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ELECTRICAL-I NSPECTOR R ECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq I Groundino I UFER ?-la-?)>-{'{1,- <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinss (T-Bar Rouqh) <br />N/eter Release ?-lu,%D./a( IU <br />I 91.M\A 4-?1 ., Zl i--f 'l 2-. <br />Rouqh 74v-?t ).4 LtO grSo--zl r--p 9? <br />Service lVleter ol -IV-Ll /x' \-v <br />FINAL Q -uoaA t Q.vr.f .l u <br />Notes, Remarks, Etc. <br />I hercby allirm under pcnalty of tf,rjury that I m cxcnrpt ftom thc Contracto6' Licensc law for thc following rcen (SecJ03l.5 <br />Busincss ard Profcssion Codc): Any City or County which rcquircs a Jrcmit to construcl, !lts, improvc. dcmlish or rcpair my <br />structurc, Irior to its issumcc, also rcquires thc 8pplicant for such lEmit to filc a si8red slalcmnt thrt hc or slE is liccn$i plmst <br />to thc prcvisions of thc Contractor's Licen$d lrw (Chaplcr 9. Comncing with S$tion 700O of Division 3 of the Business md <br />PrcfcssionsCode)orlhothcorshciscxcmptthscfmm.ndthebusisforthcallcgcdexcmption. AnyviolationofSclionT03l.5byatry <br />applicrnl for r pcrmit subjcts thc spplicmt to a civil pcmlty of not mre thu fivc hundrcd dollus ($500). <br />-1, <br />as owner of the property, or my employecs with wagcs as their solc compcnsation. will do thc work and thc stnrturc ls not <br />intended or offered for sale (Sec.7044, Business and Professions Codc: The Contractor's Liccnse law does not apply to an owncr of <br />the property who builds or improves thcrcon, and who does such work himself or hcrself or through his or hcr own employces, <br />providcd that such inrprovenrcnts arc not intcndcd or offercd for sah. If, however, thc building or improvcnrnt is sold within one year <br />of comphtion. the Owncr Builder will have tlre burdcn of proving that trc or shc dirJ not build or inqrrove the proprty for thc purposc of <br />salc). <br />_1. as owncr of thc propcrty, am cxclusivcly contracting with liccnscd contractors to construct thc project (Scc. 7W, Busincss <br />and Profcssion Codc: Thc Contraclor's Licensc Law does not apply to an owncr of propcrty who builds or improves thercon. <br />and who contracls for such projcrts with a Contracto(s) liccnscd pursuant to thc Contraclor's Licensc [:w). <br />-lanlcxcmPtundcrScction-'B.&P.C.forthisreastrn. <br />Date: <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hcreby affirm under pcnalty of pcrjury onc of thc following declarations: <br />_l havc rurd will maintain a Ccrtificatc of Conscnt to Self-lnsure for workers' compensation, as provided for by Section 3700 of the <br />[:bor Codc. for thc ;rcrformance of thc work for which thc permit ls issucd. <br />havc and will maintain workcrs'compensation insurancc, as rcquircd by Scclion 37fi) of thc labor Codc, for thc pcrformancc of <br />work this pcrmit is issucd. My workcrs' compcnsation insurancc carricr and plicy numbcr arc: <br />Policy L- t[-7L <br />_l ccrtify that in thc pcrformance of the work for which this pcrrnit is issucd. I shall not cmploy any pcrson in any manncr <br />so as to bccome subject to the workcrs'compcnsation laws of California, and agrcc that if I should become subjcct to thc <br />workcrs' compensation provisions of Section 3700 of thc Labor Codc, I shall, forthwith comply with thosc provisions.. <br />WARNING: Failurc to sccure workcrs' compensation coveragc is unlawful. and shall subjcct an employer to criminal pcnaltics and <br />civil lirrcs up to onc hundred thousand dollars (Sl addition to thc cost of comJrcnsation,as providcd for the <br />Scction 3076 of thc latnr Code, intcrcst and <br />, \e , -Zl <br />I hercby affrm undcr pcnalty of pcrjury that I arn liccnsed undcr provision of Chapter 9 (cornmencing with Scction 7000) of Division 3 <br />of thc Business and Profcssions Codc, and nry liccnse is in full forcc anddffcct. <br />Liccnsc Class:Nunrbcr: <br />r5 <br />I hcrcby affirm undcr pcn8lty of pcrjury that th@ is 8 @nstructbn lending agercy for the perforruce of lhc rcrk for which this pcrmit is <br />issued (Se. 3097, Civ. C.). <br />lendcr's Name: <br />lrndcr's Address: <br />APPLICANT NECLARATION <br />I trcrcby aflirm undcr pcnalty of perjury onc of thc following dcclarations: <br />Demolition Permits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40, Part6) <br />_Rcquircd lrttcr of Notification <br />-l <br />ccrtify that thc fedcral regulations rcgarding astcstos rcrrmvalarc not applicablc to this proict. <br />_l ccrtily that I havc rcad this application and statc that the atxrvc intbrmation is correct. I agrcc to conrply with all Cityand County <br />ordinanccs and Statc Laws rclating to building construction, and hcrcby authorizc rcprcscntativcs of this City and County to cnlcr u1rcn thc <br />o,r",X- lZ,Z1abovcnlcnlioncdproperty <br />Applicant or Agent <br />Pernrilee nnnle <br />ftlr <br />f)n.na n7 Onl tr <br />Owner:- <br />Dale: <br />a <br />! <br />c.