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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 />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor I <br />Bondinq I Groundinq I UFER 9/t,oh,t <br />Transformers I lY ( <br />Torqueinq <br />Sub-Panels <br />Air Conditioners / <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinss (T-Bar Rouqh) <br />[/eter Release <br />Rough <br />Service lt/eter /r lt <br />FINAL qltu fz, <br />Etc.Notes Re /V <br />I <br />I hcrcby aflirm undcr pcnalty of perjury lhal I m crcmpt from the Contmctos' Licen$ ljw fot the following rcasn (Se.7031.5 <br />Busincss 8td Profcssion Codc): Any City or County which rcquircs a lmit to @nstruct. trltcr, improvc, demlish or rcJtsir ony <br />structurc, prior to its issuane, olso rcquircs thc applicsnt for such permil to filc s sigrcd statcrcnt lhat he or slrc is liersd puNutrnt <br />to thc prcvisions of the Contnctor's Liccnsd llw (Chapler 9. Comrcing with Sation 7000 of Division 3 of thc Busim$ rnd <br />PrcfessionsCodc)orthathcorshciscxcmptthmfrcmandthcbasisforthesllcgedcrcmption. AnyviolalionofsetionT03!.5byany <br />applicant for a permit subjcrcts thc applicant to I civil pcnalty of not mrc than five hundred dollus (3500). <br />_1. as owncr of thc propcrty, or my cmployees with wagcs as thcir mlc compcnsation. will do the work and thc structurc is not <br />intcndcd or offcred for sale (Scc.7044, Busincss and Profcssions Codc: The Conlractor's License Law does not apply to an owner of <br />the profrcrty who builds or improvcs thereon. and who docs such work hinrsclf or hcrsclf or through his or her own employees. <br />providcd that such irnprovcnrcnts arc not irrtcndcd or offcred for sah. If. howcvcr. thc building or improvenrnt is sold within onc )Ear <br />of completion, ttre Owner Builder will havc tlre burden of proving that he or she did not build or improve the propcrty for thc puryxlse of <br />sah). <br />-1, <br />as owncr of thc property, am cxclusivcly contracting with liccnsed contractors to construct thc projcct (Scc. 7U4, Busincss <br />and hofcssion Codc: The Contractor's Liccnse Law does not apply to an owncr of property who builds or improvcs lhercon, <br />and who contracts for such projccts with a Contractor(s) liccnsed pursuant to the Contractor's Liccnse Law). <br />-l <br />am exempt undcr Scction-. B. & P.C. for this reason. <br />WORKERS' COMPENSATION <br />oacLnru{TIoN <br />I hcrcby affirm undcr penalty of pcrjury one of thc following dcclarations: <br />havc and will rnaintain a Certificate of Conscnt to Sclf-lnsurc for workers' compcnsation. as provided for by Section 3700 of thc <br />Codc, for thc lrcrformancc of thc work for which thc permit is issucd. <br />havc and will workcrs'insurance. as by Section 3700 of thc labor Codc, for thc pcrformancc of <br />carrier and plicy numbcr are:work for <br />Policy <br />_l ccrtify that in thc pcrlbrmance of thc work for which this pcrmit is issucd, I shall not crnploy sny pcrson in any manncr <br />so as to becolnc subjccl to thc workcrs' compcnsation laws of California, and agrcc that if I should bcconre subict to the <br />workcrs' conrpensation provisions of Scction 3700 of thc Labor Codc, I shall, forthwith comply with those provisions.. <br />WARNING: Failurc to sccurc workcrs' compcnsation covcrag,c is unlawful. and shall subjcct an crnploycr to crirninal pcnaltics and <br />civil fincs up to onc hundrcd lhousand dollars ($100.0U1;, in addition to cost of compensalion. damages as providcd for thc <br />attorncy's fccs. <br />NECI ^ RATION <br />I hcrcby affirm undcr penalty of prjury that I arn licenscd undcr provision of Chapter 9 (comnrcncing with Scction 7000) of Division 3 <br />of thc Business and Profcssions Code, and my licensc is in full forcc and effcct. <br />W <br />I hcrcby allirm undcr penalty of tErjury that thcrc is s constilclion lending agcrcy for lhc pcrfme of thc work for which lhis lEmil b <br />issucd (Scc. 3097, Civ. C.). <br />l4ndcr's Narc: <br />kndcr's Address: <br />APPLICANT DECLARATION <br />I hcrcby atrirm under pnalty of pcrjury onc of thc following dcclarations: <br />Dcmolition Pcrrnits-Asbestos Notification Fedcral Regulations (Title 40. Part6) <br />-Rcquircd <br />lrttcr of Notification <br />certify that thc fcderal regulalions rcgarding asbcstos rcmoval are not applicable to this project. <br />ccrtify that I havc rcad this application and statc that thc abovc information is conect. I agrcrc to comply with all City and County <br />and Statc Laws rclating to building construction. and hcrcby authorizc rcprcscntatives of this City and County to entcr upln thc <br />abovc mcntioncd property for inspcction <br />or ,,r",81 l\{Zl <br />no n7 ont tr <br />Date: Owner:_ <br />?ltlaL <br />fJ,n.