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ELECTRICAL.I NSPEGTOR REGORD <br />i <br />APPROVALS DATE ID/SIG.COMMENTS OMfi-Buildq Dccl{ation <br />I hcrcby affim undd pcnalty of pcrjury that I m cxmpt fom thc ContractoB' Li@Gc Law for thc following rcdon (scc.7031.5 Bsincs <br />ud Prcfcsim Codc): Any City or County which rrquiru a pcmit to construcr, altq, improvq dmolish or rcpai ey suuctuc, lriq to its <br />issuucc, also rcquire thc applicat for such pmit to filc a signcd statcmmt that hc or shc is liccnscd puBumt to thc provisions of rhc <br />Contrrctor's Lifficd L8w (Chapta 9, Comocing with Sction 7000 of Division 3 of thc B6in6s ud Prof6sions Codc) or rhat hc or <br />shc is cxmp tltmfrom ud thc b6is ffi thc allcgcd cxcmption.Any violation of Sction 7031.5 by uy appli@r for a pcmit subjsr thc <br />applicet to 8 civil p€nalty ofnot morc thm fivc hundrcd dollus ($500). <br />_I, c ownr of thc propcrty, or my mployc with wagc r thcir solc cmposgtion, will do thc work od rhc structw ii not intodcd <br />or offcrcd f6 sslc ( Scc.7044, Buines ed Profssifis Codc: Thc Contractor's Licosc Law dq not apply to u omc of thc propcrty <br />who buil& or improva thmn, ud who ds swh wql hiruclf or h6clf or through hic or he wo oployc, providcd that such <br />imprcvmals rc not intqdcd or offatd for ralc, If, howwr, thc building or improvmat is sold within m! ycu of complction, thc <br />Omcr-Buildq will havc thc burdm of prcving thst hc or shc not build or improvc fo thc purpsc of salc). <br />_1, c ownr of thc prcpcrty, m acluivcly ontse{trg with lictrcd conttrctoE to costruct thc Fojcr ( scc. 7(X4, Buinos ud <br />Profcsion Codc: Thc Cmtrctor's Limsc Lrw dM not apply o m omo of prcpaty who builds u improve thcon , ud who <br />contr&ts for such prcjcsa with a Cotrtreto(s) limscd pursumt to thc ConEetor's Liccnsc Law.). <br />_l am exempt under Section <br />Date: <br />I hereby affirm under pcnalty of perjury one of the following <br />_IhavcudwillmaintainaCcnificucofConsmttoSrlflnsurcforworkm'compcnsation,c prcvidcdforbyScctim3T00ofthc <br />Labor Codc, for thc pcrfmme of thc wck fc which thc pcrmir is issucd. <br />_I havc ud will maintsin wqkcE' compcnsation insurmcc, o rcquircd by Sccdon 3700 of thc Labor Codc, for thc pcrfomue of thc <br />work for which this pqmir is isucd. My workm' ompcnsation insurm@ ffiiq ud policy numbcr rc: <br />Canier <br />Policy <br />(This section need not bc completcd if the perrnit is for One dollars {$100} or less) <br />_l ccrtify that in the pcrformancc of the work for which this is in any manner so :ls to <br />became subject to the workers ' compcnsation laws <br />compensation provisions of Section 3700 of thc <br />WARNING: Failurc o sccuc workm' mmpcroation covsagc is unlawful, ud shall subjcct s cmploycr to qimiml pcnalti6 6d civil <br />fine up to onc hundrcd thoudd doUffi (t 100,000),in addition to thc c6t of compcnsarion, dmgs r prcvidcd ftr thc Scction 3076 of <br />thc L:bor Codc, intqBr ad rnomcy's fc. <br />W <br />I hacby affim unda paralty of pcrjury that I m limscd uodq prcvisifi of Chaptq 9 (comcncing with Sstion 7000) of Division 3 of <br />the Bruiness and Profcssions Codc, and my licensc is in full force and effect. <br />Licensc Class' Liccnse Numbsr <br />Date: Contractor: <br />CONSTRUCTION LENDING AGENCY <br />I hmby affim unda pcmlty of pcrjury thaf th@ is a coNfuction loding agmcy fc thc pcrfmme of thc wck fff which this pmit is <br />isucd (Sc. 3097, Civ. C.). <br />Lmds'sNm: <br />Lender's Address: <br />APPLICA}IT'S DECLARATION <br />Regulations (Title 40, Part 6)Demol i ti on Perm i ts-Asbestos Noti fi cation Federal <br />_ Required Lener of Notification <br />_l certify that thc federal regulations regarding asbcstos removal are not applicablc to this project. <br />read this application and state that the above information is correct, I agree to comply with all City and County <br />Laws rspresentatives of this City and County to enter upon the..-/above <br />Applicant or <br />should becomc <br />with those provisions.. <br />Pcrmittee <br />I <br />for <br />Lr o <br />Site-Work t ,n <br />Underground /n?A.,,-*/r-,k /r/a ) Pr4nf 't r?ta rt( <br />Pole Bases - -" a -f <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm lDampers <br />Communications Cable <br />Building <br />Under Slab I Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter tl .-\ <br />FINAL 1/ z lzr LL{?t)FlnL{D@s7b-nhb <br />Notes,Feparks, Etc.tt <br />lt <br />Ls-hall-not-crnPlor <br />I <br />Purposes.