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ELECTRICAL.!NSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safetv /Low Voltaqe Fire AIarm / Dampers Communications Cable Building Under SIab / Floor Bondins I Groundins I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush) Ceilinss (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh)I Meter Release Q'-/'(-21 4k,,"-u) J Rough )-z;b4 WC '}Jl Service N/eter FINAL cl ac,zl f?-u t Nzrs ryt Notes, Remarks, Etc. OWNIiR BUII,DER DI'I,CA RATION I hereby affirnr under penalty of prjury that I anr excnrpt fronr the Clontractors' Licen-se l-aw for thc following reason (Sec.7031.5 Busincss and Prol'ession Codc): Any City or County which requircs a pcrmit to construct, altcr, irnprove. dcmolish or repair any structure, prior to its issuance. also requires the applicart for such perntt to file a signed staternenl that lre or she is liccnscd pursuanl to the provisions of thc Contractor's l,iccnscd I:w (Chaptcr 9. Commencing with Section 7fiX) of Division 3 of thc Business and Professions Code) or that he or slre is exenpt therefronr arrd tlre basis for the alleged exenrption. Any violation of Section 7031.5 by any applicant for a pennit subjects the applicant to o civil penalty of not more than llve hundred dollars ($500). _1. as owncr ol'ttrc propcrty. or tny crnployces wilh wages as their sole compcnsation, will do the wcrk and the stnrturc is not interrlxl or offered for sale (Sec.7B+. Business and Pnrfessions Code: The Contraclor's Licensc [-aw docs not apply lo an owncr of the property wlro builds or improves lherooru and wlro does such work himself or herself or ttrough his or her own entployees, providcd that such irnproverrcnts arc rnt intcndcd or ollcrcd for sah. Il. however, the building or inprownrcnt is sold within one year of complctbru thc Owner Buikler will lrave thc burdcn of proving ttra lr or stre did not buikl or inrprove thc propaty for thc purposc of sah). _1. as owner of the propeny, am exclusively contracting with liccnscd conraclors to conslruct thc prcject (Sec. 7OU. Businers arxl Protbssi<lr Code: The Contractor's License Law does not apply to an owner of property who builds or intproves lhereon. and who conuacts for such pr<rjccts with a Contractor(s) licenscd pursuant to thc Contraclor's Licensc hw). -IantexenlptuttderSectitltt-,B.&P.C.tbrtItisreason.f l^.,.. WORKIiRS' COMPIiNSATION DECLARATION I hcreby atTirnr undcr pcnalty of pcrjury onc o[ tltc tirllowing dcclarations: _l have and will nuintain a Certilicate of Consent to Self-lnsure for workers' competuation, as provided for by Section 3700 of the Labor Code, for thc Jrcrfornuncc of thc work for which thc pcrnrit is issucd. -l have and will nraintain workers' conrpensalion insurance, as required by Section 3700 of the l-abor Code, for the 1rcrf<rrnur,.-e of thc work tbr which this pcrnrit is issucd. My workcrs' con4rcnsation insurancc carricr and policy numbcr are: Carrier: Policy Nurnbcr: Expires: _l certify that in thc 1^-rfrrrnuncc o[thc work for which thi.s pcrmit is issued, I shall not enrploy any frcrson in any menncr so as to bccomc subject to thc workcrs' compen.sation laws of California. and agrce that if I slnuld becorrc subject to the workers' c<lmpensation provisions of Section 3700 r.rf the Labor Cqle, I stull, forthwith comply with thosc provisions.. WARNING: Failurc to lrecure workers' cornpensation coverage is unlawful, and shall subjcct an employer to crirninul pcnahics and civil fines up to one hurrdrerl tlxrusand dollars ($IOO.CX)OI. in addition to the cost of comgrctsation, danuges as provided for lhc Scction 3076 of thc latxlr Coclc. intcrcst and attorncy's l'ccs. or,.,^Q-fl f- floN I hereby affrnr under ;rnalty of perjury that I anr licensctl under provision of Chapter 9 (comnrncing with Scction 7000) of Division 3 of the Business and Professions Code. and my license is in full forcc and effect. License ro3"Arl o^t", &-9 f '% Q-,1 CONSTRUCTTON LENDING AGENCY I hcrcby affirrn undcr pcnalty of pcrjury that thcrc is a construction lcnding agcncy for the pcrlbrmance of the work lbr which this grcrmit is issued (Scc. 3097. Civ. C.). Lender's Nanre: knder's Address: A PPI,ICANT DECLARATION I tucby aff-rnr undcr pnalty of pcrjury onc of thc firllowing declarations: Dcmolition Pcrnrits-Asbc'stos Notification Fcdcral Rcgulations (Title 40, Part6) -Rcquircd l.cttcr of Notification _l ccrtily that thc fcdcral rcgulations rcgarding asbcstos rcmnval arc not applicablc to this projcct. _l certify tlnt I luvc rcad this applicalion arxl statc tlut lhc ahovc infrrrnution is correct. I agrcr to conrply with all City antl County ordinanccs and Statc laws rclating to constructioq and hcrcby authorize rcprcscntatives of this City and County to cnter upon thc above rnentioncd propcrry for Applicant or Agent Pcrmitcc nanle l( 08-0 -201 I