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-ELECTRICAL-! NSPECTOR R ECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCANAflON <br />I hcrcby affrm under pcnalty of perjury that t m cxcmpt fmm thc Conrado6' Lhend Liw for thc'following rcarcn (Sc.?031.5 <br />Busincss ard Profession Codc): Any City or County which rcquircs a pcrmit Io @nstrucl. altcr, improvc. dcmlish or reJnir any <br />structurc, Itrk r to its issuance, ds requircs thc spplicant for such pemil lo file a sigrcd statcmnl thst hc or slE is liccnsd pwant <br />to lhc lrcvisions of thc Conracto]'s Lien$d tiw (Chaplcr 9. Comcrcing with Selion 7q)0 of Division 3 of lhc Busircss and <br />Profcssions Codc) or that hc or shc is cxctrrpt thcrcfrom ard thc basis for thc allcged excmption. Any violation ofsE{bn 703 1.5 by &ny <br />applicant for a pemil subjals the applicanl lo tr civil pcnalty of not rcrc thatr five hundrci dollus ($50O). <br />_1. as owner of the propcrty. or my cmployccs with wagcs as thcir sole compensation, willdo thc work and the strrcturc is not <br />intcnded or offered for sale (Sec.7044. Busincss and hofessions Codc: Thc Contraclor's License [-aw does not apply lo an owner of <br />thc proprty who builds or irnprovcs thcrcon. and who docs such work himsclf or herself or thrnugh his or hcr own cmployecs. <br />providcd that such improvcnrcnls arc not intcndcd or offcrcd for sah. If. howevcr. thc building or improvcnrcnt is sold within orc )€{u <br />of completion, the Owner Buildcr will havc thc burdcn of proving that he or she did not build or inrprove thc propcrty for thc purFnsc of <br />sah). <br />-1. <br />as owner of the propcrty, am exclusively contracting with liccnscd contractors to construct thc projcct (Scc. 7W, Business <br />and Profcssion Codc: Thc Contractor's Liccnse Law docs not apply to an owner of progrcrty who builds or improvcs thcrcon. <br />and who contracts for such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Liccnse Law). <br />_l anr cxcmpt undcr B. & P.C. fbr this rcason. <br />flolo. <br />WORNERS' COMPENSATION <br />DF'CLARATION <br />I hcrcby affirm under penalty of pcrjury onc of thc following dcclarations: <br />_l have and will maintain a Ccrtificatc of Consent to Self-lnsure for workers' compensation, as providcd for by Scction 3700 of the <br />I-abor Code. for thc perfornunce of the work for which thc Jrcrmit is issucd. <br />N?n"u" ona Section 3700 of thc [abor Codc, for thc pcrformance of <br />thc work tbr carrier and plicy number arc: <br />Lo- l '21Policyw,f,fluqD,qq L <br />N-?*nify that in thc grcrformance of thc work for which this permir is issucd. I shall not cmploy any pcrson in any manncr <br />so as to become subject to thc workcrs' compcnsation laws of California, and agrce that if I should bccomc subjcct to thc <br />workcrs' compensation provisions of Scction 3700 of thc Labor Codc. I shall, forthwith comply with those provisions.. <br />WARNING: Failurc to scurc workcrs'@mpcnsation covcmgc is unlawful, and shall subFct an cmplolar lo qiminsl Fnaltic$ and <br />civil fincs up to onc hundrcd thousand dollo6 ($100,000). in addition to thc cost of compcnsalion, damges as pmvidcd lbr Ihc <br />Scction 3076 of thc Labor Codc, intcrcst and attorncy's fccs.t,2-l l*\Cn_ <br />I hcrcby aft-rrm under pcnalty of pcrjury that I arn liccnscd under provision of Chapter 9 (comnrcncing with Scction 7000) of Division 3 <br />of thc Busincss and Professions Code. and my liccnsc is in full forcc and effcct. <br />Liccnsecturr, C\O LicenseNumber: <br />c-n3tE(a <br />z\v 0 r <br />W <br />I hcrcby affEm under pcmlty of Frjury ihat thcrc is I @nstruction hnding agcncy for the pcrformc of the work for whkh this Fmit is <br />issucd (Se. 3097, Civ. C.). <br />lrnder's Namc: <br />[.cnder's Address: <br />A PPI ICANT NT'CLARATION <br />I hcrcby aflirm under pcnalty of pcrjury onc of the folklwing dcclarations: <br />Demolition Permits-Asbestos Notification Fcderal Regulations (Titlc 40, Part6) <br />-Rcquircd <br />L,cttcr of Notification <br />-l <br />ccnify that the fcderal rcgulations rcg0rding asbestoi rcmval re not spplicable to this prcjet. <br />\E enify rlar t tuw r6d lhis applicalion ard state that thc sbovc inforEalion is coret. I agr to comply with rll City rnd County <br />odimrces ed State l2ws rclating to building constructh[ ad hercby authoria represnlatives of this City and Counly lo cntcr ulnn thc <br />abovc rncntioncd proprty for <br />Applicant or Agent <br />Pernritee name <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 /Jfoor\-,Bondinsl@IUFER lo 4l 4{fL{z)7 <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Wails (Roush) <br />Ceilinss (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough)I <br />N/eter Release 10 -zl -?(fl--C 2 t/ <br />Rough <br />Service lVleter <br />-lFINAL{tl -z -z.l rL CI'NerCaS'7ry <br />Notes, Remarks, Etc. <br />[Jnv nA onl tr <br />_ Owner:_ <br />a. - -: ^-. <br />Applicant: <br />,",. v lz-t lzl