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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 Safetv /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bondinq I Groundins I UFER o ,6/r\7r\btu/YlY I Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment â‚¬.liLYA b,t lftf 7 Factory Wired Unit \ Walls (Conduit) Walls (Rouqh) Ceilinss (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh)t t '.1/ lt/eter Release ,\)lw->t Rough Service [Vleter I I ,l .rP. FINAL rf Oi41x b&eqr bY Notes, Remarks, Etc.\I OWNER BUILDER DELCARATION I hcrcby aflirm undcr pcnalty of lrcrjury that I m cxempt frcm the Contmctos' Licens [:w for thc following rcason (Scc.?031.5 Busincss ard Profcssioo Codc): Any City or County which rcquircs a Jrmit to construct. altcr, imprcrc, dcmlish or rcpair uy structrc. prior to its issuancc. also requires the applicanl for such Frmit to file a sigrcd statemnt that hc or slrc is liccnffd pursilt to thc prcvisions of thc ContEctor's Liensd kw (Chapter 9, Commcrcing with Setion 7000 of Division 3 of thc Business ed PrcfcssionsCodc)orthathco.shcisexcmptiherefromandthcbasisforthcallcgcdcxcmption. AnyviolationofsrclionT03l.5byany applicant for a pcrmit subirts the applicant to a civil pcmlty of not mre lhrn fivc hundrcd dollus ($500). _1. as owncr of thc proJrcrty, or my enrpl<lyccs with wagcs as their solc compcnsation. will do thc work and thc structurc is not inlended or offercd for sale (Scrc.7044, Business and hofessions Codc: Thc Contractor's License [-aw does not apply to an owner of the propcrty who builds or improvcs thereon, and who docs such work himself or herself or through his or her own employccs. provided that such improvcnrnts arc not intendcd or offcrcd for sah. If, howcver. thc building or improvcnrcnt is sold within onc )car of comphtion, the Owncr Buildcr will have thc burdcn of proving that hc or she did not build or improve the propcrty for thc purynsc of salc). -1. as owncr of thc propcrty, am cxclusivcly contracting with liccnsed contractors to construct thc projcct (Sec. 7W, Busincss and hofcssion Codc: The Contractor's Licensc Law does not apply to an owner of propcrty who builds or improves thcreon. and who conlracts for such projccts with a Contracto(s) liccnsed pursuant to the Contractor's Licensc hw). -lamcxclnptunderScction-.B.&P.C'forthisreason. Ownen WORKERS' COMPENSATION DECLARATION I hcrcby affirm undcr pcnalty of pcrjury onc of thc following declarations: _l havc ard will maintain a Certificate of Conscnt to Self-lnsure for workers' compensation. as provided for by Section 3700 of thc Code.for thc pcrformance of the work for which thc pcrmit is issucd. have and will maintain compcnsation insurancc. as rcquircd by a Sc.ction 3700 of the l,abor Code. for the pcrformance of rcarrier ard plicy number are:work for which this pcrmit is workers' compensation insurance Policy lcol'L _l ccrtity that in thc pcrformancc of thc work for which this pcrmit is issued. I shall not cmploy any pcrson in any manncr so as to bcconrc subjcct to the workcrs'comlrcnsation laws of California.agree that if I should bccomc subpct to the forthwith comply with thosc provisions..workcrs' comlrcnsation provisions of Section 3700 of the labor Code, WARNING:lo workers' compcnsation covcragc and shall ernployer to criminal penaltics and civil fincs up to thousand dollars ($100.000), in to damages as providcd for the Scclion and altorrrcy's fccs. - I hcrcby aflirnt undcr pnalty of prjury that I ant of Chapter 9 (comrnencing with Scction 7000) of Division 3 of thc Busincss and and my in full effect. , Liccnsc Numbcr: for the performance of thc work for which this pcrmit isI hereby affirrn undcr pcnalty of perjury that thcrc is a issucd (Scc. 3097, Civ. C.). Lcndcr's Nanrc: [,cnder's Addrcss: APPLICANT DECLARATION I hcrcby affirm undcr pcnalty of prjury onc of thc following dcclarations: Demolition Permits-Asbcstos Notification Fcdcral Regulations (Title 40, Part6) -Requircd L.ctter of Notification rcnmvalare not applicable to this projcct. that the above infornration is corrcct. I Applicanl or lcnding I)ernrilee nanre and hercby with and Dnrr nQ n7 On{ tr , UV''AA I -\