etc. I hcrcby aflirm under pcmlty of perjury thst I m exempt ftom the ContractoB' Lien* law for thc following rc&sn (Scc.7031.5 Business ard Profcssion Codc): Any City or County which rcquircs a ;rcmit to onstrucl. alts, improvc, dcmlish or rcpair .ny structurc. prior to its issuorcc. also requires thc 8pplicant for such pcmit to fih a signcd stdemnt that lE or she is liccnscd pusmt to thc prcvisions of thc Contretor's Liccn$d lrw (Ch.ptcr 9. Comrcing with Setion 7000 of Division 3 of thc Busircss ed PrcfcssionsCodc)orthathcorshciscxcmptlhcrcfromandthebosisforthcallcgcdcrcmption. Anyviolationofsâ‚¬tkn703l.5byrny applicant for 8 ]rcmit subFcts thc applicant to a civil pcnalty of not mrc than five hundred dollus ($500). -1. as owncr of thc propcrty. or my cmployccs with wagcs as thcir solc compcnsation. willdo thc work and thc stnrturc is not intcndcd or offcrcd for sale (Sec.7044, Business and Professions Codc: Thc Contractor's Licensc [-aw does not apply to an owncr of lhc propcrty who builds or improves thcrcon. and who docs such work himself or hersclf or through his or her own cmployces. providcd that such improvenrenls are not intendcd or offcrcd for sah. If, howcver. thc building or improvenrcnl is sold within onc )tar of completion. thc Owncr Buildcr will have the burden of proving that lrc or she ditt not build or improve the proprty for ttrc purpse of sale). _1. as owncr of thc propcrty. am cxclusivcly contracting with liccnsed contraclors to conslruct thc projcrt (Sec. 704/., Busincss and Profcssion Codc: Thc Contractor's Liccnsc Law docs not apply to an owner of propcrty who builds or improves thcrcon. and who contracls f<lr such projccts with a Contractor(s) licensed pursuant to thc Contractor's Liccnsc [aw). -IamcxcmptundcrScction-'B.&P.C.forthisreason. WORKERS' COMPENSATION DECLARATION I hcrcby affirrn urrtlcr pcnalty of pcrjury onc of thc following declarations: -l havc and will maintain a Certificate of Conscnt to Self-lnsure for workers' compcnsation, as providcd for by Scction 3700 of the I-abor Code. for the lrcrformancc of the work for which the pcrmit is issued. _l havc and will maintain workcrs' compcnsation insurance. as required by Scction 3700 of thc l.abor Codc. l<lr thc pcrformance ot thc work for which this prmit is issued. My workers' comFrensation insurance carrier and policy numbcr are: ccrtify that in thc Jrcrfrlrmancc of thc work for which this permit is issued. I shall not cmploy any lrcrson in any manncr so as to bccomc subict lo thc workers' comgrcnsation laws of California, and agrec that if I should bccomc subjcct to thc workers' comJrcnsation provisions of Scction 3700 of thc L-abor Code, I shall. forthwith comply with thosc provisions.. WARNING: Failurc lo sccurc workers' cornlrcnsation is unlawful. and shall subjcct an crnployer to criminal pcnalties and civil fincs up lo onc hundrcd lhousand dollars ($cost of comgrcnsation. darnagcs Bs provided for the Scclion labor Code, inlcrcst and attorncy's a I hcrcby alfirm under pcnalty of pcrjury that I am licenscd under provision Chaptcr 9 (comrrcncing with Scction 7UX)) of Division 3 of thc Busincss and Profcssions Codc. and my liccnse is in full force and effect. Liccnsc I hcrcby aflirm undcr Fnalty of pcrjury lhat thcrc is r construction bnding agcncy for the Frformncc of lhc work for which this Ismit is ()\olâ‚¬v71 issued (Sec. 3097, Civ. C.). l.ender's Namc: lrnder's Address: APPLICANT DECLARATION I hcrcby allirm undcr pnalty of prjury onc of thc following dcclarations: Demolition Pcrmits-Asbcstos Nolification Federal Regulations (Title 40, Part6) _Rc<luircd lrttcr of Notifrcation ccrtify lhat thc fcdcralrcgulations rcg:rding asbcstos rcmovala-re not applicablc to this pr<rjcct. ccrtify that I havc rcad this and statc that the above information is corrcct. I agrclc to conrply with all City and County and Statc [.aws and hereby authorizc rcprcscntalivcs of this City and County to cnlcr uprn thc abovc nrcntioncd propcrty frlr Applicant or Agent Pernrilee name El,rrr nO n7 On{ tr a Date:_ "ro%/rt'lz'ct , I