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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG-COMMENTS OWNER BUILDER DELCARATION t hereby affm unds penalty of perjury lhat I an exempt fronr the Contracton' Lic6e Law for the following reNn (56.7031.5 Buines od Profcsion Code): Any City or Counly which rcquiro a ponit to construct, altq. improvc. dmolish or rcpair my structuc, prior lo its isuance, also reluirs the applicmt for such pqmit to file a signcd slatmmt that he or she Ls licensed pumuilt to the provisioN of the Contractor's Liccnsed [aw (Chaptq 9, Commencing wilh Sstion 7000 of Division 3 of the Business od Profesions Code) or that he or shc is exempt thgefrom ild the b6is for the alleged exmplion. Any violation of Sation 70.31.5 by any applicantforapemitsubj(tsthe applicanttoacivilpenaltyofnotrnorethmlivehundreddollas($500). I. m owna of the propâ‚¬(y. or my employs with wages I their slc compensation, will do the work od the structuc is not intodsl oroffoed for sle (58.7044. Busins md Prof*iom Codq The Conlraclor's Licrue law do6 not apply to il ownq of lhepopeny whobuildsorimprovsthsan.adwhodo6suchworkhimselforherselforthroughhisorherownemployee. provided that such inprovsnols &c not intmdol oroflsed for sle. If. howwq. the building or improvmmt is sld within one yw ofcomplc,tion. the Ownq Builda will have the budo ofproving that he or she did not build or improve the prcpoty for the putpose of elc). _1. 6 o$Ts of the propo'ly. m excluively contracting wilh licrued contracloElo coNtrucl the projel (Sq- 7044. Buins ed kol6sionCodei'fheCoilractor'sLicenseLawdo6notapplytoeown6ofpropertywhobuildsorimprovesths@n, and who contracts for such projats with a Contmoo(s) licmed pursuml 1o lhe Contraclor's LiceN trw). I m cxemDl undcr Setion-, B. & P.C. for this r6on. I)a(c: WORI(ERS' COI\TPENSATION DECLARATION I hceby affrm unda penalty ofpojury one ofthe following delaatiom: _l havc md will mainrain a Cdificale of CoNent to Self-l6uc for work6' compcnsalion. c prcvided for by Setion 3700 of the Labor Codc, for the pofonnmce of the work for which the ponit is issucd. il have and will maintain workers' compeBation insurancc. I required by S*tion 3700 of thc kbor Code, for thc pqfomocc of thc work for whiEb this p6mit is issued. My work6' compcrodion iruurilcc mio md policy numbq ile: Policy -l cenify that in the psformance of the work for which this ponrit is issued, I shall not qrploy any pmon in any rnmncr s 6 to bscornc subjsl to lhe workm' compcnstion larvs of Califomia, od agre that if I should become subjcl lo lhc workm' compensalion provisions of Srlion .1700 of the Labor Code. I shall. fonhwith comply with thos provisiss.. WARNTNG: Failure to sure workqs'compcnsation covcrage is unlawful, and shall subject an enployer to siminal pqnltis and civil ftncs up to one hundrcd thouwd dolles addition to the cost of compeNlion, d@gcs a providcd for thc Sstion 3076 ofthe Labor Code.md attomey's TlL,''. Co.e I lc"- I, IC E N S d]rt'O N'I' RA CiO R DLCLARA'I'ION I hrcby affrm undtr poahy of psjury that I an licmsed under provision of Chapto 9 (commencing with Section 7000) of Division 3 of the Busin6s ild Profsiom Code, md my licose is in full force md effect. lgzsxLiceme Class:e fo CONSTRUCTION LENDING ACENCY I hoeby aflim undo pnahy of perjury that thffe is a coBlnrction lending agocy for the pdfonruce of the work for which this pmit is issucd (Se. 3097, Civ. C.). I4ndq's Nmc: - l.cnder's Addrcss: APPLICANT DECLARATTON I hsdyafinn undq pcnalty ofpojury one ofthe following d(luatioos: Demolition Psmits-Asb6los Notification Fedtral Rcgulations (Tillâ‚¬ 40, Part6) -Rcquired Lett6 of Notification -l cdiry that the fedgal regulatiom regrding obctos rmoval ue not applicablc to this prcjat. y'! ,aity *utl have read this application &d state that the abovc infomation is corct. I agre to comply with all City and Coun(y ordinancs ud State Laws relating to buildinS coNtruction. ild htrcby authorize reprecntatives ofthis City ed County to flttr upon the above mfllioned propcaty for a4Applicant or Agrilt I I'rrnrilrc ) owt*n^-l.lo, r l)ate:O1 o Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bondinq / Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) Meter Release Rough ,-?-o.aa \^--C Service Meter \v- raz^ FINAL L-7^-2o / Notes, Remarks, Etc. Rev.08-07-2015 c*ro, S4atf-Ee,.qd