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APPROVALS DATE ID/SIG.COMMENTS OWNERBUII,DERDELCARATION <br />'I hercby affrnr undcr pcnalty of pcrjury that I am excmpl frcnr lhe ContractoN' License hw for thc following rcason (Scc.7031.5 <br />liusincss and Prolession Codc): Any City or County which rcquircs a permit to construct, altcr. improve. dcm)lish o, rcpair uy <br />slruclurc, prior to ils isruance. also rcquircs lhe applicail fbr sucl [Emtt lo filc a si8rcd statcmil thal lE or strc b liccred pusumt <br />to lhc pmvisions of lhc Contractor's Liccnscd lrw (Chapte, 9. Commcncing with Scction 7m0 of Division 3 of thc Busircs ed <br />ProfessionsCode)orlhatheorsheisexempttherefiomardtlEbasisfortlEallegedex.mption. AnyviolationofsecrirtrT0Sl.5byany <br />applic.nt for 0 pcnnit subjccls the applicanl to a civil pcnally of not rrcre than [ivc hundrcd dollds ($500). <br />_1. as owncr ol thc prolrc(y. or my crnployccs with wagcs as thcir $lc compensation, willdo ttE work and fic stmw is mt <br />intcdcd or offercd for slc (Se.7(X4. Busincss and Profcssions Codc: Thc Coilraclor's Liccnsc Law d@s nol apply lo e ownc! of <br />thepNFny wlDhildsorinprcwslhcB)triuxlwlDdffiswlrworklrimelforherselforlhroughhisorhdrownenrployees, <br />providcd that such irn[trovcrrcils dc mt inlcrded orollercd for $lc. If, lb*ta. the hiiHiog or irprovcmnt is $ld wihin orc ]rd <br />ofconpbliotr th. Owrcr Buikkr will hsvc the burdcn ofprcving tlu hc or shc did mt buill o. itrprcvc thc pmpqty for lhc purpos of <br />sk). <br />_1. as owner of thc pmperly, am exclusivcly contracting wilh licenscd contmcloE to conslruct thc prcjcct (Sac. 7(X4. Business <br />arrl holL-sioilCode:TheContracbr'sLicenseLawdocsnotapplytouownerofprolenywhobuildsorimprovcsthe!@n. <br />and who conuacls for such projccls with a Contmcto(s) licc[ed pursldl lo lhc ConBador's Liccosc Law). <br />_l amerempt under Section_, B. & P.C. lbr this r.a$n. <br />woRKER"S', ('( ll\t PItNSA',ilON <br />I)}:CI-ARATION <br />I hcrcby affirm undcr pcnaltyofperjury onc ofthe following dcclaratioNj <br />-l <br />havc and will nuinlain a Cc(il'icalc of Conscilt to Self lnsurc for work6s'compcnsation, u pmvidcd for by Scction 3700 of the <br />Lnhor Codc, for the pcrforDurcc ofthc work lbr which thc p€rnlit is issued. <br />_l have ald will nrnirilrilr workers'illsurancc. as by Scction 3700 oflhe [:krr Code, for the perfomunce of <br />lhc axl lDlicy numbcr dr: <br />tlt'olicy <br />_l ccnify that ir lhc lrrli)rnuncc of tlrc work for which tlris pcrnrit is issocd, I shall not employ uy frcrson in any nranncr <br />$ as to bccom subjcc( (o thc workcm' conlpcnsation laws of Califomia, and agrec that if I s]nuld bccorre subjcct to the <br />wod(ers' conrpensalion prutisions of Scction l7m of the tibor C'ode, I slull, fonhwilh conrply with tho* prcvisions.. <br />WARNING: Failurc to *cure workcrs'compcnsation covcfrg. is unlawful, and shall subict sn cmploycr to ffiminal pcmlies ild <br />civil lliles up k) one huilred thousand dollars ($100.000). n1 lhc danugcs as providcd for lhc <br />Scction i and oltorrcy's <br />I hcrcby affirm under pcnalty of pcrjury thal I dnl [censcd undcr prcvision ofChapt.r 9 (comEncing with Setion 7000) of Division 3 <br />of thc Busincss and I'rcfessions Codc. arxl rnv license is in lull force and cffect. <br />0 t <br />,?_ <br />LiccrL\c Numb€r: <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby aflirm undcr p(nahy of perjury thd thcre is a con$ruction bnding agercy for thc pqlbrlrec of thc work for which this permit is <br />issuc'l (Scc. 1097. Civ. C.). <br />lrn,ler's NanE: <br />knder's Address: <br />@ISLPEE@I!q <br />I hor*ry aIlimundcr Fnally of perjury orc of the following d(kalionsl <br />DcnDlition Pern)its-Ashcsk)s Ndfication Fcdcral Regulatkrns (Titlc 40, Pd6) <br />_Rcquired [xncr of Notification <br />_l ccnily that lhc ladcralrcgulations rcgilding asbestos rcmoval dc not applicablc lo lhis pmj(t. <br />-l <br />cmify lhal I luvc rcad tlus applicalbn iuxl stale that lhc ak,vc with all Cily and County <br />and County to cntu uponthcordimmcs ild Statc [iws rcLaing to <br />abovc rrcntioned prupcny lor <br />IApplicxut or Agcnl <br />l'cmilcc ilame <br />and <br />Site-Work <br />Underqround <br />Pole Bases <br />Light 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 />Bondinq / Groundinq / UFER <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 />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rough) <br />l\tleter Release <br />Rouqh <br />Service Meter I <br />F!NAL 2/oz/z ,r4.D n.A,.fu/ ) <br />Notes, Remarks, Elc. /r- -.-/ <br />ELECTRTCAL.INSPECTOR RECORD <br />Rev.08-07-2015