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ELECTRICAL.INSPECTOR R ECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affrm under Jrcnslty of pcrjury that I m crcmpt frcm the Crntracton' Liccns kw for the following rc8sn (Scc.7031.5 <br />Busincss and Profcssion Codc): Any Ciry or County which rcquircs a pemit to snslruct. alts, improrc. dcmlish or rcpair 4y <br />structre, prbr to its issure, also rcquircs the applicant for such permit to file a signcd statcrcnt th.t lE or shc is licen*d pusumt <br />to thc prcvisions of thc Contractor's Licensd kw (Chaplcr 9, Comncing with S$tion 7000 of Division 3 of the Business ed <br />PrcfcssionsCodc)orthalhcorshciscxcmptthrcfrom.ndthcbasisfortheallcgcdcxcmption, AnyviolationofSectbnT03l.5byany <br />applicant for a pcrmit subjccts thc applicant to a civil pcnolty of not mrc than Iivc hundrcd dollus ($50O), <br />-1. <br />as owner of the propcrty. or my cmployecs with wagcs as thcir sole compcnsation. willdo thc work and the structurc ls not <br />intendcd or otTcrcd for sale (Scc.7044. Business and Profcssions Code: The Contraclor's Liccnse kw does not apply to an owncr of <br />thc propcrty who builds or improvcs ttrcreon. and who docs such work himsclf or hcrsclf or through his or her own employccs. <br />providcd that such improvcnrcnls are not intcndcd or offcrcd for sale. lf, howcver. thc building or improvenrnt is sold within onc )rar <br />of conqrhtion, the Owner Buildcr will have the burden of proving thal he or she did not build or inprovc thc property for the purSnsc of <br />salc). <br />_1. as owncr of thc propcrty. am cxclusively contracting with liccnscd contractors lo construct thc projcct (Sec. 7W, Busincss <br />and krofession Codc: The Contractor's Liccnsc Law docs not apply to an owner of propcrty who builds or improvcs thcrcon. <br />and who contracts for such projects with a Contractor(s) licenscd pursuant to the Contractor's License Law). <br />-lamexcmr,tundcrScctiott-.B.&P.C.forthisrcason.Dale: Owner:- <br />UAUE&LCOMTENSAIIQN <br />DECI.AMtrON <br />I hcrcby affum under pmlty of prjury orc of the followhg delantbns: <br />-lhave{dwill <br />mintsinsCertifrcatcofConsnttoSelf-lnsurcforwork6'cotr{Enstion,as prcvidedforbySction3T00ofthe <br />tibor Codc, for thc IErformrce of the work for which thc pcrmit is issucd. <br />_l havc and will maintain workcrs' comlEnsstion insurorcc, s rcquircd by Setion 3700 of thc Lrbor Code, for thc pcrforlMcc oh <br />thc work for which this permit is issucd. My workc$' @r{rcnsation imurarce tricr rnd policy number rc: <br />cmier: Alt:-4 l*r,waqto fuqr.t. l*. <br />?.Policy cA, Jooo lo zv zo I to -, -zo2l <br />_l ccrtify that in thc pcrt'orrnancc of thc work for which this pcrmit is issucd. I shall not employ any person in any manncr <br />so as to becomc subjcct to lhe workcrs' compensation laws of California, and agrec that if I should bccome subjcct to the <br />workers' conrpcnsation provisions of Section 3700 of thc Labor Code, I shall, forthwith cornply with thosc provisions.. <br />WARNING: Failurc to sccurc workers' compcnsatiorl covcragc is unlawful. and shall subjcct an cmploycr to criminal pcnaltics and <br />civil fines up to onc hundred thousand dollars ($100.000). in addition to the cost of compcnsation, damages as providcd for thc <br />Scction 3076 of thc Lrbor Codc, interest <br />t- F3' ?oal <br />DECI-ARATION <br />I hereby affirm under penalty of pcrjury that I am licensed undcr provision of Chapter 9 (commcncing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my liccnsc is in full forcc and cffect. <br />License ctors OA Liccnsc Number:tl 70 <br />zo. I Contraclor: <br />W <br />I hcrcby afILm undcr Fnalty of Jrrjury that thsc is s @nstruction hnding sgcrcy for thc pcrfomnce of thc work for which this pemil is <br />issued (Scc. 3097, Civ. C.). <br />[-ender's Nanre: <br />Lcnder's Addrcss: <br />APPI TCANT DECLARATION <br />I trrcby affrm undcr pcnalty of perjury one of thc following dcclarations: <br />Demolition Permits-Asbcstos Notification Fedcral Rcgulations (Title 40, Part6) <br />_Rcquired lrttcr of Notification <br />-l <br />certify that thc l'cdcral regulations rcgarding asbcslos rcmovalare not applicablc to this projcct. <br />_l ccnify th{t I huvc rcad this application od statc lhut thc trtDvc informtion is corccl. I agle lo comply with sll Cily snd County <br />ordinorccs and Statc bws rclating to building construction. and hcrcby authoria rcprcrcntativcs oflhis City and County Io cnls utpn thc <br />ahnvc mcntioncd propcrty ttlr <br />Applicant or Agent Dare: 7'lt'2o2, <br />Pernrilee name ( print ):T--n. D- }lbvi;t <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Groundins / UFER <br />Transformers <br />Torqueinct <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Nleter Release <br />Rouqh <br />Service lVleter I <br />FINAL l€l{17 b{dd-6 <br />Notes, Remarks, Etc. <br />Dn.no n7 .,n{ tr