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ELECTRICAL-INSPECTOR RECORD <br />t'\7 ,)/\-i l: <br />APPROVALS DATE ID/SIG.COMMENTS OWNERBUTLDERDELCARATION 't <br />I hcrcby allinn undcr FEnalty of Frcrjury th{t I iln cxcnrpl fmm thc Conlraclos' Licnsc Lrw for lhc following rcasn (Scc.70-11.5 <br />Busirrcss and Profcssion Codc): Any City or County which rcquircs a ;rcrmit to mnslruct. alls. improvc. dcmlish or rcplit any <br />structurc, prior lo its issunncc. ulso rcquires thc applic{nt for such lrcnnh to filc a signcd slalcmnt lhal he or shc is liccnrcd pursuanl <br />lo lhc prcvisions of thc Controctor's Liccnscd Law (Chaplcr 9. Comrncrcing silh Sslion 7U)() of Division 3 of thc Busincss atd <br />Prelcssions Codc) or that hc or shc is cxcmpt thcrcfrom and lhc bdsis for thc alhgcd cxcmption. Any violation of Smtion ?03 I .5 by any <br />spplicant for a Frmil subjels lhc applicanl lo a civil pcnally of nol morc lhan fivc hundrcd dollars ($5U)). <br />_1. as owncr of thc propcrty. or my cntployccs wilh wagcs as lhcir solc compcns:ltion. rvill do thc work and the stnrlurc is not <br />intcndcd or otlcred t'or salc (Sec.7044. Busirrcss and hofcssions Code: Thc Contractor's l,iccnse Law does nol apply lo an owner of <br />lhe proJrcrty rvho builds or inlproves thcrctrn. and who dtrcs such work hirnsclf or hcrsclf or through his or hcr own employces. <br />provided that such inrprovcnrcnts arc not intcndcd or otTcred for sah. If. horvcvcr. thc huilding or irnprovenrcnt is sold withirt onc )rcar <br />of conplction. thc Owncr Buildcr will havc thc burdcn of proving that hc or shc ditl nol build or itnprovc the proprly for thc purposcof <br />sah). <br />-1. <br />as owncr of the propcrty. atrr cxclusivcly conlracting with liccnsed contr:rctors lo conslruct thc projcct (Scc. 7044. Busilrcss <br />and Prutbssion Codc: "I'hc Contractor's l,icensc Law docs nol apply to iln owner of propcrly who builds or itnprovcs thcreon. <br />and who conlracts for such projccts with a Contraclor(s) liccnscd pursuanl to lhe Contraclor's Liccnse Ltw). <br />I arrr cxcrttrrl undcr Scclion . ti. & P.('. lirr this rcasolt. <br />I)ate: Ou'ner: <br />WORKERS' COMPENSATION <br />DF'CLARATION <br />I hercby affirm undcr penalty of pcrjury one of the following declarations: <br />-l <br />have and will maintain a Ccrtificatc of Consent to Self-lnsurc for workers' comlrcnsation. as provided for by Section 37fi) of the <br />I-abor Codc. for the perfirmancc of the work for which the permit ls issucd. <br />-l <br />havc and will maintain workers' conrpensation insurance. as required by Section 3700 of the l-abor Code. for thc performance of <br />thc work for \hich this permit is issued. My workcrs' com;rcnsation insurancc canicr and policy numbcr are: <br />.- <br />Policy Number: Expircs: <br />_l ccrtily that in lhc pcrfrrrnrancc of thc work lirr which this pcrrnit is issucd. I shall nol cnrploy any lrcrson in any nlanncr <br />so as to hccornc subjcct to thc workcrs'cornpcnsation lilws ol'C-'alifornia. antlagrcc that if I should hccottrc suhict to thc <br />workcrs' conrpcrrsation provisions of Scction 37U) of thc l;rhrr Codc. I shall. forthwith contply with those provisions.. , <br />WARNING: Failurc to sccurc workcrs' compensation covcragc is unlau'ful. and shall suhjcct an cntploycr to criminal pcnalties and <br />civil fincs up l() onc hundrcd thousand dollars ($in addition to thc cost of compcnsation. clamages as providcd for thc <br />Scclion 3076 ol'lhc Lalxrr Ctxlc. itttcrcst attd 5-Jtr,,,o 1-l z- ln .S <br />I hcrchy af llnn undcr pcnalty of pcrjury thal I arn licensed unrlcr of Chapter 9 (commcncing with Scction 7000) of Division 3 <br />of thc Busincss and Profcssions Codc. and rny license is in full fbrce and cffcct. <br />Liccnsc Nunrhcr:a/ fll?3 <br />D"t", q 1211 <br />I hcrcby aflirm under lrntlty of pcrjury that lhrc is a @nstructhn lending agercy for thc 1rcrformrce of lhe wolk for which this tEmit is <br />issued (Se. .1097. Civ. C.). <br />[.nder's Nf,rc: <br />I-clxlcr's Atlclrcss: <br />APPLICANT DFCLARATTON <br />I hcrcby aflirm undcr penalty of pcrjury one o[ the folkrwing dcclaral ions: <br />Dcnrolition Pcrmits-Asbcstos Notification Fedcral Rcgulations (Title 40. Part(r) <br />-Rcquired <br />lrttcr of Notification <br />-l <br />ccrtify thal lhc fcdcml rcgulations rcgarding asbcslos rcrmvalarc not spplicablc to this Pmjcu, <br />_l ccnify that I havc rcad this application and stalc thal lhc atDvc informtion is corcct. I agre to @mply with sll Cityand Counly <br />ordinamcs lnd Statc lnws rclaling to building construction, nd hercby authoria rclrcs/I.tivcs ofthis Cily and County to ents ulnn thc"^#,:::#ili, <br />^r_1147*"-u**.",rnn rir-- 4fn ;it- 5, B rik <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safetv /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor , <br />Bonding I Grounding / UFER ghqla <br />Transformers t I I <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Wails (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs [-Bar Rouqh), <br />Meter Release 9lfilzt k*,4o <br />I I <br />Rouqh <br />Service lVleter tl <br />FINAL glrE lz, <br />Notes Re Etc.I <br />J <br />,tr (d trG<-dwc-