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ELECTRICAL.INSPECTOR RECORD <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 Voltase <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Grounding IUFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit)\. I at^1 <br />Walls (Roush)tt \\\\o\tw <br />Ceilings (Hard & Soffit Roush I \ <br />Ceilinqs (T-Bar Rouqh) <br />lMeter Release <br />t\^/l <br />Rough Irlb \ \-\la |C <br />Service N/eter \\ft \fl Dtlt A <br />FINAL lslilgl?.Y <br />Notes, Remarks, Etc. <br />!----r--_-r <br />I <br />\ <br />/ <br />I hcrcby alfirm undcr penally of pcrjury th{l I am exctrrpt from lhc CoDtracbrs' Liccnre Law for lhc following rcason (Scc.70-11.5 <br />Busirrcss and hofcssion Codc): Any City or County which rcquircs a Jrrnit lo @nstrucl. altcr. improvc. dcrmlish or rclEir un} <br />structurc. prior lo ils issuancc. also rcquircs lhc applicanl for such JEnrit to ,ilc a signcd slatcnEnt that he or shc is liccnscd pursurnt <br />to lhc prcviskrrs of thc Conlractor's Liccnrcd law (Chaptcr 9. Conilncf in8 wilh SNlion 7U)0 of Division 3 of lhc Business md <br />Prrfessi<ns Codc; or thut hc or shc is cxcmpt lhcrcfrom nnd thc basis lirr thc allcgcd cxcmption. Any violation of Sslion 7O-l L5 hy trny <br />applicunl for a pcrmit subjccts lhc applicant to a civil pcnalty of not mrc than fivc hundrcd dollars (S50O). <br />-l.as <br />owncrofthcprotrcrly.orrnycrnployccswithwagcsaslhcirsolcc<lrnpcnsalion.willdothcworkandthcstnrclureisnol <br />intcntlcd or olTcrcd ltlr salc (Scc.7044. Busincss and hofcssions C<xlc: Thc Clorrtraclor's Liccnsc Law docs not apply lo an owner of <br />thc pnrpcrty who builds or intpnrvcs tlrcrcort. and who drrcs such work himsclf or hcrself or through his or hcr <lwn cmployees. <br />provitlecl that such inrprovcnrcnls arc nol irrlcndcrl or oll'erctl for salc. l[. howclcr. thc huilding or improvcnrnl is sokl within onc ycar <br />ol'cotnplctiott.lhc Owncr lluildcr willhavc thc bunlen of proving that hc or shc ditl rurt huild or irnprovc thc proprty for tlrc purprcof <br />salc). <br />-1. <br />as owncr of thc prol)crty. am exclusivcly contractirrg with licerrscd contraclors to conslruct thc projcct 1.Scc. 71144. Business <br />antl Pnrfession Codc: Thc Contruclor's Liccnsc l-aw docs nol apply to an owner of propcrty who huilds or inrprovcs thcreon. <br />altd wh<l contructs f<rr such projects with a C<lntractor(s) liccnscd pursuant lo thc Contractrrr's [-iccnse Law). <br />-latttcxclllt)ltttttlcrScclit,lt-.l}'&l,.(..lirrl]tisrcitstrtt. <br />l)atc. Orvner: <br />WORKERS' COT}IPF'NSATION <br />DECLARATION <br />I hcrcby alTirnr undcr pcnllty of pcrjury onc of thc following tleclarations: <br />-l <br />have and will rnaintain a Certificatc of Conscnt to Self-lnsure fior workcrs' comJrnsation. as providcd for by Scction 37(D of the <br />Lubor Codc. frrr thc pcrformancc of thc work for which thc grcrrnit is issucd. <br />-I <br />havc ir lttl will ntairrtain workcrs' contpcnstliorr insurancc. as rcquircd by <br />which this pcrnrit is issued. My workcrs' conllrcnsation insuralrcc <br />.Sccl ion .17(X)ol'thc .ahrlr of <br />thc work lirr carncr and 6rlicy nurnhcr <br />^tAra4pLI68-]/-U /Ns uA{ <br />b, <br />-l <br />ccrlity that in thc pcrtkrrrnancc of thc work for which this pcrrnit is issucd. I shall not employ any pcrson in any manncr <br />so as lo bccorttc subjcct lo lhe workcrs'conrlrcnsation laws of Calilbrnia. and agrce lhat if I should bccorrrc subject to the <br />workcrs' corttpcnsati<ln provisions of Scction 37(U of thc Latxlr Crdc. I shall. lbrthwith cornply with thosc provisions..a, <br />lVARNING: Failurc lo sccurc workcrs' corupcnsalion covcragc is unlawlul. arrd shall suhject an cmployer to criminal Jrenaltics and <br />civil lincs up lo onc hundred thousand dollars (Sl00.UX)). in addition to lhc cost of conlpcnsation. damagcs as providcd for the <br />Secliorr 3076 of the l,ahrr Codc. inlcrest and attorrrcy's fces.?-/o-/q orrffi 4su ztwarrra, <br />a <br />DECLARATION <br />I hcrehy atfirnt undcr pnalty of pcrjury that I anr licenscd undcr provision of Chaptcr 9 (commcncing with .Section 70m) of Division 3 <br />of the Busincss and Profcssions Code. and my liccnse is in full lbrce and etfcct. <br />-/o <br />l)ale:&-et-u A C, <br />IW <br />I hcrcby affirn undcr Jrcnalty of pcrjury that thcre is a construction lcnding a8cncy for thc lrcrfomnce of thc woik for shich tl6 [Ennit Ls <br />issucd (SN. 3097. Civ. C.). <br />lxndcr's Namc: I <br />[-cndcr's Addrcss: <br />APPLICANT DECI AR ITION <br />I lrcrcby affirm undcr pcnalty of pcrjury onc of the following dcclarat ions: <br />Dcrnolition Pcrnrits-Asbcstos Notillcat ion Fcclcral Rcgulat ions (Title 40. Part6) <br />-Rcquired <br />Lcttcr oI Notillcation <br />-l <br />cedify thal thc fcdcralrcgulations rcSarding asbcstos rcmvalarc not ilpplicablc to this pmjet. <br />-l <br />ccrtify that I havc rcad this apnlicalion and statc thal thc atnvc informilion is corcct. I agrc to emply with all Cityand County <br />ordinarccs and Statc kws rching lo building con$lruction. afil hcrcbyaulhorizc rcprcrentativcs of this City and County to cnts uJnn thc <br />q4 u/* <br />t).\,, n() fl r2rti H <br />[r^ml <br />or Agent Signalure:_ <br />lDernrilec nitnte ( prilrt ):4 DA*t Au <br />rncrrtioncd propcrty lirr