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ELECTRICAL-I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS ow-Builds D*hntion <br />I hacby rffirm undcr pculty of pajury that I m mpt fom thc Contndon' Licile hw for thc following r*on (te.7031.5 Buinor <br />md Proferion Codc): Any City or Couty which rcquircs a pcmit to oEtrucl, rltc(, improvq dcmlilh or rcpair uy rtructwg prioi to iu <br />issune, rlso rcqubo thc rpplimt for luch pcmit o filc e rigncd rtatcmt th.t hc or shc is licffid punufit to ths prcvitiou of.h. <br />Contrrctor's LieEcd Lrw (Chrpt6 9, Commcncing with S@tion 7000 ofDivirion 3 ofthc Buinqr rnd Profer3io[ Codc) or thrt hc o] <br />shc ir ucmpt thuc&om urd thc brir for tlp rllcgod remption .Aay violrtion of S6rioa 7031.5 by uy rpplimt for r pmit rubjocE thc <br />Epplient !o r civil pcmlty ofnot morc thrn fivc hundrcd dollrn (t500). <br />_I, I oms of th€ proporty, or my cmployq with sg6 u thcir rclo @mpcutioq will do the mrk ud thc ttruduc b mt in&ndcd <br />or oficrcd for rlc ( Sc.7O44, Buiur ud ProfBlioro Codc: Thc Contnctor'r Liffi lrw ds rct.pply to u omc of thc proporty <br />who builds or improw thaoq ud who doe lwh worh hinlclf or hwlf or through hir or ha om omploya, providod lht lwh <br />improvcmcnts ec not intcndcd or ofrcrcd for nlo. I{ howcvcr, rhc builditrg or improrcmcnt it told within onc yu of omplaion, thc <br />Omq-Buildcr will hrvc thc burdcn ofproving thrt hc or shc not build or improw for thc purposc ofuld. <br />_1, s oms of thc propcty, rm *lurivcly @rtnctinS with li@Mcd @ntncto[ to 6[truct thc projst ( Sc. 70{4, Buioos rod <br />Prcfsion Codc: Thc Contnctor'r LiccNc Lw doo mt epply o u ow of propaty who buildr or improB tls@n , md who <br />@ntEctt for tuch projct! with r Contnctor(r) licocd purunt !o thc Contncor'i Liem [rw.). <br />_I am exempt undcr Scction B. & P.C. for this rcEson. <br />Date: <br />@ <br />I hcrcby rfiirm unds pculty of pajury orc of ths following dchntioru: <br />_I havc rnd will miilrh s Cortifiqt! of CoE6t to Sclf-Iruurc for wrko' mmpsution, u providod for by Sslion 3700 of thc <br />Lrbor Codc, for thc pqformrncc oftho work for which thc pffmit ir isucd. <br />I havc end maintain workers' compensEtion Es requircd by Section 3700 of thc Labor the perforrnancc of the <br />work this pcrmit is issued.insurance csrrier and policy <br />Policy cr o?J> <br />(This section not bc completed permit is for Onc hundred dollars or <br />_l certify that in thc pcrformancc of the work for which this permit <br />became subjcct to thc workcru ' compensation hws of Californig and <br />ls not peruon in any msnner so 8s to <br />ifr subjcct to the workcrs' <br />provisiom of Section 3700 of the tabor Provisions.. <br />e^07 <br />Failure to secure workcrs'and shall subjact an employcr to criminalpenalties and civil <br />compcnsEtioq darnages as provided for the Section 3076 of <br />the [.abor Codc, intcrcst and attorncy's fecs. <br />I hereby affirm pcnalty of pcrjury that am 9 with Section 7000) of Division 3 of <br />the Business my liccruc is in full forcc and 6Numbcr <br />Date: <br />I hercby affirm undar ponslty of perjury that there is a <br />issued (Sec. 3097, Civ. C.). <br />Lcndcr's Name: <br />aSency pcrformsncc of thc work for which this pcrmit ic <br />Lendcr's Address: <br />APPLICAI\IT'S DECLARATION <br />Demolition Permits-Asbestos Notification FederalRegulatioru (Title 40, Part 6) <br />_ Required Lettcr of Notifrcation <br />_l ccrtify that the fodcralregulstions regarding asbestos removslare not applicablc to this project. <br />_ I ccrti$that I have rcsd this above information is conect I agrec to with all City and County <br />and County to cntcr upon the <br />above mcntioned <br />Applicant or agent <br />Permittee name <br />state <br />and hereby authorizc rcprescntativcs <br />G--- F^b <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 lDampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / 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 & Sotfit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL ?e-'/'21 I?JL':,r)uzd='?fJ <br />Notes, Remarks, Etc.I A-.n <br />y <br />7 /r r/ <br />T <br />is <br />the cost