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ELECTRICAL.I NSPECTOR RECOR D <br />f,Jr.r, nO n7 Onltr <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcreby allirm undcr FmlIy of lErjury that I m excmlt frcm thc Controcto6' Liccnrc lrw for thc following rcasn (Ss.70316 <br />Busirrcss and Prcfcssion Cqlc): Any City or County which rcquircs s Frmit Io construct, altcl irnprovq dcmlish or rcpair any <br />strudurc. prior lo its issurrcc, nlso rcquircs thc applicant for such pcmit to filc a sign€d stalcmnt lhat hc o. shc is liccnsd pwsuant <br />to rhc pmvisions of thc Contrrclor's Licenscd I:w (Chapter 9, Comrcing with Section 7q)0 of Division 3 of thc Busiress and <br />PrcfcssionsCodc)orthathcorshciscxcmptthcrcfromsndthcbasisforthcallcgcdcxcmption. AnyviolationofSecrionT03l.5byany <br />applicant for a lrcrmit subjerts thc applicant to a civil pcnalty of not rcrc than fivc hundrcd dollas ($5fl)), <br />_1. as owncr of thc propcrty, or my enrployccs with wagcs as thcb solc comlrcnsation. willdo thc work and thc stnrturc is not <br />intcnded or offcred for sale (Sec.7044, Business and Profcssions Code: The Contractor's Licensc l.aw docs not apply lo an owner of <br />thc proprty who builds or inU)roves thercon. and who does such work himsclf or herself or through his or hcr own employces. <br />providcd that such improvenrcnts arc not intendcd or otTercd for s:rle. lf. howcvcr. thc building or improvcnrcnt is sold within onc )car <br />of comphtion. the Owncr Buildcr will have thc burdcn of proving thar hc or she did not build or improve the propcrty for thc purlnse of <br />salc). <br />-1. <br />as owncr of thc prolrcrty, am cxclusively contracting with liccnscd contraclors to construct thc projcct (Scc. 7W, Business <br />and hofcssion Code: The Contractor's Liccnsc Law does not apply to an owncr of property who builds or improves thercon. <br />and who conlr.lcts for such projccts with a Contractor(s) Iiccnsed pursuant to thc Contractor's Liccnsc Law). <br />-IarncxcmptundcrScction-.B.&P.C.forthisrcason.Date: Owner:_ <br />EABf,EESII}MTENSA]XON <br />DEGIAEAIIAN <br />I hcrcby afftrm under pcnolty of pqjury ore of lhe following dslarstiom: <br />-I <br />havc {d will mintain 8 Cenifrcate of Crnsent to Sclf-lnsurc for workcn' ompensation. I prcvllcd for by Setior 3700 of thc <br />Labor Codc, for the perforrec of the work for which thc pcmit is issued. <br />(t mw ana witl mintain workem' comlrcnsation insuErcc. &i rcquircd by sstion 3700 of thc kbor Codc, for th€ performre of <br />thc work lbr which pcrmit is issucd. My workcrs' compcnsation insurancc carricr and plicy numhr are: <br />t <br />7- [-ZZPolicy <br />_l ccrtify that in thc pcrformnncc of thc work for which this pcrmit is issucd. I shall not employ any lrcrson in any manncr <br />so asto bcconrc subjcct to the workers'compcnsation lawsof California. and agrec that if I sttould becomc subjcct tothc <br />workers' compcnsation provisions of Section 3700 of thc latnr Codc. I shall. forthwith cornply with those provisions.. <br />WARNING: Failure to sccurc workcrs'cornpcnsation covcragc is unlaw[ul. and shall subjcct an cmploycr to crinrinal pcnaltics and <br />civil fincs up lo onc hundred thousand dollars (S100.000), <br />Scction 3076 of thc [:krr Code. intercst and attorncy's fces. <br />tn to thc cost of cornlrcnsalion. damagcs as providcd for the <br />-L( <br />I hcreby allirnr undcr penalty of pcrjury that I arn liccnscd undcr 9 (corrurrcncing with Scction 7000) of Division 3 <br />of the Busincss and Profcssions Code. aml my licensc is in tull force and effcct. <br />Liccnsc 4o Nurnbcr:looeT?o-Z <br />W <br />I hcrcby affum undcr Fnalty of perjury that th@ is a @[struction lcnding agcncy for thc pcrforme of thc work for which lhis pcrmit is <br />issucd (Se.3097, Civ. C.). <br />l,cntlcr's Narnc: <br />I-,endcr's Addrcss: <br />APPI ICANT NECLAITATION <br />I lucby affrm under pcnalty of pcrjury one of thc following dc"clarations: <br />Demolition Permits-Asbestos Nolification Federal Regulations (Title 40. PBrt6) <br />( R.quir"d l.etter of Notification/a I certify that thc fedcralregulations rcgarding asbcstos rcmoval arc not applicable ro this projcct. <br />I t c"r'titythat I havc read this application to conr;rly with all City and County <br />ordinanccs and Statc [-aws rclating to of this City und County to entcr ugrn thc <br />above mcntioncd propcrty for <br />Applicant or Agent <br />Pernritee name <br />lhat the corrcct. <br />D*",r-z?4 <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Sl ab I Floor t <br />Bonding I Grounding I UFER LO tq v\w,ry>1 <br />Transformers <br />Torqueinct <br />Sub-Panels <br />Air Conditioners tl <br />Roof Top Equipment 7 lt,,vl Dft4.?r 7 <br />Factory Wired Unit ll <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh)lt n <br />[t/eter Release 7 lv 1/l t\A/H2 -/ <br />I \ <br />Rough lt <br />Service lt/eter I,A u -2\Dtgv'7 <br />FINAL th ,u'7)t>tuIL9i 7 <br />Notes, Remarks, Etc.Y <br />I <br />a \,t <br />Exoires: