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ELECTRICAL.I NSPECTOR R ECOR D APPROVALS DATE ID/SIG.COMMENTS OWNI',R B UII,DI'R DIiI,CA ITATION I hcreby affrm untler penalty of frjury that I arn exenpt frorn the C:ontractonr' License I:w f<rr the following rcason (Sec.7031.5 tlusincss and Profcssion Codc): Any City or County which requircs a permit to construct, altcr, itnprovc. dcmolish or rcpair any strucrure, prior to its issuance. also rcquires the applicant for such pernrit to file a sigrrcd slatement lhat lre or she is licensed pursuant to the pmvisions o[ tlr Contractor's l,iccnscd law (Chaptcr 9, Commcncing with Section 7fiX) of Division 3 of the Busincss and Professions Code) or that he or she is exenpt tlrerefronr arxl tlre basis for the alleged exenrption. Any violation of Section 7031.5 by any applicantforaperrnitsubjectsthe applicanttoacivilpenaltyofnotmorethanllvehundreddollars($500). _1. a-s owner of thc propcrty, or rny ernployecs with wages as their solc compensation, will do thc work ard the structure is not interxletl or offered ftrr sale (Sec.7tXa, Business and Professions Codc: The Contractor's Licensc Law does not apply to an owner o[ the proprly wlrc builds or imgnoves thereon, and wlro docs such work himself or lrerself or through his or her own enrployees, provided that such impmvcnrents arc not intendcd oroffcred for sale. I[, howcvcr, 0rc building or inprovenrcnt is sold within one ]aar of completiotL the Owrcr Buikkr will have the burtlen of proving that he or she did mt build or improve tlrc prcperty for thc purposc of sah). _1. as owner of the pmperty, am exclusively contracting with liccnsed conlractoni to conslrucl thc projcct (Scc. 704+, Business ard hofr:ssion Code: The Contractor's License l-aw does not apply to an owner of prolrcrty who builds or improves thereon. and who contracts for such prcrjccts with a Contractor(s) licensed pursuant to thc Contrector's Liccnse l-aw). -l anr exempt under Section-, B. & P.C. for this reason. WORK ERS' COM PIINSATION DECLARATION I hereby aftirm under pcnalty of pcrjury onc of thc lbllowing declarations: _l have arxl wilt nraintain a Certificate of Consent to Self-lnsure for workers' compensalion, as provided for by Section 3700 of the Labor Code, for thc Jrcrformance of the work for which thc pcrrnit is lssued. VI hur. aml will nuintain workers' conrpensation insurance, as required by Seclion 3700 of the Labor Code, for the grcrforman"^e of are:tlrc is issucd. My workers' conrpensation insurancc carricr arxl plicy numbcr d Firo o^J Celteq [t.o T Policy OF W r3 \a t t ?-l _l ccrtify that in thc lxrftrrnuncc of thc work for which this 1rcrmit is issucd, I shall not employ any person in any nrallncr so as to bccorne subject to thc workcrs' cornlrcnsalion laws of California. and agrce that if I should becotnc subjcct to the workers' conlpensation provisions of Section 3700 of the Labor C'ode, I shall. forthwith conrply with thosc provisions.. WARNING: Failure to sccure workers' compensation coverdgc is unlawful, and shall subject an employer to crirninal pcnahics and civil tirrcs up to one hundred thousand dollars ($100.000). in tlre cost of compensation, danuges as provided for lherlattorney's l'ecs. a DECI,ARATION I hercby affrnr untler penalty of pcrjury that I anr licensetl under provision of Chapter 9 (cotturpncing with Section 7000) of Division 3 of the Business and Professiorrs Code. and my license is in full force and effect. Licerxe -b /cto ,l0?.q bl.t ,t CONSTRUCTION LENDING AGENCY I hercby aflirm undcr pcnalty of pcrjury that thcre is a construction lcnding agcncy for thc performancc of the work lbr which this permit is issued (Sec. 3097, Civ. C.). knder's Name: A PPI,ICANT DECLARATION I hrchy allirnr under Jrcnalty of perjury onc of thc following dcclarations: Demolition Permits-Asbcstos Notification Fcdcral Regulations (Titlc 40. Pan6) -Requircd lrttcr rtf Ntlification _l ccrtily that thc fcderal regulations rcgarding asbcstos rcmoval arc not applicablc to this projcct. t$+*"nilty that I lravc rcad this application uxl statc that lhe abovc infrrrmarion is corrcct. I agrce to conrply with all City antl County ordinanccs and Statc Laws rclating to hcreby auttnrize reprcscntatives of this City and County to cntcr upn thc above rnentioned propeny for inspection ,[lApplicant or Agent Pcrnritec namc a q LD Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding I Grounding I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Rough) Ceilinss (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) Meter Release Rouqh Service lVleter I FINAL t//o ?/tn*r, /#W/,/ Notes, Remarks, Etc. ' '// \'J vl/ Rev. 08-07-201 5 o