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ELECTRICAL-INSPECTOR R ECORD <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 />Buildinq <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 />Wails (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rouoh <br />Service Meter <br />F!NAL <br />Notes, Remarks, Etc <br />I hcreby afftrm undcr pcnalty of pcrjury that I m excmpt ftom thc Contrsctors' Liense law for lhc followinll,rcasn (58.7031.5 <br />Busincss and Profcssion Codc): Any City or County which rcquircs a Jrcrmil to @nstruct, altq, improrc. dcmlish or, rcpoir any <br />struclurc, prior to its issuare, also rcquircs thc applicant for such Frmit to filc a signcd statcrcnt that lrc or shc is licensd iursumt <br />to thc prcvisions of thc Contractor's Liccnsd [iw (Chaptcr 9. Comrcncing wilh Setion 7000 of Division 3 of thc Business and <br />PrcfcssionsCodc)orthatheorsheiscrctrrptthmfrcmandthcbasisforthcsllcgcdcxcmption. AnyviolationofScctionT03l.5byany <br />applicant for a prmit subjccts thc applicant to a civil pcn8lty of not !rcrc than fivc hundrcd dollus ($50O). <br />-1. <br />as owner of the propcrty. or my cmployccs with wagcs as their solc comlrcnsation. willdo thc work and thc stnrcturc is not <br />intended or offcrcd for sale (Scrc.70l4, Business and hofcssions Codc: The Contraclor's Liccnsc law docs nol apply lo an owncr of <br />thc property who builds or improves thcrcon. and who docs such work himself or hcrsclf or through his or hcr own cmployecs, <br />provided that such improvcnrnts arc not intcndcd or offcrcd for sah. If. howcvcr. thc building or improvcnpnt is sold within one year <br />of comphtion, thc Owncr Buildcr will havc thc burdcn of proving Orat hc or shc did not build or improve the propcrty for thc purposc of <br />salc). <br />-1, <br />as owncr of the proprty, am exclusivcly contracting with licensed contreclors to construct thc proict (Sec. 7044, Business <br />and Profcssbn Code: The Contractor's License Law docs not apply lo an owncr of propcrty who builds or improves thereon, <br />and who contracts for such projc-cts with a Contracto(s) liccnscd pursuant to the Contractor's Licensc kw). <br />-IamexcmptunderSection-,B.&P.C.forthisrcason.Date: <br />WORNFIIS' COMPTNS {TION <br />DF'CLAITATION <br />I hcrcby affirm undcr penalty of prjury one of thc following dcclarations: <br />-l <br />have urd will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as providcd for by Section 3700 of thc <br />[:bor Code, for the pcrformance of the work for which thc prmit is issued. <br />{, <br />thc <br />have and will maintain workcrs' compcnsation insurance. as rcquired by Section 3700 of thc labor Codc, for the lrcrfornunce of <br />work for which this pcrmit is issucd. My workers' comlrcnsation insurancc carricr and plicy numbcr are: <br />Policy c1 I l\l7L <br />-l <br />ccrtify that in thc lrcrformancc of thc work for which this;rcrnrit is issucd. I shall nol cnploy any pcrson in any manner <br />so as to bccomc subjcct to thc workers' cornlrcnsation laws of Calitbrnia. and agrcc thal if I should bccomc subjcct to thc <br />wortcrs' compensation provisions of Scction 3700 of the l-abor Codc. I shall. forthwith contply with thosc provisions.. <br />WARNING: Failurc lo liccure workcrs'compcnsation covcragc is unlawful. and shall subjcct an crnploycr to crintinal pnaltics and <br />civil fincs up lo onc hundrcd thousand dollars (S100.0m). in addition to thc cost of comlrcnsation, damagcs as providcd for thc <br />Scction 3076 of thc l-ahlr Codc, inlcrest and attortrcy's <br />DF'CI ARATTON <br />I hereby affrm under pcnalty of pcrjury that I am liccnscd undcr prcrvision of Chaptcr 9 (commcncing with Scction 7000) of Division 3 <br />of the Business and Profcssions Codc, and my liccnsc is in full force and effcct. <br />Liccnsc *!*,'hr b5n. <br />0{conrr".tV 4tt IVJ. (Ai/\' -t <br />W <br />I hercby affirm under Fnalty of pcrjury that thcrc is a construction lending ogcncy for thc perfornuncc ofthc work for which this Frmit is <br />issucd (Sc. 3097, Civ. C.). <br />Lcnder's Name: <br />lrnder's Address: <br />-l <br />certify that thc fedcral rcgulations rcgarding asbcstos rcmoval arc not applicablc to this projcct. <br />certify that havc read this application and slalc that thc above inlbrmation is correct. I agrcc to comply <br />I rcprcscntatives of this City <br />with all City and County <br />and Statc laws rclating building construction.and County to cntcr <br />above rnentioned property for <br />oqApplicant or Agent <br />Permitee name <br />lo <br />purlnscs. <br />and hcrcby authorizc <br />ot <br />upon thc <br />[Jnrr nA n7 ')n'l tr <br />APPLICANT DECLARATION <br />I hcrcby aftirm undcr pcnalty of pcrjury one of thc following dcclarations: <br />Demolition Permits-Asbcstos Notification Fcderal Rcgulations (Title 40. Parl6) <br />-Rcquircd <br />l*ttcr of Notification <br />7