|
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'
|