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ELECTRICAL.INSPECTOR RECOR D <br />APPROVALS DATE ID/SIG COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building I ,'l <br />Under Slab / Floor t lttt/'?-(Y*4 '5Y <br />Bondinq I Groundinq I UFER <br />Transformers ^ <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit)A , <br />Walls (Roush)tll4l?L .wvr€, <br />Ceilinqs (Hard & Soffit Rouqh /Z <br />Ceilinqs [-Bar Rouqh) <br />N/eter Release <br />Rough <br />Service N/eter <br />FINAL tol olu I-"ftrl.ro <br />Notes Remarks Etc. <br />I hereby affirnr urrder penalty of pr.iury that I anr exenrpt frortr the Contracloni' License law for the following, reason (Set'.7031.5 <br />llusincss and Prol'cssion Codc): Any City or Countv which rcr;uircs a perrnit to conslruct. altcr. irnprovc. dcrnolish or rcpair any <br />structure. prior to ils issuance. also requires tlre applicaut tirr such perntl to frle a signed slalenrenl that lr or she ls licerused pursuant <br />to thc. pmvisions of the. Contractor's l.iccnscd law (Chapter 9. Cornrncncing with Scction 7(XU of I)ivision 3 of the Busincss and <br />ProfessiorrsCode)ortlratlreorslwisexenrpttherefronrandtlrcbasisfortlrcallegedexenrption. AnyviolationofSeclionT03l.5byany <br />applictnt for a perrnit subjects thc appliclnt to il civilpennlty of not rnore than five hundred dollars ($500). <br />_1. a.s o\t'ncr ol'ttrt propcrly. or tny crnployccs with wagcs as thcir vrlc compcnsalion, willdo thc work and thc structurc is rrrt <br />interxled or offered lor sale (Sec.7(]14. Business and Professions Ctxle: Tlre Contraclor's Licensc Law does not apply to an owner of <br />tlre pnryerly who truilds or inrproves lherurn, und wlm does such wrlrk lrinrself or lrerself or tlrouglt his or lrer own entployees, <br />providcd that such irnprovcrncnts arc not intcrxlcd or ollcrcd for sah. Il. howcvcr. thc building or furprovcnrnt is sold within one ycar <br />of conrpletiou the Owner Buikler will have the burtlen of pnrving tha hc or she did not buikl or improve tlrc pnrpary ftrr the pr,rrposc of <br />sale). <br />_1. as owner of the propeny, am exclusively contracting with licenscd conlracloni to construct thc project (Sec. 7(X+. Business <br />anJ hotessirxt CorJe: The Corrtractor's Licerrse Law drrcs not apply t() an owner <lf proprrty wh<l buil<Js or inrproves thereon. <br />and who contracts lor such pr<rjccts with a Grntraclor(s) licenscd pursuant to thc Contraclor's Liccnse l-aw). <br />-l <br />anr exenrpt urxJer Sectiun-, B. & P.C. lbr this reasott. <br />WORKIiILS' COM PIiNSATION <br />DECLARATION <br />I hcrcby affirm under pcnalty of pcrjury onc ()[ the lirlkrwing dcclarations: <br />haveandwill nnilrtainaCertilicateofCorrsenttuScll-lnsureftrrworkers'conlpensatirttt,as providedtirrbySection3T00oftlrc <br />Crxlc. frrr thc Jrcrfonrmncc of thc work lirr which thc pcrntit is issucd. <br />Iravearrdwill rnaintainworkers'courpensationilrsururrce,as requiredbySection3T0OoftheLatxrrCode,forlheJrrfornunceof <br />work lirr which tlris lrcrnrit is issucd. My workcrs' conrpcnsation in.surancc can'icr iuxl prlicy ttunrbcr iuc: <br />s F qnJ <br />Nunt"r, 7// 28 7/ -.% b r:xpires: O ': e ) Zl <br />_l ccrrily that in tlrc 1^-rfirrnmncc of thc work frrr wlrich this pcrnrit is issuctl. I shall not cn4rloy any lrcrs()n in any nlanncr <br />so astobccomcsubjccttothcworkr'rs'cornp('nsationlawsofCalifornia.andagrccthatiflshouldbecomcsubjccttothc <br />workers' cornlrnsatiorr provisiorrs of Section 3700 of the Labor Code, I shall, forthwith corlply with thosc provisiotts.. <br />WARNTNG: Failure to sEcure workers'conrlrnsation coverdge is unlawful. and shall subject an employcr to crirninal penaltics itnd <br />civil fines up to one hurrdred tlxrusand dollars (S100.m0). in adrlition to llrc cost of comJrcnsalion, danuges as provided for lhe <br />Scction 3076 of thc Lalxrr Crxlc. intcrcst and altorncy's l'cc's. <br />nppncmt: Yt*/ ol *ttt $ /n <br />LICEIqSED CONTRdCTOR <br />DIiCI,ARA'I'ION <br />I hereby aftirnr under penalty of perjury tlut I anr licensed under provision of Chapter 9 (contnrcncing with Section 70m) of Division 3 <br />of the llusiness and l'rofessions Code. arxl rnv license is in full force and effect. <br />.Licerrsc Nunrber:?fc 77/ <br />CONSTRUCTION LENDING AGENCY <br />I hercby alf irm undcr p-nalty of pcrjury that thcrc is a construction lcnding agency for thc pcrl'orrnance of thc work l'or which lhis pcrrnit is <br />issued (Sec. 3097. Cir'. C.). <br />l.ender's Narrrc: <br />knder's Address: <br />A PPI,ICA NT DECI,ARATION <br />I lrrchy aflirnr untlcr p^*nalty of pcrjury onc o[ thc folkrwing declarations: <br />Dcnxrlition Pcrntits-Asbcstos Nttification Fctlcral Rcgulat ions (Titlc 40. Part6) <br />_Rcquircd l*ttcr of Notitrcation <br />_l ccrtily that thc l'cdcral rcgulations rcgarding asbcstos rerxrval arc not applicablc to this proirt. <br />ccrtily tlrat I havc rcatl this application arxl st:rtc thal lhc atxrvc inlornration is corrccl. I agrcc to cotnply with all City and Courtty <br />and Statc Laws rclrting to truilding con51ru.1ion. and hcrcby authorizc rcprcscntativcs o[ this City and County to cntcr upon thc <br />ahlve lrrcntioned pr()pen.y frrr inspection purF)ses. <br />Al4llicarrt or Agenl <br />l'crmitcc nonlc <br />2o <br />lev. 08-07-2015 <br />a <br />I <br />I Contractrrr: 4E ,aEO f ?.+r;/ r.* '