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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affirm under penalty of pcrjury that I m cxctrrpt ftom thc Contmctotr' Lhcnr lrw for thc following rcen (56.7031.5 <br />Busincss and Prcfession Codc): Any City or County which rcquircs a grmit to construcl, alts, improvc. demlish or rcpair any <br />strucrurc. prhr to its issuarce, alrc rcquircs the applicail for such Jrcmit to lih a sigrcd strtcmnt that hc or shc is licensd pwant <br />ro thc provisions of the Contrrctor's Liccn*d taw (Chaptcr 9, Comncing with Scction 7000 of Division 3 of thc Busircss and <br />PmfcssionsCodc)orthathcorshciscrctrrptthcrcfromendthcbasisforthcalhgcdcxcmption. AnyviolationofSetionT03l.5byany <br />applicant for a pcmit subjects thc applicsnt to a civil penalty of not morc the fivc hundrcd dollas ($500). <br />-1, <br />as owncr of thc property, or my cmployccs with wages as thcir solc compensation. will do the work and thc stnrcture is not <br />intcndcd or oflered for salc (Scc.7044, Business and Professions Codc: Thc Contractor's License [-aw does not apply to an owncr of <br />thc propcrty who builds or improves thcrcon, and who docs such work himsclf or hersclf or through his or her own cmployces, <br />providcd that such improvcnrcnts arc not interdcd or offercd for salc. If, howevcr, thc bnilding or improverEnt is sold within one )tar <br />of conrphtion. thc Owncr Builder will havc thc burdcn of proving that tre or shc did not build or improve the property for the purpos€ of <br />sah). <br />-1, <br />as owncr of the profrerty, am exclusivcly contracting with licenscd conlraclors lo construct thc projcct (Scc. 7W, Busincss <br />and ftofcssbn Code: The Contractor's License Law does not apply to an owncr of propcrty who builds or improvcs thcreon, <br />and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Licensc l-aw). <br />-l <br />unr cxcmpt under Section-, B. & P.C. for this rcason. <br />f l.rl o. <br />WORKERS' COMPFNSATION <br />DECLARATION <br />I hcrcby affirrn undcr penalty of perjury onc of thc following declarations: <br />-l <br />havc and will maintain a Certificatc of Consent to Self-lnsurc for workcrs' compensation. as provided for by Section 3700 of thc <br />tabol Code, for lhc pcrformance of the work for which the permit ls issucd.,/,J.ll havc and will maintain workers' compcnsation insurancc, as requircd by Scction 3700 of the krbor Codc, for thc Jrcrformancc of <br />thc work for which this permit is issued. My workcrs' compensation insurance carrier and policy number arc: <br />cu,ri"r,' Stafnrf ln5. <br />_l ccrtify lhat in thc pcrformancc of the work for which this permit is issucd. I shall not employ any pcrson in any manncr <br />so as to tlc.corrc sub.iect to thc workcrs'compensation laws of California. and agrcc that if I should bccome subject to the <br />workcrs' comSlcnsation provisions of Section 3700 of the l-abor Codc, I shall. forthwith comply with thosc provisions.. <br />WARNING: Failurc to sccure workcrs' <br />civil l-rnes up to onc hundred thousand <br />Scction 3076 of thc Latnr Code, intcrcst <br />and shall subjcct an <br />to lhe cost <lf as provided for the <br />antl all<lrncy's fccs. <br />I hcrcby alfirnr undcr penaltyof pcrjury thal I arn liccnscd 9 (commencing with Scction 7000) of Division 3 <br />of thc Busincss and Professions Code, and my licensc is in full force and effcct. <br />Liccnsc b Numbcr: . 8L4'LA1 <br />W <br />I hercby affirm undcr penalty of perjury that th@ is a @nstruction lcnding agcrcy for thc prforrc of thc work for which this pemit is <br />issued (56. 3097, Civ. C.). <br />Lendcr's Name: <br />[.ender's Addrcss: <br />APPLICANT DECI ARATION <br />I lrcrcby alfirm under penalty of perjury onc of thc following declarations: <br />Dcmolition Pcrmits-Asbestos Notification Fcdcral Rcgulations (Titlc 40, Part6) <br />_Rcquircd lrttcr of Notification <br />,/t ""niruthar the <br />"f,**nry,tr, I have <br />federal rcgulations removalarc not applicablc to this projcct. <br />read this application is corrcct. I agrec to comply with all City and County <br />ordinanccs and State l-aws relating to of this City and County to enter u;nn thc <br />atxrvc mcntioncd propcrty for inspection <br />Applicant or Agent <br />I'ernrilee nunre Y l(4,{ <br />thc <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor I t rl ^ t ) <br />Bondinq I Groundinq I UFER c{'fl ,Ytffirtf / <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners I I f) <br />Roof Top Equipment (,w 7l vvwt 7 <br />Factory Wired Unit vl <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinss (T-Bar Rouqh)I I /1 <br />Meter Release 'aa /w{v/,-r <br />UI <br />Rouqh <br />Service N/eter I I \.A ll n.-O- <br />FINAL L 70 Prt<6/ <br />Notes, Remarks, Etc. <br />J <br />El,-.., nO n7 On{ tr. <br />^ <br />ol <br />Owner:- <br />,' o1 lot lzzPolicyNunu"r,t fll\lUW@ I'3'7I 4/ <br />to crilrrinal Jrcnaltics and <br />,,r".- o(l w lLl <br />D^r", ' 01 I 30 i?-t <br />ULa(* <br />Drt.' t Og ltolz'