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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq I Groundinq I UFER Q-Za'Ol D-4 4a,- Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rouqh) [Vleter Release g-?rt - 14 >-.-( ttl Rough 9.97 . ?l Je-( 7+ Service N/eter FINAL ?-19-Ll G--'-( Notes, Remarks, Etc. I hcrcby affirm undcr Fnally of Frjury that I m cxcmpt frcm tlE Contracto6' Licens hw for thc following rcun (Sc.7031.5 Busincss md Prcfcssion Codc): Any City or County which rcquircs a lrcrmit to @nstruct, altcr, improvc, dcmlish or rcpair sny struclurc, frior lo its issusncc, also rcquires thc applicant for such lrcmil to filc a sigrcd stslcmnt Ihal he or shc is liccnrcd puuant to thc prcvisions of thc Contracttr's Liccnsed L:w (Chaplcr 9, Comrcrcing with Scction 7000 of Division 3 of the Eusincss ud PmfcssionsCodc)orthathcorshciscxcmptlhcrcfromandthcbasisforthâ‚¬allcgcdcxemption. AnyviolationofsectionT0-3l.5byany applicant for a pcrmit subjets the opplicant to a civil pcnalty of not mrc than fivc hundrcd dollas ($500). as owncr of thc property, or my employecs with wages as lheir solc comgrcnsation, willdo the work and the stnrture is not intendcd or offcrcd for salc (Scc.7044, Business and Professions Codc: Thc Contractor's Liccnse law does not apply to an owner of thc profrcrty who builds or improvcs lhcrcon, and who docs such work hinrsclf or hcrsclf or through his or hcr own employccs. providcd that such improvcnrcnls arc not intcndcd or oflcrcrl for salc. If. howcvcr. thc building or ilnprovcrEnt is sokl within onc )lcar of comphtion. thc Owner Buildcr will havc thc burden of proving that hc or she did not build or improvc thc propcrty for the purynsc of salc). -1. as owncr of the proprty. am exclusively contracting with licensed contraclors to construct thc projcct (Scc. 7W. Busincss and hofession Codc: The Contractor's License Law does not apply lo an owncr of pro;rcrly who builds or improvcs thcrcon. and who contracts for such projects with a Contractor(s) liccnscd pursuant to the Contractor's Licensc Law). _l arrr cxcntpt undcr for I hcrcby affirrn undcr pcnalty of pcrjury one of thc following dcclarations: -l havc and will maintain a Ccrtificate of Conscnt to Self-lnsure for workcrs' com;rcnsation. as providcd for by Scction 3700 of the I-atxrr Code, for thc performance of thc work for which the ;rcrmit is i.ssucd. -l havc and will maintain workers' compensation insurancc, as rcquired by Scction 3700 of the labor Code. for the performance of thc work for which this pcrmit is issucd. My workers' comlrcnsation insurancc carrier and plicy numbcr are: Policv Number: Exoires: ccrtify that in the pcrformance of thc work for which this pcrmit is issued. I shall not cnrploy any person in any manncr so as lo bccomc subject to thc workcrs'compcnsation laws of California. and agrcc that if I should becornc subjcct to thc workcrs' compcnsation provisions of Scction 3700 of thc kbor Codc. I shall. forthwith conrply with thosc provisions.. WARNING: Failure to sccurc workcrs'comyrcnsation covcrage is unlawful. and shall subjcct an cnrploycr to crirninal pcnaltics and civil fincs up to one hundred thousand dollars ($100.000). in to thc cost damages as providcd.for thc Scction 3076 of thc Code, intcrcst and attorney's DECLARATION I hercby affirrn under pnalty of Jrcrjury that I am liccnsed undcr provision of Chaptcr 9 (comnrcncing with Section 7000) of Division 3 of the Busincss and Profcssions Codc, and my liccnse is in full force and effect. License Class: License Number: C(TNSTRUCTION LENDING AG['I{CA I hcrcby amrm undcr Fnalty of pcrjury that thcrc is a @nstruction hnding agcncy for thc pcrfomre of thc work for which this lEmit is issucd (Scc. 3097, Civ. C.). lrndcr's Narc: Lcndcr's Addrcss: APPLICANT DECL{RATION I hcrcby affrnn undcr pcnalty of perjury onc of thc following dcclarations: Demolition Permits-Asbeslos Notification Federal Regulations (Titlc 40. Part6) _Requircd l.ettcr of Notihcation -l certify that the federal rcgulations rcgarding asbcstos rcmoval arc not applicable to this propct. ccrl ify that havc rcacl this application with all City and County and Statc [-aws rclating and County to cnlcr upon thc abovc nrcntioncd proprty for Applicant or Agent Pernritee name ( to and strtc that thc ,-rt, nA n'7 Onl tr Iu'ur Carrier: Conlrnclor: information