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ELECTRICAL.I NSPECTOR RECOR D <br />Dr.., nQ n-7 On{ tr <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby alItrm undcr penalty of Frjury that I am exempt frcm thc CrntractoE' Liccns kw for thc following rcasq'o (Se.7031.I <br />Busincss and Profcssion Codc): Any City or County which rcquircs a pcrmit to onslruct, altcr improvq dcmlish or rcpir anf <br />struclurc, prior to its issuancc, also rcquircs thc applicdt for such Frmit Io file r signcd slalcrcnt thlt hc or shc is liccnsd pusuul <br />to thc prcvisions of thc Conmctor's Liccnsd [rw (Chaptcr 9. CommrcinS with Section 7000 of Division 3 of Ihe Busincss od <br />PrcfcssionsCodc)orthathcorshcisexcmptthmfromandthcbasisfortheallcgcdcxcmption, AnyviolationofSdionT03l.5byany <br />applicant for 8 pcrmil subjcts lhe opplicant lo I civil penalty of not mrc thrn fivc hundrcd dollas ($500). <br />-1, <br />as owncr of thc propcrty. or nly employecs with wagcs as thcir sole comlrcnsation. willdo thc work and thc structurc is not <br />intcndcd or offcrcd for salc (Scc.7044, Busincss and hofcssions Codc: The Contraclor's Licensc Law docs not apply to an owner of <br />thc propcrty who builds or improves thcrcon, and who docs such work himsclf or hcrself or through his or hcr own cmployecs. <br />providcd that such improvcnrcnts :rre not intendcd or ofl'crcd for sale. lf, howcvcr. thc building or improverrrcnt is soh wilhin onc ycar <br />of complction. thc Owncr Buildcr will havc the burdcn of proving that hc or she did not build or irnprove the propcrty for thc purposc of <br />salc). <br />-1. <br />as owncr of thc propcrty, am exclusivcly conlracting with liccnscd contractors to construct the project (Scc. 7W, Busincss <br />and hofession Codc: Thc Contractor's Licensc Law does not apply lo an owner of propcrty who builds or improves thcrcon, <br />and who conlracts for such projccts with a Contractor(s) licensed pursuant to thc Contractor's Liccnse kw). <br />-IamcxcmptundcrScction-.B.&P.C.forthisrcason.Date: Owner: <br />WORKT'RS' COMPF'NSATION <br />DECI {RATION <br />I hercby aflrm under pcnalty of prerjury one of the following declarations: <br />_l havc and will maintain a Ccrtificate of Consent to Sclf-lnsurc for workers' cornJrcnsation. as providcd for by Scction 3700 of the <br />[:bor Codc, for thc pcrformancc of the work for which thc lrcrmil is issued. <br />-l <br />havc and will maintain workcrs' comfrcnsation insurancc. as required by Scction 3700 of thc labor Codc. for thc lrcrformancc of <br />the work for which this pcrrnit is issued. My workcrs'insurance carricr and plicy numbcr arc: <br />i <br />l t <br />Policy <br />_l ccrtify that in the performance of thc work for which this prmit is issued, I shall not employ any person in any manner <br />so as to bcconrc subjcct to the workers' compensation laws of California, and agrce that if I should bccome subjcct to the <br />workcrs' compcnsation provisions of Scction 3700 of thc l-abor Code. I strall. forthwith comply with those provisions. <br />( <br />WARNING: Failurc to sccurc workcrs' comfrcnsalion coveragc is unlawful, and shall subjcct an employcr to criminal pcnalties and <br />civil lincs to one hundrcd thousand dollars ($ln to thc cost of damagcs as for thc <br />Scction intcrest and fees. <br />DI.]CLARA'I'I0N <br />I hcrcby af'firm under pnalty of pcrjury that I am liccnscd undcr provision of Chaptcr 9 (commcncing with Scction 7000) of Division 3 <br />of thc Business and Profcssions Code, and my license is in full force urd effect. <br />,Cl ,27-tSE8Liccnsc <br />W <br />I hmby affrm undcr pemlty of pcrjury thal therc is E construction bnding 8gcncy for thc psformnce of thc work for which this pemit is <br />issucd (Ss. 3097, Civ. C.). <br />[.cndcr's Namc:a <br />lrndcr's Addrcss: <br />APPLICANT NT'CI.ARATION <br />I hcrcty affrmunder grenalty of perjury one of the following declarations: <br />Dcmolition Permits-Asbestos Notification Fcderal Regulations (Title 40, Part6) <br />_Rcquircd lrttcr of Notification <br />-l <br />ccrtify that thc federalrcgulations regarding asbestos renrovalare not applicable to this project. <br />_l ccrtify lhat I havc rcad this application statc that thc abovc inlbrrnation with all City and County <br />ordinanccs and Statc L:ws rclating to anrl <br />abovc- rncntiorrcd propcrty for inspcctkln <br />Applicant or Agent I <br />Pernritee nanre (nrint): <br />t Z <br />thc <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor h ? <br />Bonding I Grounding I UFER ) <br />(/1,Dffi>7 <br />Transformers l- <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh)I <br />[/eter Release 0 9 Dfr\rtfo / <br />Rouqh I 1 .-? <br />Service fi/eter 0 <br />-4 DTV6 >7 <br />FINAL t o l' ,r,lh,l Dk#8 t <br />Notes, Remarks, Etc.I <br />Ir I a <br />D <br />\,9\d <br />1,0 <br />t))\r.H -Y7