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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DELCARATION <br />I hcrcby allirm undcr Fnalty of [Erjury that I m cxempt ftom thc ContrrcloN' Liens kw for thc fotlowing rcasn (Se.7031.5 <br />Busincss ud Prcfession Code): Any City or County which rcquircs a tmil to construct. eltcr, imprcve, &mlish or rcpaL my <br />structurc, Irior to its issuance, als rcquircs thc applbut for such lEmit Io filc a signcd ststcmnt that he or she ir liccnsd pu$dt <br />to thc pmvisions of thc Crntractor's Liccnsd Law (Chptcr 9, Commncing wilh Selion 7000 of Division 3 of thc Busincss.ild <br />PmfcssionsCodc)orlhatheorsheiscxcmptthcrcfromedthcbaslsforthcallcgcdexcmption. AnyviolationofsetionT03l.5bydy <br />applicant for a trcmit subjsts thc applicant to I civil pcnalty of not mrc than fivc hundrcd dollus (S50O). <br />_1. as owner of thc propcrty. or my employecs with wages as thcir soh compcnsation. willdo thc work and the struclurc i.s not <br />intcndcd or offercd for salc (Scr.7Ut4, Business and Profcssions Codc: Thc Contractor's Liccnse [:w does not apply to an owncr of <br />the propcrty who builds or improves thcreon, and who drrcs such work himsclf or hcrsclf or lhrough his or hcr own cmployccs. <br />providcd that such improvcrncnts are not intcnded or offered for sah. lf, however, thc building or improvcrncnt is sold within onc ycur <br />of completion, the Owner Buildcr will have thc burdcn of proving that hc or shc did not build or improve the propcrty for thc purp.rs;e of <br />salc). <br />-1. <br />as owncr of the property, am exclusivcly contracting with liccnsed contraclors to construct thc prof.ct (Sec. 7W. Busincss <br />and Prrofcssion Code: The Contractor's Liccnse Law does not apply to an owner of property who builds or improves thereon. <br />and who contracts for such projects with a Contracto(s) liccnscd pursuant to thc Contractor's Liccnse hw). <br />-IamexemptundcrScction-,B.&P.C'forthisrcason. <br />Date: <br />WOBf,EBI.GT}MEENSAIAN <br />DECI.ASAIIAN <br />I hcreby affum uodcr penalty of perjury orc of thc folbwing dclantions: <br />-l <br />have ard will mintain I Cerlifrcate of Consnt to Selflcurc for wkss' @trpensarion, s prcvided for by Setion 3700 of the <br />trbor Codc, for the lErfomnce of the work for whth the permit is i$ucd. <br />(-l havc and will rointsin workcB' compcnsation insurance, s rcquirct by Setion 3?OO of the Lrbor Code, for thc lgformncc of <br />' the work for which this permit is isscd. My work6' conpenration insurucc cmier ud [Dlicy number ue: <br />[-7 2-6- ->l <br />Policy <br />-1 <br />t <br />_l ccrtify that in thc pcrlbrmancc of thc work for which this pcrnrit is issucd, I shall not cnrploy any pcrson ir?tny tnanncr <br />so as lo bcconrc subjcct to thc workers'conrpcnsation laws of California, and agree that if I should bec<lmc subject to thc <br />workcrs' compensation provisions of Section 3700 of the labor Codc. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failurc to sccurc workcrs' compcnsation coverage is unlawful. and shall subjc.ct an cmployer to criminal pcnalties and <br />civil fincs to orrc hundrcd thousand dollars ($100.000), in addition to the cost of compcnsation. damages as providcd for the <br />Scction of interest and attorncy's\.L <br />DECLARATION <br />I hcrcby affrm under pcnalty of grcrjury that I am liccnsed under provision of Chapter 9 (comnrencing with Section 7000) of Division 3 <br />of the Busincss and Profcssions Codc, and my license is in full forcc and cffcct. -{ <br />Liccnsc Nunrbcr: <br />otrt(q.1 <br />W <br />I hcrcby allirm undcr pcnalty of p€rjury that thcE is a @ostruction krdirg agcrcy fo. the Frforc of the work for which this pcmit b <br />issucd (Se. 3097, Civ. C.). <br />knder's Nam: <br />Lender's Address: <br />APPLICANT DECLARATION <br />I hcrcbyaffrmunder penalty of pcrjury one of the following declarations: <br />Demolition Pcrmits-Asbestos Notification Fedcral Regulations (Title 40, Part6) <br />\Reouired lrttcr of Notifrcation-\ <br />-I <br />certify that the fcderal regulations regnrding asbcstos removal are not applicable to this project. <br />I <br />/ I ccrtify that I havc read this application ard state that the is correct. I agrce to cornply with all City and County <br />ordinanccs and State l-aws relating to building construction, and represcntativcs of this City and <br />abovc mcntioned property for <br />Applicant or Agenl <br />Permitee nanre <br />-aulhorizc <br />a <br />lo cnlcr ugrn thc <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <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 />Walls (Roush) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinss (T-Bar Rouqh) <br />N/eter Release <br />Rouqh <br />Service N/eter lr <br />FINAL qlLa A f 6rfi- <br />Notes, Remarks, Etc.I \J <br />t <br />Qnrr nO n7 Onl tr