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ELECTRICAL-INSPEGTOR RECORD <br />nQ n7 ?n4 s, <br />APPROVALS DATE !D/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm lDampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Groundins / UFER <br />Transformers <br />Torqueing <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 />Ceilings (T-Bar Roush) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL l0- 5-A \I{D.tV Ir <br />Etc.Notes Rema v <br />OWNER BUILDER DELCARATION <br />I hactry affm unda poalty of pajury thar I m crmpt from thc ContmctoE' Lic@c kw for thc followitrS r@n (5€.7031.5 <br />Busins and Prcfsion Codc): Any City or County which rcquirs a po'rnit to coNtruct. alto, improve. dqnolish or rcnFir ary <br />struc{uq Eior to its isumcc. also rcquirB thc applicant for such pcmit to filc a signed statmot that hc or slE b lic$cd plmant <br />to the prcvisiom of tlE Contractor's Licoscd taw (Chapttr 9. Commcncing with Setiotr 7000 of Division 3 of thc Busin* md <br />hofGsions Codc) or lhat hc or sh€ is qcmpt thqcfrom md thc bsis for thc allcgcd crmption. Any violation of Scrbn 7011.5 by my <br />applicilt for a pdrnit subj(ts thc applicut to a civil pcmhy of not morc the fiv€ hundred doll8s ($500). <br />__1. as o\r'ner of the F,ropcrty. or my employecs with wages as their sole compensation. willdo the work and the stntclure is not <br />intended or offcred for sale (Sec.7044. Business and Professions Code: 'l'he Contractor's License Larv does not apply to an owner of <br />the property who builds or irnproves theron, and who does such rvort himself or herself or through his or her orvn employees. <br />provided that such improvanents are not intended or offered for sale. If. horvwer. the building or improvement is sold within one year <br />of cornplaion. the Owner Builder will have the burden of proving that he or she did not build or irnprove the propoty for the purpose of <br />sale). <br />_1. as owner of the proptrly. arn exclusively contracting with licensed contraclors lo construct the project (Sec. 7U4, Business <br />and Proftssion Code: T'he Contractor's License Larv does not apply to an owner of property who builds or inrproves thereon. <br />and who contracts for such projects with a Contracto(s) licensed pursuant to the Contraclor's [.icense Larv). <br />_l arn cxempt B.reason. <br />1-. <br />I hereby affrrm under penalty of perjury one of the follorving <br />-l <br />have and will nraintain a Cerliflrcate of Consent to Self-lnsure for rvorkers' compensation. <br />Labor Code. for the perforrnance of the rvork for which the po:rrit is issued. <br />by Sc,ction 3700 of the <br />-l <br />have and rvill maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the performance of <br />the u,ork for rvhich this permit is issued. My workers' compensation insurance carrier and policy number are: <br />Carricr: <br />Policy <br />__l certify that in the performance of the s'ork for rvhich this permit is issued. I shall not employ any person in any manner <br />so as to become subject to the rvorkers'compensation lau,s of California. and agree that if l should become subject to the <br />workers' cornpensation provisions of Seoion 3700 of the l-abor Code. I shall. forthwith comply rvith thosc provisions.. <br />WARNING: [;ailure to secure rvorkers' compensation coverage is unlarvful. and shall subject an ernployer to crirninal perralties and <br />civil fines up to one hundred thousand dollars tn the cost of conrpensation. darnages as provided for the <br />Section Code. interest and fees. <br />F I <br />I hereby affirm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing rvith 7000) of Division 3 <br />of the Business and Professions Code. and my license is in full force and effect. <br />License Class:-I i^o-oo Nurnber: <br />I) rr i r.'Contractor: <br />CONSTRUCTION LENDING ACENCY <br />I hreby aflirm undo Fnalty of pqjury that thqe is a construction lmding sgocy for the psfomucc of thc work for which this p6mit is <br />issucd (Sa. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPLICAN'T DECI TRATION <br />I hereby affirm under penalty of perjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Parl6) <br />_Required Latcr of Notilication <br />_l certify that the federalregulations regading asbestos removalare not applicable to this project. <br />_l certify that I have read this rvith all City and County <br />and County to enter upon theordinances and State Larvs relating to <br />above mentioned property for <br />Applicnnt or Agenl <br />Permitee nnme <br />that <br />t.t- <br />Exoires: