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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affirm undcr pcnlhy of pcrjury thrt I m cxcmpt fmm the ContmctoN' Licenrc [:w for the following rca$n (Sc.7031.5 <br />Busincss ard Prcfcssion Cqlc): Any City or County which rcquircs a Frmit to construct. alts, improve, demlish or Epair any <br />structuc. prior lo its issuarcc, alm rcquircs thc spplicant for such lEnnil lo lilc a sigrcd statcmnt that hc or slrc is liccnscd puNuant <br />to thc prcvisions o[ thc Contractor's Licensd law (Chaptcr 9. Commcncing with Sction ?00O of Division 3 of thc Busircss atrd <br />Prcfcssions Codc) or that hc or shc is cxcmpt thcrcfrom and th€ basis lbr thc dhged excmplion. Any violatioo of SNtion ?03 1.5 by any <br />applicqrt for a pcmit subjccts thc applicant to a civil pcnalty of not mre than fivc hundred dollars ($500). <br />(Af S.**, *thc prcFny, or my cmployccs with waScs as thcir slc comlrcnsation. willdo the work aid thc st]rriw is mt <br />ilileldcd or ofIcrcd for sle (Se.7O44. Busircss and Profcssions Codq Thc Contractor's Licens bw d@s not apply to an owner of <br />thcpmlEny whobuildsorimprcresthcmn.srxlwhod@ssrchw*himsclforhcrslforthrcughhisorhcrowncmployccs. <br />providcd that $uch imprcrcmnts rc mI inrcndcd tr olIcrcd for sh. If. howcw. thc building or imprcwmnt is sld vithin onc ]au <br />of conrphtion. thc Owncr BuiHs will hsrc tlrc burdcn of ,mving thal lE or shc did rct buiH or imlrmre tlrc pmFaly for the pu]JDs of <br />eh). <br />-1. <br />as owncr of thc property, am cxclusivcly contracting with liccnscd contractors to conslruct thc project (Scc. 7W, Busincss <br />and Pmtbssbn Codc: The Contraclor's Licensc Law docs not apply to an owncr of propcrty who builds or improvcs thcreon, <br />and who contracls for such projccts with a Contracto(s) liccnsed pursuant to thc Contractor's Liccnsc kw). <br />_l am P.C. tbr this <br />x a r1 LT <br />DECI ARATION <br />I hereby affirm under penalty of pcrjury one of the following declarations: <br />-l <br />have and will maintain a Certificate of Consent to Self-Insurc for workers' compensation. as provided for by Section 3700 of the <br />Labor Code, for the performance of the work for which thc pcrmit is issucd. <br />-l <br />have and will maintain workers' compensation insurance, as rcquircd by Section 3700 of the Labor Code, for the performance of <br />thc work for which this permit is issued. My workers' compensation insurance carrier and policy number arc: <br />Carrier: <br />Policv Numbcr: Exoires: <br />ft-fi"nify that in thc pcrtbrnunce of thc work for which this pcrmit is issued. I shall not cmploy any lrcrson in any manncr <br />so as lo bccomc subjcct to thc workcrs' compcnsation laws of California. and agrcc that if I should bccomc subict lo the <br />workcrs' conrpcnsation provisions of Scction 3700 of thc Labor Codc, I shall, forthwith cornply with thosc provisions.. <br />WARNING: Failurc to securc workcrs'compcnsation covcrilg,c is unlawful, and shall subjcct an employcr to criminal pcnaltics and <br />civil fines up to onc hundrcd thousand dollars ($100.m0). in addition to lhc cost of compcnsation. darnagcs as providcd for thc <br />Scction 3076 of Ccxlc. interest and atlorncy's <br />B (1 LI <br />NT'CLARATION <br />I hercby affirm under pnalty of pcrjury that I am licenscd undcr provision of Chapter 9 (commencing with Section 7000) of Division 3 <br />of the Busincss and Professions Codc, and my license is in full force and cffccl. <br />Liccnsc Class: Liccnsc Number: <br />Date: Contractor: <br />W <br />I hcrcby aIfirm undcr Fmlty of pcrjury lhat Ihcrc is a construction bnding agercy for thc JErfomrc of thc work for which this pcrmil is <br />issued (Se. 3097. Civ. C.). <br />kndcr's Narc: <br />lrndcr's Address: <br />APPT IC ANT NT'CLARATION <br />I Mry affrnn under pcnalty of prjury onc of thc following declarations: <br />Dcmolition Pcrrnits-Asbcstos Notification Fedcral Regulations (Title 40, Part6) <br />_Requircd lrtter of Notifrcation <br />_l ccrtify that the fedcral regulations regarding asbestos rcnroval arc not applicable to this projcct. <br />Mhty rhat I havc rcad this applicarion and state that the abovc information is corrcct. I agrcc to cornply with all Ciry ancl County <br />ordinanccs and State Lrws relating to authorizc rcprcscntativcs of this City and County to entcr u;nn thc <br />abovc rncntioncd proprty <br />Applicant or Agent <br />Pernritec nanre (A <br />conslruction. <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 Slab / Floor <br />Bondino lGroundinq I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />N/eter Release <br />Rough ?q.*rL 4-?-ll E)-{^P 4t <br />Service N/eter <br />FINAL Ol-Z-]l Eta,_? t{n <br />Notes, Remarks, Etc <br />Y <br />nQ n7 ont trfJ^. <br />6'v