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ELECTRICAL-INSPECTOR R ECOR D <br />APPROVALS DATE ID/SIG.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 lFlcr,r <br />Bondinq I Q{ou ndind I UFE R ( t ls-?(1lc ?) <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Nleter Release lo49 zt tl>cZ r) <br />Rough <br />Service Nleter d <br />FINAL / o )-{'-2'1 k 25 Y€iaS 'Zt:l <br />Notes, Remarks, Etc <br />' -a' <br />( <br />OWNER ITTIILI)T.]R <br />I hcrcby aflirm undcr pnally of prjury that I en excmpt fmm the Contractos' Liccns llw for thc following rcasn (Scc.7031.5 <br />Busincss rrxj Profcssion Codc): Any City or County which rcquircs a lErmit to construct, altcn improvc. dcmlish or rcpair any <br />structurc. prior to its issumce, ols rcquircs thc lpplhatrt for such Frmit to lilc a signed statcmnt that hc or shc is liccn$d pusuoht <br />lo thc previsions of thc Contrrctor's Licensd law (Chtrptcr 9, Comncing wilh SNtion 70fi) of Division 3 of the Busincss md <br />PrcfcssionsCodc)orthathcorshciscxcmptthcrcftomandthcbasislbrthcallcgcdcrcmption. AnyviolalionofSetionT03l.5byany <br />applicant for a 1rcrmit subjects the applicant to a civil pcnalty of not mre lhan fivc hundrcd dollus (3500). <br />_1. as owncr of thc propcrty. or my cmployccs with wagcs as thcir rcle compcnsation. will do thc work and thc structure is not <br />intcndcd or ofl'cred for salc (Scc.704+. Busincss and hofcssions Codc: The Contraclor's Liccnsc l-aw docs not apply to an owncr o[ <br />thc propcrty who builds or ilnprovcs thcrcnn. and who does such work himself or hcrsclf or through his or hcr own cmployccs. <br />providcd that such improvcmcnts arc not intcnded or offercd ltlr salc. Il, howcvcr. thc building or improvcrncnt is sold within one ycar <br />of complction. thc Owncr Buildcr will havc thc burden of proving that hc or shc did not build or inrprovc the propcny for the pur;nsc of <br />salc). <br />-1, <br />as owner of thc property. am exclusivcly contracting with liccnscd contraclors to construct thc project 1Scc. 7W, Business <br />and Prrofcssion Code: The Contractor's Liccnsc Law does not apply lo an owner of property who builds or improves thcrcon. <br />and who contracts for such proiccts with a Contractor(s) liccnscd pursuant to thc Contractor's License hw). <br />-l <br />am cxcmpt under Section-. B. & P.C. for this reason. <br />Date:_ <br />WORKERS' COMPENSATION <br />DECL^ RATION <br />I hcreby alfirrn undcr Jrcnalty of perjury onc of the following dcclarations: <br />_l havc and will nraintain a Ccrtificate of Conscnt to Sclf-lnsure fbr workers' conrpcnsation, as providcd for by Section 3700 of thc <br />l-abor Codc, for thc pcrformance of thc work for which thc pcrrnit is issucd. <br />_l havc and will maintain workcrs'37fi) of the Labor Codc. for the performancc of <br />the work tbr which this perrnit and grlicy numbcr arc: <br />Policy <br />_l ccrtify that in thc pcrforrnancc of thc work for which this permit is issucd, I shall not cmploy any pcrson in any manner <br />so as to bccome subject to thc workcrs' compcnsation laws of California. and agrcc lhat if I should become subict to thc <br />workcrs' comlrcnsation provisions of Scction 3700 of thc L^abor Codc. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failurc to sccurc workcrs'compensation covcragc is unlawful. and shall subjcct an cmployer to criminal pcnaltics and <br />civil fincs up lo one hundrcd thousand dollars ($100,000). in addition to thc cost of com[rcnsation. danragcs es providcd for thc <br />Scction thc intcrcst and attorney's <br />I hercby all-rnr undcr penalty of prjury that I am liccnscd <br />DECLARATION <br />undcr provision of Chaptcr 9 (commencing with Section 7000) of Division 3 <br />of thc Busincss and Professions Codc, and my licensc is in full force and cffcct.(e <br />Liccnsc <br />W <br />I hcrcby affum undcr pcnalty of perjury that thcrc is . @nslMtlrtr bnding agcncy for lhe psforlrlffie of lhe mrt for which this gnririt is <br />issued (Ss. 3097, Civ. C.). <br />t <br />lrnder's Addrcss: <br />APPLICANT DF'CLARATION <br />I hcrcby affirm under pcnalty of pcrjury onc of the following declarations: <br />Demolition Pcrmits-Asbestos Notification Fcderal Rcgulations (Titlc 40, Part6) <br />_Rcquircd Lrttcr of Notification <br />-l <br />ccrtify that thc federal rcgulations rcgarding asbcstos rcunvalarc not applicablc to this project. <br />_l ccrtify that I havc rcad this application and state that lhc atxrvc information is correct. I agrcc to comply with all City and County <br />above mcntioncd propcrty for <br />Applicant or Agcnl <br />Pernritee name <br />construction. and hcrcby authorizc rcprcscntatives of this City and thc <br />[J,^'rr na n7 On'l tr <br />L <br />_Expircs: