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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/S!G COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under SIab / Floor <br />Bonding I Groundinq / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />N/eter Release <br />Rough <br />Service N/eter I I A <br />FINAL ZI*IZI Jpl vu , <br />Notes, Remarks, Etc.,l <br />I hcrcby dllirm undcr Fnalty of pcrjury thal I m cxempt fmm lhc ContracloN' Liccnsc kw for thc following rc8sn (Scc.7031,5 <br />Busincss arxl Profcssion Codc): Any City or County which rcquircs a tEmit to onstruct, allcl imprcvc. dcmlish or rcpaL any <br />structurc, pri)r to its issuancc. also rcquircs thc applicant for such [Ermil to filc a signcd slatcmnt that hc or shc is liccnsd pursuant <br />to thc prcvisions of thc Contr.ctor's Liccnrcd taw (ChapIcr 9, Comrrcncing with Setion 7000 of Division 3 of thc Busircss md <br />PmfcssionsCodc)orlhathcorshciscxcmptthscfromandthchasisforthcallcgcdcxemption. AnyviolationofselionT03l.5byany <br />applicant for a pcrmil subjccts thc applicant to a civil pcnally of nol rmrc lhan fivc hundrcd dolltrs ($500). <br />_1. as owner ot'thc propcrty. or my enrployecs with wagcs as thcir solc compcnsation. willdo the work ancl thc slnrcturc is not <br />intcndcd or oll'crcd f'or sale (Scc.7044. Busincss and Prol'cssions Codc: 'Ihc Contractor's Liccnse hw docs not apply lo an owner of <br />thc propcrty who huilds or inrprovcs thcreon, and who docs such work hinrsclf or herself or through his or hcr own enployecs. <br />Jlrovidcd that such irrrprovcrrrcnts arc not intcndecl <lroflbrcd ttrr salc. lt, howcvcr. the building or inrprovcrncnt is sold within one ycar <br />of cornplclion. thc Owncr Buildcr will havc thc burdcn of proving that hc or shc did not build or improve thc pmprty firr lhc purynsc of <br />salc). <br />_1, as owncr of thc propcrly. anr cxclusivcly contracting with liccnscd contractors to consuuct thc projcct (Scc. 7U4. Business <br />and Profcssk>nCodc: Thc Contractor's Licensc Law docs nol applylo anowncr of proJrcrtywho builds or irrtprovcs lhercon. <br />and who contracls for such projccts with a Contracto(s) liccnscd pursuant to thc Contractor's Liccttsc [.aw). <br />-latncxctuptundcrScction-.B.&P.C.forthisrcason. <br />Owner: <br />IuOBTEESSQMTENSASQN <br />DECIdEAIION <br />I hcrcby sflirm undcr pnaltyof prjury onc of the following dcluations: <br />.7lt <br />g!]havcmdwillruintrinaCcnificatcofConsnltosclflnsurcforworkcrs'compcnsathn,as pmvidcdforbyScction3T0Oofthc <br />kbor Crdc, for thc Frfomncc of thc work for which thc Frmit is issucd. <br />havc and will rnaintain workcrs'compensation insurancc, as required byScction 3700of the [:borCodc. forthc pcrlbrnunccof <br />thc work for which this pcrrnit is issucd. My workcrs' comlrcnsalion insurancc carrier and policy nurnbcr arc: <br />sAJ f,t_/r\7\ <br />Policy h.-21-)l <br />_l ccrtily that in thc pcrfonruncc of thc work for which this pcrrrrit is issucd. I shall not cnrploy any 1rcrson in any nranncr <br />_so as to bcconrc subjcct to thc workcrs' comJrcnsation laws of California. and agrcc that if I should bccotttc subjcct to thc <br />workcrs' compcnsation provisions of Scction 37fi) of thc Lahlr Codc. I shall. tbrthwith cornply with thosc provisions.. <br />WARNING: Failure to sccure workers'compensation covcragc is unlawful. and shall subject an empl<lycr to criminal penalties and <br />civil tincs up to onc hundrcd thousand dollars ($100,00t11. in addition to the cost of compcnsation. danrages as providcd for thc <br />Scction 3076 of thc labor Code, intercst and attorncy's fecs. <br />nare:1.-8-I\ Appricanr: #csU"V-t^-b, <br />LICENSED Ct)NTRACTOR I <br />DECLARATION <br />I hercby affirm undcr pnalty of Jrcrjury that I am licenscd undcr provision of Chapter 9 (commcncing with Scctbn 7000) of Division 3 <br />of thc Busincss and Profcssions Code. and my licensc is in full forcc and cffcct. <br />aqa c.bSLiccnscNutttl."--r: <br />Date:_L <br />W <br />I hcrcby affirm urdcr Jrcnulty of pcrjurythat tlrcrc is a onstruction hnding lgcrcy for thc pcrlbrmncc of thc work for which lhis tsmit Ls <br />issued (Se. 3097, Civ. C.). <br />lrndcr's Nam: <br />lrndcr's Addrcss: <br />APPLICANT DECLARATION <br />I trcrcty affrnn undcr pcnalty of pcrjury one of the following declaralions: <br />Dcrnolition Pcrrnits-Asbcstos Notification Federal Rcgulations (Titlc 40. Pan6) <br />_Requircd lrttcr of Notification <br />_l ccrtify that thc fcderal regulations regarding asbcstos rcmovalarc nol applicablc to this projcct. <br />D ccrtify rhat I havc read this application and statc that thc atnvc irrtbrmation is correct. I agrce to cotttpty wirh all City and County <br />ordinanccs and Statc Laws rclating to buildirrg construction. and hcrcby rcprcsentativcs of this City and County to entcr upon thc <br />atxrvc nrcntiortc<l ;lroJrcrty krr <br />2-8:21 <br />Dere: C.-d'-2 |Applicant or Agent <br />Permitee name (print): <br />Rev 08-07-2015 <br />y\A ELL <br />t