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ELECTRICAL.I NSPECTOR R ECOR D <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Lioht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor <br />Bondinq I Groundinq I UFER <br />Transformers \ <br />Torqueinq <br />Sub-Panels \ <br />Air Conditioners F <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouqh) <br />N/eter Release <br />Rough <br />Service N/eter s ?rh )./ <br />lJ)n^ rcl rF!NAL lplt?lil f <br />Notes, Remarks, Etc.,Utrt <br />I hcrcby ollirm undcr pcnalty of pcrjury Ih{t I m cxcnrpl fom lhc Contracrom' Liccn* t w for thc folldwing rcasn (5€.'/031.5 <br />Busincss and Profcssion Codc): Any City or County which rcquircs a lEnnit to onstruct. altcr. imprcvc, dcrclish pr rcpair any <br />structurc, prior to its issuarcc, also rcquircs thc applicsnt lbr such lrcrmit to filc I signcd shlcrcnt that he or she is licensd pusuani <br />lo lhc pmvisiorrs of thc Contructor's Liccnscd Law (Chrpter 9. Commcncing with Setion 7000 of Division 3 of the Busircss and . <br />PrcfcssionsCodc)orthalhcorshciscxcmptthcrcfrcmandthcbasisforthcallcgcdcxcmption. AnyviolationofscctionTO3l.5byany <br />epplicant for a Frmit subjccts thc applicant to a civil pcnalty of not mrc than five hundrcd dollus ($500), <br />-1. <br />as owncr of thc propcrty. or my employces with wagcs as thcir solc compcnsalion. willdo thc work and thc structure is not <br />interrdcd or offcrcd for sale (Sc'c.7044. Busincss and hofcssions Codc: Thc Contraclor's License [:w docs not apply lo an owner of <br />thc profrcrty who builds or inrproves thcrcrrn. and who drrcs such work himsclf or hcrsclf or through his or her own cmployecs, <br />providcd that such improvcnrnls arc not intcndcd orollcrcd for salc. lf. howcvcr. thc building or improvcmcnt is sold within onc ycar <br />of complction. thc Owncr Buildcr will havc thc burden of proving that hc or shc did not build or improvc thc proprty for the purynsc of <br />sale). <br />_1, as owncr of thc propcrty. arn cxclusivcly contracting with liccnscd controclors to construct thc projcct (Scc. 7U4, Busittcss <br />arrd Pnlfesskrn Codc: The Contractor's Liccnsc Law docs not apply to an owncr of propcrty who builds or improves thcrcon. <br />and who contracts for such projccts with a Contructor(s) liccnscd pursuant to the Contractor's Liccnsc l-aw). <br />_l anr cxcmpt undcr Scction_. B. & P.C. lbr this rcason. <br />Owner: <br />}VORK IiRS' CONIPI'NSA TION <br />DECI,AIIATION <br />I hcrcby atljrm undcr pcnalty of pcrjury onc of thc following dcclaratkrns: <br />and will maintain a Ccrtificate of Consent to Sclf-lnsurc for workcrs' compcnsation, as provided for by Scction 3700 of the <br />Labor Cotlc. for thc pcrformancc of the work frrr which thc perrnit is issucd. <br />work <br />and will maintain workcrs'comlrcnsation insurancc. as rcquircd byScction 37fi)of the LaborCode, forlhc perfornurnceof <br />for which this perrnit is issued. My workcrs' compensation insurancc carricr and plicy numbcr arc: <br />o 2o7 I <br />ccflify that in thc perfornrancc of thc work for which this pcrnrit is issucd. I shall not crnploy any pcrson in any manncr <br />so as to bccome subjcct to thc workcrs' comgrcnsation laws of California. and agree that if I should bccomc subject lo thc <br />workcrs' comJrcnsation provisions of Scction 3700 of thc Labor Codc. I shall. forthwith comply with thosc provisions.. <br />, <br />WARNING: Failurc to scurc workers'compcnsalion r'ovcEgc is unlawful. and shall subjcct an cmploycr to oiminal pmltics and <br />civil fincs up to onc hundrcd lhousand dolles ($100,000), in addilion lo thc cost of comlEnsation, damgcs &s providcd for llE <br />SNIion 3076 of thc tibor Codc, intcrcst and iltorrcy's fccs. <br />hercby allirnt urrdcr pcnalty of perjury <br />of thc Busincss and Profcssions Codc, and my liccnsc is in full force and effcct. <br />cu.r' 3 License Number:Attzzqq <br />v-I, <br />W <br />I hcrcby aflirm undcr frcnalty of pcrjury lhat therc is a construction lcnding agcncy for the JrcrfoMc of thc work for which this Frmit is <br />issucd (SN. 3097, Civ. C.). <br />[.cnder's Address: <br />APPLICANT DF'CLARATION <br />I hcrcby alfirmundcr pcnalty of pcrjury onc of the following dcclarations: <br />Dcrnolition Pcrmits-Asbestos Notification Federal Regulations (Titlc 40, Part6) <br />-Rcquircd <br />l-ctter of Notificalion <br />-l <br />ccrtiti that thc t'cdcral regulations rcgarding asbcstos rcnrcvalarc not applicablc to this projcct. <br />with all City and County <br />and County to cnlcr uF)n thc <br />abovc mcnlioncd propcrty lbr purposcs. <br />or Agent <br />Pcrnritee nnnle ( rlrint ):Erna Mcdrna <br />L ,,,", ahbl 2,t2( <br />fJnt no n7 onr tr <br />) <br />Date:_ <br />,+ <br />alt <br />LL( <br />[.ender's Namc: