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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNER BUTLDER DELCANATION <br />I hercby allirm unds lrcmlly of perjury that I m excmpt from the ContmctoB' Liccns hw for thc followirg rcasn (Sec.703l.l <br />Busincss ard Prcfcssion Codc): Any City or County which rcquircs a prmit to construct. altcr. improve, demlish or rcpair uy <br />structurc. lrior to its issure. 8ls requircs lhc ryplictrtrt for such pcrmit ]o lile a signcd statemnl thal hc or she is liensd pmust <br />to thc pmvisions of thc Contractor's Licrnsd trw (Chaptcr 9, Commcrcing with Section 7000 of Division 3 of thc Busircss ed <br />Prcfcssions Codc) or thst hc or shc is cxcErpt lhqcfrom and thc b&ris for thc alhgcd cxemption. Any violation ofselion 703 1.5 by lny <br />applicant for a pcmit sublEts thc rpplicant to a civil pcElty of mt mrc than five hundrc{ dollus ($500). <br />_1. as owncr of the profrcrty. or my cmployecs with wagcs as thcir solc comFrcnsation, will do the work and thc structure is m)t <br />intcndcd or offered for salc (Sec.7044. Busincss and hofcssions Codc: Thc Contractor's Liccnsc l-aw docs not apply to an owncr of <br />thc pmperty who builds or iryrrovcs thcrcon, and who docs such work himsclf or hcrsclf or through hi.s or hcr own cmployccs, <br />providcd that such improvcnrcnts arc rrlt intended orofferd for sah. If, howcvcr. thc building or improvcment is sold within onc )car <br />of complction. the Owncr Builder will have thc burdcn of proving that hc or shc dirt not build or irrprovc thc propcrty for thc pur;nsc of <br />salc). <br />-1. <br />as owner of the profrcrty, am exclusivcly contracting with liccnscd contractors lo construct thc proict (Sec. 7W, Business <br />and Profcssion Codc: Thc Contractor's Liccnsc Law docs not apply to an owncr of property who builds or improves lhereon. <br />and who contracts for such projccts with a Contracto(s) liccnsed pursuant to thc Contruclor's Liccnsc [:w). <br />_l am cxcmpt undcr <br />WORKERS' COMPFNSATION <br />DECLARATION <br />I hcrcby affirm under penalty of perjury onc of the following dcclarations: <br />/fiavcanawitt minlairaCcflifrcrtcofConsnttoself-lnsurcforworks'@mpcnsation.as pmvidcdforbySetion3TOOofthc <br />/ (tor Crdc, for thc pcrfomc of thc sork for which thc frmit is issucd. <br />mlffi" "rd *ill .aintaitr workes' @mlrcnsation insumnce, &s rcquircd by Setion 37OO of tlE kbor fuc, for the [rcrforuc of\. lhc work for which this pemit is issucd. My workm' ompcnsation insurance cmier ard pothy number rc: <br />11 t (yu**O <br />o.<-06 - zL <br />_l certify that in thc pcrformancc of thc work for which this permit is issucd, I shall not cmploy Bny pcrson in any manncr <br />so as to bccornc subjcct to the workcrs' compensation laws of California. and agrce that if I should bccomc subjcct to the <br />workcrs' compcnsation provisions of Scction 3700 of thc Lrbor Code. I shall. forthwith comply with thosc pmvisions..1 <br />WARNING: Failurc to sccurc workcrs'compcnsation covcragc is and shall subict an cmployer to criminal pcnaltics and <br />civil fincs up to onc hundrcd thousand dollars ($100.000), in <br />Scclion 3076 of thc Labor Codc. intcrest and atlorncy's fees. <br />cost of compcnsation, damages as provided for thc <br />ft*", Tqloqf zt <br />NECI-ARATION <br />I hcrcby affirm under pcnalty of pcrjury that I am liccnscd undcr provision of Chapter 9 (commencing with Scction 7000) of Division 3 <br />of thc Busincss and Profcssions Code, and my liccnse is in full force and cffcct. <br />Nurnbcr:IOo TorLl <br />LI <br />W <br />I hcrcby allirm undcr lrcnalty of pcrjury that tlrcre is a @nstruction bnding rgcrcy for thc Jrcrfomncc of thc work for which this Imit k <br />issucd (Ss. 3097, Civ. C.). <br />kndcr's NsnE: <br />lrndcr's Addrcss: <br />APPI ICANT DF'CI ARATION <br />I trcrcby allirm under pcnalty of pcrjury onc of thc following declarations: <br />Dcrnolition Pcrrnits-Asbestos Notification Fcdcral Rcgulations (Titlc 40, Part6) <br />_Rcquircd [*tter of Notification <br />-l <br />ccnity thlt tlE fedcnl rcgulations rcgarding asbcstos rcmval rc mt rpplicabh to lhis prcjirc{. <br />IPt cenify rtror I havc rcrd this spplicatioo ud state thal tlE abovc infomtion is coEet. I sgru to ompty with sll City snd County <br />-ordinorccs and Statc hws rchtitrg to building mnstruction, sd hcreby authorizc rcprc$ntatives of this City 8nd Couoty to cntq upon thc <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltase <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor <br />Bonding I Grounding IUFER <br />Transformers \) <br />Torqueinq <br />Sub-Panels \ <br />Air Conditioners <br />Roof Top Equipment <br />Factorv Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh)/ <br />N/eter Release <br />Rouqh <br />Service N/eter \r lc.,,- <br />FINAL \u \ \-u \7\E'J.YYZ / <br />Notes, Remarks, Etc.\ <br />\ <br />,/ <br />no n7 ont tr <br />conrracro r, PQ.oTf c*{ ,CE'hL CO '(TPtlCTldl) <br />abovc <br />P*t*pr <br />o,r", 0q/o7 L /