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ELECTRICAL.I NSPECTOR RECORD <br />f).'.'rlCI fl? -)/\{ lx' <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 AIarm I Dampers <br />Communications Cable <br />Building <br />Under SIab / Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torqueing <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 />[\4eter Release <br />'A rl.2l a /Rough UlrlM'r;L8) <br />Service Jt/eter 3.lt u -- <br />'++,ffiFINAL <br />-Zl-Z)Remarks Etc. <br />OWNERBUILDERDEI,CARATION - , ID <br />I hqeby affrm undo pcnalty of pcfjury thst I m cxmpt from thc Contr.clors' Licensc Law for thc following r€en (F7031.5 <br />BNin6s dd Profsior Codc): Any City or Counly rvhich requirG a p6mit to coNtruct. altq. improv€. danolish or npair ary <br />struc{w. prior to its issuocc. also rcquirc thc applicet for such psmit to filc a signcd stalmot tha trc or slrc b licmscd pmant <br />lo thc provisioE of thc Contraclor's Liccnsed lrw (Chapts 9, Commcncing with Sction 7000 of Division 3 of thc Buines md <br />Prcfcsions Codc) or that hc or shc is cxcmpt thsefrom ad thc besis for the allegcd cxmpion. Any violation of Scctbn 7031.5 by any <br />applicet for a pemit subjets thc applicut to a civil pcmlty of not morc ths fivc hun&cd dollus ($500). <br />-1. <br />as owner of the propeily. or my employecs with wages as their sole compensation. rvilldo the work and the structure is not <br />intended or offered for sale (Scc.7044, Business and hofessions Code: The Contractor's l,icense Law does not apply to an orvner of <br />the property who builds or improves thereon. and who does such work hinrself or herself or through his or her orvn employees. <br />provided that such improvonents are not intended or offered for sale. lf. horvsver. the building or improvement is sold within one year <br />of completion. the Orvner Builder will have the burden of proving tha he or she did not build or improve the propoty for the purposc of <br />sale). <br />-1. <br />as owner of the propoly. arn exclusively contracting with licensed contraclors to conslruct the project (Sec. 7044. Buiness <br />and hoftssion Code: The Contractor's License 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) licensed pursuant to the Contraclor's License taw). <br />-l <br />arn exempt under Section-. B. & P.C. for this reason. <br />Il.r r a.()n'ner: <br />wonxrns'coNtp <br />DECLARATION <br />of the follou'ing declarations:I hereby aflirm under penalty of po'jury onc <br />-l <br />have and will maintain a Certificatc of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the <br />l-abor Code. for thc performance of the work for which the pennit is issued. <br />-l <br />have and will maintain workers' cornpensation insurance, as required by Section -i700 of the Labor Code. for the perfonnance of <br />the work for which this permit is issuod. My workers' compensation insurance can'ier and policy number are: <br />Policy Number: Expires: <br />_l certi& that in the performance of the work for which this pcrmit is issued, I shall not employ any person in any manner <br />so as to become subject to the workers'compensation laws of California. and agree that if I should become subject to the <br />workers' compensation provisions of Serrion 3700 of the labor Code. I stnll. forthwith cornply rvith thosc provisions.. <br />WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an onployer to criminal penalties and <br />civil frnes up to one hundred thousand dollars ($100.000), in addition to the cost of compensation. damages as provided for the <br />Section 3076 of the Labor Code, interest and attorney's fees. <br />A rrrrlinonl. <br />LICENSED CONTRACTOR <br />DEC! {RATION <br />I hereby affirm under penalty of pojury that I am licensed under provision of Chapter 9 (cornrnencing with Section 7000) of Division 3 <br />of the Business and Professions Code, and rny licerxe is in full force and effect. <br />License Number: <br />W <br />I h@by affm udq pcoalty of pajury th8t thqc is a onsrruabn knding agcy for thc pofomcc of thc work for which thig pqrnh b <br />issucd (56. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPI ICANT DECI 'AILATION <br />I hereby affinn under penalty of perjury onc of the following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) <br />-Required <br />lrtter of Notification <br />-l <br />c6|iry that thc fedqal rcgulatiom rcguding sbGtos r@oval de not applicablc to this prcj$r. <br />-l <br />cdiry that I have rad this application ed state that the above infomtior is corst. I agre to comply with all City ild County <br />ordimncG od Slate laws rclaling to building construction, ed h6eby authorizc rc?rslativc of this City md Couty to mtq upon thc <br />above motioned prcpcrty for iGpction purpos. <br />Applicnnt or Agent Signuture: <br />l'errrritce nanre (prinl): <br />Date:_ <br />Contrrctor:_