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ELECTRICAL.I NSPECTOR REGORD L rt <br />APPROVALS DATE ID/SIG COMMENTS Ow-Buildq Docleario! <br />I hscby affim udq poalty of pajury that I a q@pt fom thc ConEaclos' Licc Irw for thc folhwiag rren (e.7031.5 Buinc0, . <br />ud Profcsiol Codc): Any City or Couty which rcquis a pauit to oat$c4 alts, hprovq doolish or rtpah ay stnrc'turc, Fdr o its <br />ismc4 also rcquis tbc applicaor for uch pqDit to 6lc a siglcd statcMt thst hc or shc is lic@scd puEuot to thc prcvisioc of thc <br />Contncror's Licascd kw (Cbapa 9, Commilg with SE-tion 7000 of Divisio! 3 of thc BEils ed Prof6sioB Co&)br tbrt hc tr <br />shc is aop the&om ud thc basis for thc allcgod aoption .Any violation of Setion 703 I .5 by ey eplimt for e paait subjcrs ihc <br />epplicet to a civil paalty of mt mrc tho fivc hundrcd dollar ($500). <br />or my cmploycG with as thcir solc compcosation, will do thc work and thc stnrcture is not inteodcd <br />Thc Contractor's Liccosc Law docs not apply to an owncr of thc property <br />who builds or improvc thcrcon, and who docs such work himsclf or hersclf or through his or hcr own cmployocs, Providcd that such <br />improvcmcnts are not intcodcd or offcrcd for sale. I( howorer, the building or improvcmcot is sold within onc ycar of completion, thc <br />Oumer-Buildcr will havc thc burdcn of proving that hc or she not build or improvc for thc purposc of salc). <br />_I, s owncr of thc proqiy, a.E cxclusivcly contractrng with liccasod coatractors to coDstruct thc projcct ( Scc. 7W, Brsincss and <br />Profcssion Codc: Thc Contractor's Liccnsc [-aw docs not apply to ao owDcr of propcrty who builds or improvcs thcron, and who <br />contracts for such projocts with a Contractor(s) liccoscd pursuant to thc Contractor's Liccosc t aw.). <br />_I am cxcmpt undcr Scction B. & P.C. fel this rsasou <br />I hcrcby affrm undcr pcnalty of pcrjury onc <br />_I havc and will maintain a Ccrtificatc of Crnscot to Sclf-Insurc for workcrs' compcosatioq as providcd for by Setion 3700 of thc <br />I-abor Codc, for thc pcrformancc of thc work for which thc pcrmit is issud. <br />_I bavc ud witl mahtain worLo' oryosation imcq I rcquircd b Sctior 3700 of thc kbor Codc for thc psbrc of thc <br />wort for which this psmit is isucd My wortc' ouposaioa ioswe cuia ard policy aubc re: <br />Policy Number: Expircs: <br />(This scctioo n" oi r*)-./ <br />z-{ cqifythat in thc pcrformaacc of thc work for which this pcrmit is issuo4 I shall not cmploy any pcrson iu any menncr'so as to <br />bccamc subjcct to thc workcrs ' compcnsation laws of Catiforniq and agrec that if I should bccomc subjcct to thc workcrs' <br />compcosation provisions of Soction 3700 of thc Labor Codc,I shall, forthwith comply with thosc provisions.. <br />WARNING: Failrc to sre wortc' omtmation ovcagc is ulawfut, and shall subjcl e @ploys to qininal panltic ud civil <br />fi!6 up to oG huldrcd thousnd dollrs (S100,000),in additioa to thc @s of @Ep6$tio!, daDg6 e Fovid.d for tbc Setbr 3076 of <br />thc kbor Co&, inact aod atomy's fe. <br />LICENSED CONTRACTORII DECLARATION <br />I bsdy affm uds poahy of pajury ila I u licas.d ulds trovision of Chapta 9 (oming with Sction 7000) of Division 3 of <br />rhc Buins ad Profssior Codg ud my licw is i! full fore ed cfcr. <br />Liccnsc Class: Liccosc Number <br />Datc: Contractor: <br />CONSTRUCTION LENDING AGENCY <br />I hEcby 8trm udq pa8lty of pqjuy thst thc is a ortuaion lcodiry ag@y for tLc psfot@e of thc wqt for which this pmh is <br />Civ. C.). <br />knder's Address: <br />Doolitior pmit*Asbqtos Notifi catbo Fcdanl -*ffi <br />_ Roquirod Lata ofNotificatior <br />_I qliry tha thc fcdaal rcgulatbu rcgrdirg rbctos mval re aot applieblc to this !roj6-t. <br />J *,iry O"t I t u" rud this application od statc thrt thc abovc iDbmtioo is @rcct I agr to coryly with dl City 8[d Couty <br />ordimB ald Stits Lffi rclstilg to building @EtructioD, and hcby uthorirc rcprqatatis of thir City rad Couaty to @rq upo! rhc <br />aborc motioacd propaty for inspocrion prpos. <br />Applicant or agcnt <br />Pcrmittcc narne <br />o <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm I Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding lGrounding I 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 I I <br />FINAL q 7-l2l W a-l <br />Notes, Remarks, Etc.'l I