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ELECTRICAL-INSPECTOR RECORD <br />rlc n7 Dn-i tr <br />APPROVALS DATE ID/SIG COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Grounding I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walts (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />lVleter Release <br />Rouqh <br />Service lVleter t, <br />FINAL 16 lnlz-t tz&r n <br />Notes, Remarks, Etc.tl <br />-Zl -(J o*tL- <br />E <br />UT I <br />\r- <br />I hcrcby aflirm undcr pcnalty of;rcrjury lhat I am cxempt l'rom lhc ConlEclom' Liccnsc Law for lhc following rcason (Se.70.ll.5 <br />Busincss atrd Profcssion Codc): Any City or County which rcquircs a Jrnnit lo conslrucl. altcr. improve. dcmlish or rcp.ir any <br />structurc. prior to ils issuance. also rcquircs thc applicant for such [Ermil lo filc a signcd slatcmnl that hc or she is liccnsd pursuanl <br />to lhd pmvisions of rhc Conlractor's Liccn*d Law (Chilptcr 9. Commncing with Sstion 7(XD of Division 3 of thc Busircss and <br />Pmfcssions Codc) or thnl hc or shc is cxcmpl lhcrcfrom and thc basis for lhc allcgcd cxcmplion. Any violalkrn of Scction 7O.l I ..5 by dny <br />applicant for a Jrcrnrit subjccls tlrc applicanr lo a civil pcnalty of not morc lhan fivc hundrcd dolles ($500). 1 |' <br />-1. <br />as owner of the propcrty. or my cnrployccs with wages as thcir sole cornpcnsalion. u,illdo thc work and thc stnrture is txrt <br />intcndcd oroffcred for sale (Sec.7B4. Busincss and Prot'cssions Clodc: Thc Contruclor's Liccnse Law docs not applyto anowncro[ <br />thc proprty who builds or irnproves thercon. and who docs such work hirnsclf or hcrself or lhrough his or her own employces. <br />providcd thal such irnprovcmcnts arc not intcndcrl or offcrcd for sah. lf. horvevcr. ttrc building or improvctncnl is xrld within one ycar <br />of cornphtion. thc Owncr Buikler will havc thc burden of proving that hc or shc ditl nol build or inprovc thc pr)Frty for thc purynse of <br />sah). <br />-1. <br />asowner of thc propcrly. arncxclusively corrtracting with liccnscd conlraclors lo conslruct thc projcct (Sec. 7M4. Busirtess <br />and ProfbssionCodc: ThcContractor'sl.iccnsel-awdocsnotapplyloanowncrofpropertywhohuildsorimprovcsthcrcon. <br />and who contracts lirr such projccts with a Contractor(s) licerrsccl pursuilnl lo the Contraclor's License Law). <br />-lantexemptundcr.Section-.B.&P.C.ftlrthisrcason.I)ale:()rr ner: <br />}VORKERS' COIII PENSATION <br />DF'CLARATION <br />I hcrcby alf inn undcr pcnalty of'pcrjury onc of thc folkrwing rlcclarations: <br />-l <br />have and will rnaintairr a Ccrtificatcof Conscrrl to Sclf-lrrsurc for wrlrkcrs'cornpcnsation. as provided lbr byScction 37fi)of thc <br />Labor Codc. lbr thc perfornuncc of the work for which thc pcrmit is issucd. <br />-l <br />havc and will nrairrtain workers'compcrrsalion insurancc. as requircrl by Secliorr 370O of thc Labor Code. for the pcrfirrtnartcc o[ <br />thc work tbr which this pcrrnit is issued. My workcrs' conrpcnsalion insurancc carricr and Jxrlicy numhcr arc: <br />Policv Nurnbcr: Exnircs: <br />_l ccrtity that in thc pcrlornrance o[thc w<lrk lbr which this pcrnrit is issucd. I shall nol crnploy any person in atry manncr <br />so as lo bccornc suhjcct to llrc workcrs' compensalion laws of Calif'ornia. and agrec that if I should hccome suhjcct lo thc <br />workcrs' contpcnsation provisions of .Scction -37fi) ot'thc krtxrr Codc. I shall. forthwith cornply with thosc provisions.. <br />WARNING: Failurc to sccurc r+,orkcrs' cornpensation covcragc. is unlawful. and shull subjcct an crnploycr to crirninal pnaltics and <br />civil lincs up to onc hundrcd thousand dollars ($l(X).(XX)). in addition to the cost of conlpensation. damagcs as providcd tbr thc <br />Scction 3076 of thc Labor Codc, intcrcst and allorrrcy's lbcs. <br />o^", K'/24f <br />I hcrchy aftirnr undcr pcnalty of perjury that I arrr liccnscr.l provisiorr of'Chir;rter 9 (conrrncncing with Scclion 70U)) of Division 3 <br />ol' the Ilusincss and Prot'cssions Codc. ard rtty liccrtsc is in t'ull frrrcc ard cll'ccl <br />I-icensc <br />Date:-/ 2-q ('ottlractrlr: <br />W <br />I hcrcby aflirmunder Fnally of Jrcrjury thst thcrc is a consrruclion lcnding agcrcy for thc lrcrfornuncc of lhc work for which this ]Emil ir <br />issucd (Scc. 3097. Civ. C.). <br />knder's Nare: <br />I-clttlcr's Atklrcss: <br />APPLICANT DECLARATION <br />I hcrcby alfinn under pcnalty of perjury onc of the following dcclaralions: <br />Dcnxrlition Pcrmits-Asbestos Nolification Federal Regulalions (Title 40. Part6) <br />-Rcquircd <br />Lcttcr of Notification <br />_l ccrtity that thc fcdcralrcgulalions rcgartling asbcstos rcrn<lval arc rrol applicahlc lo this projccl. <br />_t ccrtily tlrlt havc rcarl this application atxlvc irrforrnat iott is corrcct. I agrcr to conrply <br />reprcsentativcs of this City <br />u,ith all City alrrl County <br />rlrdinrnccs alrd Statc laws rclaling atttl Couttty Io cnlcr upon <br />abovc nrcntioncd propcrty for <br />Applicanl or Agent <br />I)enrrilee nanre ( print): <br />lo <br />alttl stllc <br />L <br />lund herchy autlurrize <br />orr"€-/ 2--(7 <br />thc <br />FIIITUR.€5 <br />'*LL_