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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq I Groundi nq I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Wdls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rouqh) [/eter Release Rough Service N/eter I FINAL t/tq lz,L^s:.'% Notes, Remarks, Etc.I I I I hcrcby afftrm unds pcmlly of pcrjury that I m excmpt from the Contmctom' Liccns kw for thc following rcasn (Ss.7031.5 Busincss and Prcfcssion Codc): Any City or County which rcquircs a pcrmit to conslrucl. altcl improvc. demlish or rc,pair uy struclre, prk r lo ils issuare. also requircs the applhill for such JEmil to 6le a sigrcd slatemnt lhat he or shc is liccnsd puEuilt lo lhc prcvisions of thc Contraclor's Lbcnsd [3w (Chapter 9, Commercing with Seclion 7000 of Division 3 of thc Busircss and PmfcssionsCodc)orthathcorshciscxcmplthercfromondthcbosisforthcallegedcxcmption. AnyviolstionofsNtionT03l.5byany rpplicant for a Jrcrmit subj(ts lhe applicant to a civil pcmlty of not mre tho fivc hundrcd dollus ($500). -1. as owncr of thc propcrly, or my employccs with wages as thcir solc comgrcnsation. willdo thc work and thc stnrturc is not intcndcd or ofl'ercd for sale (Sc'c.7044, Busincss and Professions Codc: The Contraclor's Liccnsc Law docs not apply to an owner of thc propcrty who builds or inrprovcs thercon. and who dclcs such work himsclf or hersclf or through his or hcr own cmployccs. provided that such improvenrcnts arc not intcndcd or ofIcrcd for salc. If, howcvcr. thc building or improvcnrcnt is sold wilhin one ),cil of cornphtion. thc Owner Builder will havc the burdcn of proving that he or shc did not buikl or improve thc propnty for thc purJnse of sah). _1. as owncr of the propcrty. am cxclusivcly contracting with liccnscd contractors to construct the projcct (Scc. 7W, Busincss and Profcssion Codc: Thc Contraclor's Licensc Law docs not apply lo an owner of proyrcrty who builds or improves thereon, and who conlracts for such projects with a Contractor(s) licensed pursuant to thc Conractor's Liccnsc Law). _l amcxcmpt under Scclion_, B. & P.C. for this rcason. \YORKI,RS' CONT PFNSATION Dt..CLARA'tION I hcrcby altlrrn undcr pcnalty of pcrjury one of thc following dcclarations: -l havc and will maintain a Ccrtificate of Conscnt to Self-lnsurc for workcrs' compcnsation, as providcd for by Section 3700 of the Lrbor Codc. for thc perfornunce of thc work for which thc Jrcrmit is issucd. have and will maintain workcrs' compcnsation insurancc, as requircd by Scction 3700 of the Labor Code, for thc pcrformancc of thc work for My workers' compcnsalion insurancc carrier and gllicy numbcr arc: Policy (o tr lzl h ccrtify that in the pcrforrnance of thc work for which this grcrmit is issucd. I shall not cmploy any pcrson in any manncr so as to bccomc subjcct to the workers' compcnsation laws of California. and agree that if I should bccourc subjcct to the workers' cornpcnsation provisions of Section 3700 of the [:bor Code, I shall. forthwith comply with thosc provisions.. WARNING: Failurc lo sccurc workcrs' civil fincs up to one hundrcd thousand is urrlawl'u!. and shall suhjcct an cmJrloycr to criminal penaltics and to thc cost of damages as provided for lhc Scction 3076 of the ^...^.8 ltz I+bor Crxlc.lzl inlerest and attorrrcy's O<ti I hercby affirrn undcr penalty of pcrjury that I am licensed undcr provision of Chapter 9 (cornnrencing with Section 7000) of Division 3 of thc Busincss and Professions Code, and my liccnsc is in full forcc and effcct. Liccnse C C Nunrbcr:3"1 5b ZI \,/'t\/l CONSTR.UCTION LENDING AGENCY I hcrcby aflrrn undcr Fn.lty of pcrjury thal rherc is a construction hnding agcncy for lhc pcrformc of thc work fo, which this pcrmit is issuc{ (Scc. 3097. Civ. C.). lrndcr's Numc: l-cndcr's Addrcss: APPLICANT DECI ARATION I hcrcby affirm undcr pcnalty of pcrjury onc of the following dcclarations: Dcrnolition Permits-Asbestos Notification Fcdcral Regulations (Title 40. Part6) -Requircd l-cttcr of Notilication -l certify that thc fedcralrcgulations rcgarding asbestos rcrnovalarc nol applicablc to this projcct. NB ccrtify that havc read this application ard state that thc abovc rlrdinanccs and .Statc [.aws rclaling construction.and atxlvc mcntioncd propcrty Applicant or Agent Pernritee name for t() 4=gJ.,+r\ thc [Jr.rr nA n7 Ont tr Owner:_