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ELECTRICAL.INSPECTOR R ECORD <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATTON <br />I hcrcby affrm under pcnalty of perjury that I u ercnpt ftom thc Coilracto6' Liccnse llw for thc following rcamn (Sm.7031.5 <br />Busincss and Profcssion Code): Any City or Counry which rcquircs 8 lrrmil to construct, alts, imprcvc, &mlish or rcpair .ry <br />structw, prior to its issumce, alrc rcquircs the applicMt for such Frmil to filc a signcd slalorcnt thrt hc or she ir liccnEd pursanl <br />to thc Eovisions of thc Contractor's Licensd txw (Chapter 9. Comncing uilh Setion 7000 of Division 3 of lhe Business md <br />PrcfcssionsCode)orthatheorshciscxcmptthqcfrcmildthcbasisforthcallcgcdcxcmplion. AnyviolalionofSetionT0-ll.5byany <br />applicanl for a permit subjets thc applicant to a civil pcnalty of not mrc than fivc hundrcd dolltrs (5500). <br />CA <br />-1. <br />os owncr of the prcpcny, or my cmplolccs wilh wagcs as lhcir mle com;rcnsalion, will do lhc wqk ild thc strwtrc is mt <br />irtcndcd or offcrcd for gle (S8.7(X4, Busincss and Professions Codc: Thc Contrelor's Liccns lrw docs rcl spply lo m owrcr of <br />lhc pmlErty uho builds or itrprcE thc@n. aM who dc och wrk himsclf or hcrsclf or lhrcugh his or hcr own cmpk yccs, <br />prcvidcd that such imlrcremnts rc mt iilcrdcd or ollcrcd for eh. If. howcwr, thc building or itrprcwmnt is sld within orc )ru <br />of @tr{rhtiotr the Owrcr Buikkr will haw rhe burdcn of prcvisg tlul hc or shc dil rct hriH or in{mw lhc propcrty for the Jroqn* of <br />sb). <br />_1. as owncr of thc proprty, am cxclusively contracting with liccnsed conlraclors lo conslruct thc pr<ljcct (Scc. 7W, Busincss <br />and Profcssion Codc: Thc Contraclor's Liccnsc Law docs not apply to an owner of profrcrly who builds or improvcs thcrcon. <br />and who contracts for such projccts with a Contraclor(s) liccnscd pursuant lo lhc Conlraclor's Licensc [:w). <br />_l am cxcmpt Section-. B. & p.c. rgffir"rldn. <br />dt t owner: Z.-U*(\ <br />rV r r R X n RsiCt(Tp r"r,rsf rlf i N <br />DECLARATION <br />I hereby affirm under penalty of perjury one of the following dcclarations: <br />_I have and will rnaintain a Certificate of Consent to Self-lnsurc for workcrs' compensation, as pmvided for by Section 3700 of thc <br />l-abor Codc, for the performarrce of the work for which the pcrmit is issued. <br />_l have and will maintain workcrs' compensation insurarrce, as required by Scction 3700 of the Labor C-ode, for the performarrce of <br />the work for which this permit is issued. My workers' conpensation insurarrce carrier and policy number arc: <br />Carrier: <br />Policy <br />C A, ccrtify that in the performance of thc work for which this pcrmit is issued. I shall nor cmploy any f,crson in any manner <br />so as to bccome subject to the workers' compensation laws of California, and agrce that if I should bccomc subject to thc <br />workers' compensation provisions of Section 3700 of the L:bor Code, I shall, forthwith comply with thosc provisions.., <br />WARNING: Failure lo sccure workers'compcnsation coverage is shall subjcct an cmployer to criminal J:cnaltics and <br />compensation. damages as providcd for thccivil fines up to onc hundred thousand dollars ($100.00O). in of <br />Scction 3076 labor Codc, intercst and attorncy's fecs. <br />q ?Lr <br />I hercby af firm under Slenalty of perjury that I am liccnscd under provision of Chaptcr 9 (commencing with Scction 7000) of Division 3 <br />of the Business and Professions Code. and my liccnsc is in full forcc and effcct. <br />License Class: License Number: <br />Contractor: <br />W <br />I hcrcby afltrm undcr Fmtty of perjury that thcrc is a onstruction bnding agcncy for thc Jrcrforronce of thc work for which Ihis Jrcrmit is <br />issucd (S@. 3097, Civ. C.). <br />lrnder's Namc: <br />I-rndcr's Address: <br />APPLICANT DF'CL A ITATION <br />I hcrcby affrm under penalty of pcrjury onc of thc following dcclarations: <br />Dcmolition Pcrmits-Asbestos Notification Federal Regulations (Titlc 40, Part6) <br />-Required <br />lrtter of Notification <br />_l certify that the federal regulations regarding asbestos removal arc not applicablc to this projcct. <br />Ctr <br />_l certify that I have rcad this application and state that the above information is corrcct. I agree to comply with all City and County <br />ordinanccs and State Laws relating to building and hcreby authorizc rcprcscntativcs <br />atxlvc nrcntioncd propcrty for inspcction <br />Applicant or Agent <br />Permitee name (orint):CA 1S UG;1vtt Aa,.q(q 0L ?, <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab I Floor <br />Bondinq I Groundinq I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs [-Bar Rouqh) <br />N/eter Release <br />Rouqh <br />Service N/eter t I /? <br />FINAL te\\)d\a VA#A Y <br />Notes, Remarks, Etc.lr I <br />.rr, nQ n7 Onlq <br />q