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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / FIoor <br />Bonding lGrounding I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Roush <br />Ceilings (T-Bar Roush) <br />N/eter Release <br />Rouqh <br />Service Meter \\ <br />FINAL \\\/ <br />Notes, Remarks, Etc. <br />\ <br />OWNIiR BUILDER DEI,CARATION <br />I hereby affrnr under penalty of perjury that I anr exempt from the Contractors' Licensc [:w for the following rcason (Scc.7031.5 <br />Busincss and Profcssion Codc): Any City or County which requires a pcrrnit to construct, alter. irnprove, demolish or repair any <br />slructure, prior to its issuance. al.so requires the applicant for such prernrit to file a signed slaternenl that lrc or she is licensed pursuanl <br />to thc provisions ol'thc Contractor's l,iccnscd law (Chaptcr 9. Commcncing with Section 7fi)0 of Division 3 of the Busincss and <br />Professions Code) or that he or she is exempt therefronr and tlre basis for tlre alleged exenption. Any violation of Section 7031.5 by any <br />applicant for a lrnnit subjects the applicant to a civil penalty of not more than five hundred dollars ($5Otl1. <br />_1. as owncr ol'the propcrty. or my employccs with wagcs as their solc compensation, will do thc work and thc structurc is not <br />interxled or offered for sale (Ser.7B4, Business antl Pnrfcssions Co<Jc: Thc Contractor's License Law docs not apply to an owncr of <br />the progrerty wln builds or inrproves thcreon, arxl wlxl does such wort hinrself or herself or through his or her own enrployees, <br />provided that such improvenrcnts arc not intendcd orollcrcd for salc. ll. howevcr, thc building or improvcnrcnt is sold within one ycar <br />of conrpletion, tlre Owner Builder will have thc burtlen of proving that he or she rlid ntx build or improve tlrc properry for thc purpose of <br />sale). <br />-1. <br />as owner of the property, am exclusivcly contracting with licens,etl conlractoni to conslruct thc projcct (Sec. 7(Xa. Business <br />anl Prutbssion Code: The Contractor's License Law dcrcs not apply to an owner of property who builds or improves thereon. <br />and who conuacts for such projccts with a Contractor(s) liccnsed pursuant to the Conuactor's Liccnse [:w). <br />-l <br />am exempt unrJer Section_, B. & P.C. tbr this reason. <br />f 1...^. <br />WORKIqR.S' COM Ptr]NSATION <br />DECLARATION <br />I hercby aflirm undcr penalty of pcrjury onc of thc following dcclarations: <br />_l have and will nninlah a Certilicale of Con.sent to Self-lnsure for workers' compensation, as pmvided for by Scction 3700 of the <br />is issucd. <br />by Section 3700 of the l-abor Code, for lhc perfornurrce of <br />carricr ard policy numbcr are: <br />Policy 1\' \' 2-O <br />NE,ccrtifythat inthc 1^*rlirrnrance'of tlrc work fcrrwlriclrtlrispcrnrit is issucd, I slrall not cnrployanylrcrsoninanymanner <br />so as to bccornc suhjcct to thc workcrs' conrpcnsation laws of California. and agrcc that if I should becorne subjcct to the <br />workers' conrlxnsation provisiorl o{Secligr 3700 of the Labor Code, I slull, forthwith conrply with thosc provisions.. <br />t :i, <br />WARNING: Failure to secure workers'comlrcnsation covcrirgc is unlawful, and shall subject an employer to criminal penalties mtl <br />addition to the cost of danuges a.s provided for the <br />Scction 3076of the l.abor Codc. <br />,,,", \o tt.+ [ZC <br />inlcrcst anrl <br />I hereby affrnr under ;rnalty of perjury that I anr 9 (cornmencing with Section 7m0) of Division 3 <br />o[ the Business and Professions Code. and my license is in fu]l force arxl effect. <br />License C\C Nunrbcr: <br />q1 5 <br />\o V\CAT <br />CONSTRUCTION LENDING AGENCY <br />I hcreby al'lirrn under penalty of pcrjury that thcrc is a construction lending agency for the pcrlbrmance of thc work ltlr which this pcrmit is <br />issued (Scc. 3097. Civ. C.). <br />[.cnder's Nanre: <br />Lrnder's Addre.ss: <br />A PPI,ICANT DECI,ARATION <br />I hrchy affrnr undcr penalty of pcrjury onc of thc foll<lwing dcclarations: <br />Dcnxrlition Pcrnrits-Asbcstos Notification Fcdcral Regulations (Titlc 40, Part6) <br />_Rcquircd lrttcr of Notifrcation <br />_l ccrtify that thc fcdcral rcgulations rcgarding a.sbcsto.s rcmoval arc not applicablc to this project. <br />state tlrat thc atxlvc infornulion is corrcct. I with all City and County <br />and county to enter upon thc <br />D lr*\zcabovc mentioned property for <br />Applicant or Agcnt <br />Pcrntitee namc <br />construction. and hereby of this <br />Flev. 08-07 15 <br />\ <br />\\ <br />\\\ <br />,r\\ <br />I <br />\ <br />\ <br />I.ulxrr (iurlc, lirr tltc <br />and n'ill nraintairr workers'insuralrce,as <br />tlrc which this is issucd. <br />l- <br />I havc rcarl this <br />and State l:ws rclating