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ELECTR ICAL-I NSPECTOR R ECOR D El ,^,r, nO n7 On{ q APPROVALS DATE ID/SIG COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor tt ,l Bondino I Groundino I UFER Y 4 '7/\T),fi*>*I ,/ Transformers A Torqueinq ll I W/kt/lSub-Panels 7// I 2t Air Conditioners I Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh rl ,\.t l) Ceilinss (T-Bar Roush)U ..-N,{)/ N/eter Release \\l V Rough Service Meter l-l ^ [tr 1 Z ,/ FINAL 0 7 'Ll Dt{\ o I NoFs, Bemarks, Etc.il ,l ^/tl a I I +filwl --D D --z C -aL+ .- ) f+w8of v \-a I hercby aItrrm undcr pcnalty of pcrjury thal I m cxcmpt from thc Contreto6' Licens kw for thc followng rc&$n (Ss.7031.5 Busincss and Profcssion Codc): Any City or County shich rcquircs a Jmir to construct, alt6, imprcrc. dcmlish or repir aqy srucrw, Jrbr to its issuancc, slso rcquircs thc applicut for srch pcmit to filc ! signed stalemnt that hc or dE is licensd plNut to rhe prcvisions of thc Contnctor's Licensd kw (ChrpIcr 9. Comrcrcing with S6tion 700O of Division 3 of thc Busircss md Prcfc$sions Codc) or that hc or shc is cxcmpt thsefrom ard thc boris for the alhgcd cxcmption. Any violation of Scction 703 I .5 by aoy applicant for a Frmit subj$ts the applicant to a civil pemhy of not mrc than fivc hundred dolles ($500). _1. as owncr of thc propcrty, or my employccs with wagcs as thcir srlc conrpcnsalion. will do thc work and thc struclurc is not intcndcd or offcrcd for salc (Sec.7044, Business and Profcssions Codc: Thc Contractor's Liccnse law does not apply to an owncr of thc propcrty who builds or inrpnrvcs thcrcrn. and who docs such work himsclf or hcrsclf or through his or her own cmployccs. providcd that such improvcrncnts arc not intended or offercd fbr salc. l[ howcver. thc building or irnprovemcnt is sold within onc ycar of complctiorr. thc Owncr Buildcr will havc thc burden of proving that hc or she did not build or improve thc propcrty for thc pur;nse of salc). _1. as owncr of thc propcrty, am cxclusivcly contracting with liccnscd conlraclors to construct thc projcct (Sec. 7(W. Busincss arrd Profession Codc: Thc Contractor's License Law docs not apply to an owncr of propcrty who builds or improves lhcrcon. and who contracts for such projccts with a Contracto(s) liccnscd pursuant to thc Contractor's Liccnsc Law). -IamexemptundcrScction-.B.&P.C'forthisreason. WORKERS' COMPENSATION DECLARATION I hcrcby affirm undcr pcnalty of perjury one of the following declarations: haveandwill rnaintainaCcrtificatcofConsenttoSclf-lnsurelbrworkcrs'conlpcnsation.as providedforbyScction3Tfi)ofthc l.atxrr Codc,tbr thc pcrtirrnurncc of thc work fbr which thc pcrnrit is issucd. 7D nou"and will rnaintain workcrs' compcnsation insurance, as rcquircd by Scction 37fi) of the L:bor Codc, for thc ;rcrformancc of for which this pcrrnit is issued. My workcrs' compensation insurancc carricr and plicy number are: Alller,t lurrrerc 5u-}r., f ., thc work Numbcr. CA laoo IO at to t Expires: to lot lzo c t _l certify that in thc pcrfornrancc of thc work for which this 5rcrmit is issucd. I shall not cmploy any pcrson in any mantrcr so as to becornc subjcct to thc workcrs'compensation laws of California. and agrcc that if I should become subp.ct to thc workers' compcnsation provisions of Section 3700 of the L:bor Codc. I shall. forthwith comply with thosc provisions.. WARNING: Failurc to sccurc workcrs'comJrcnsation coveragc is unlawful. and shall subject an cmploycr to crirninal pcnaltics and civil fines up to onc hundrcd thousand dollars ($100.0001, in addition to thc cost of compcnsation. damagcs as providcd for thc 3076 of thc l,rrtnr Codc, intcrcst and attorney's fccs.--lamct -D.{. lq^,e '5.2.1 - ZOZ t LICENSED CONTRACTOR DECL{RATION I hereby affirrn undcr pcnalty of perjury that I am licenscd under pmvision of Chaptcr 9 (commencing with Section 70m) of Division 3 of thc Business and Prrrfessions Codc, and my license is in full forcc and effect. curs Dfr Licensc Numbcr:75 u 30Licensc -2O21 R?ftj D f-.,r.c - D11.|..love J W I hercby aflirm undcr lEnalty of Frjury that thcrc is a onstruction lending sgcncy for Ihe pcrforffie of thc work for which this IErmil is issued (Scc. 3097, Civ. C.). Namc: Address: APPLICANT DECLAITATION I hcreby affirm undcr pnalty of perjury onc of thc following declarations: Demolition Permits-Asbcstos Notification Federal Regulations (Titlc 40. Part6) _Rcquircd lrttcr of Notification _l certify that the federal regulations rcgarding asbstos removal arc not applicable to this project. that I have rcad this application and state that the atnvc information is correct. I agrcc to comply with all City and County ordinanccs atrd Statc Laws rclaring to building constructio[ and hercby authorirc rcprcsntativcs ofthis City and Counly to cntcr ulnn thc abovc DA o*". b'Z4-?oz l nanre (orinr): 7t *.+toz Dr,&n"- IYA t