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ELECTR ICAL.INSPECTOR RECORD APPROVALS DATE ID/S!G COMMENTS Site-Work Underground Pole Bases Light Standards , ,/lt -rr/'Spas, Pool, Fountains ,/flru fffifl/ffi g7a Signs (monument)I tt Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor -.,I Bonding / Grounding / UFER l2lfta/Al00/*, )- ^/ Transformers &uflap){t/6/ gz'3 Torqueinq / ,GE lruW Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) Meter Release Rouqh a Service lVleter ^/J-Iri -n- d FINAL 1/o/ r,q(444,Yq) Notes, Remarks, Etc. OWNER BUILDER DELCARA'I'ION I hereby affirm under penalty of perjury that I am exempt fnrm the Contractors' License Law for the following rea.son (Sec.7031.5 Business and Prtrfession Ccxle): Any City or County which requires a permit lo construct. alter, improve, dernllish or repair any structure. prior to its issuance. also requires the applicant frrr such permit to file a signed statenEnt that he or shc is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9, Commencing with Section 7000 of Division 3 of thc Business and Professions Code) or that he or she is exempt therefronr and the basis for the alleged exemption. Any violation of Section 7031 .5 by any applicant for a permit subjects the applicant to a civil penalty of not mure than five hundred dollars ($5U11. _1. as owner of the proFrerty, or my employees with wages as their soh compensation, will dr> the work and the struclurc ls not intentled or offered frrr sale (Sec.7044, Business and hofessions Code: The Contractor's License Law does not apply to an owner of the pnlgrerty wtxr build.s or improves thereon, and wlxr dtrcs such work himself or hcrself or through his or her own employees. provided that such improvenrnts are m)t interxled or offered for sah. If. hrwever, the building or irpruvenrnt is sokl within one )â‚¬ar of completion, the Owner Buikler will have the burden of proving ttrat he or she dkJ not buikl or improve the property for the purpose of sale). _1. as owner of the property, am exclusively contracting with licensed contractoru to construct thc pnrject (Sec. 7Ha, Business and Prrofessirn Code: The Contractor's License Law does not apply to an owner of property who builtls or improves thereon. and who contracts for such pnrjects with a Contracto(s) licensed pursuant to the Contractor's License kw). -IamexelnptunderSection-.B.&P.C.forthisreason.Owner:_ WORKERS' COMPENSATION IrI'CLARAl'ION I hereby affirm under pnalty of perjury one of the folkrwing declarations: _lhaveantlwill rnaintainaCertificateofConsenttoSelf-lnsureforworkers'compensation.as providedforby.Section3T00ofthe Latxrr Code, firr the performance of the work for which the permit is issued. _l have antl will maintain workers' comlrcnsation insurance. as required by Section 3700 of thc Labor Cotle. frlr the performance of the work for which this permit is issual. My workers' compensation insurance carrier arxl plicy numher are: Policy Number: Expires: _l certify that in the performance of the work for which this permit is issued. I shall not empby any person in any mannâ‚¬r so asto beconr subject to the workers'c()mpensation laws of California, antl agree that if I shrukl become subject tothe workers' comyrcnsation provisions of Section 3700 of the [.:rbr Code, I shall, forthwith comply with those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousantl dollars ($1fi),fiX1;, in addition to the cost of compensation, damages as provided for the Section 3076 of the Labor Crxle, interest and attorney's fees. Dete: Applicant: l lcrusrn coryrlttc'rolt DECLARATION I hereby affirrn under pnalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7Un) of Division 3 of the Business and Professions Code. and my license is in full force antl effect. License Class: License Number: Date: Contractor: CONSTRUCI'ION LE,N DING AGEN CY I hereby affirm untler penalty of perjury that there is a construction hntling agency fur the performance of the work for which this permit Ls issued (Sec. 3()97. Civ. C.). Lender's Name: Lender's Address: APPLICANT DtsCLARATION I trrcby affirm under pnalty of grcrjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Requiretl Letter of Notifrcation -l certify that the federalregulations regarding asbestos renrrvalare nol applicable to this project. _l certify that I have read this application and state that the ahrve information is correct. I agree to comply with all City antl County onlinances and State Laws relating to building construction, antl hereby authrrize representatives of this City and County to enter u1rcn the above mentioned property for inspection purposes. Applicant or Agent I'ermitee name (print):_ Date:_ 0B-07-2015 \ Date:_