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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNIE,R B UILDIiR DELCA RATION I hereby affirnr under penalty of perjury that I arrr exempt fronr the Contractors' License l-aw for the following reason (Sec.7031.5 Busincss and Prol'cssion Ccxle): Any City or County which requires a pcrmit to construct, alter, irnprove, demolish or rcpair any structure, prior to its issuance. also requires the applicurt for such Jrernrit to file a signed statemenl that lte or she is licenscd pursuant to thc provisions of the Conlractor's l,icensed I:w (Chapter 9. Commencing with Scction 7fiX) of Division 3 ol'the Business and Professions Code) or that he or she is exempt therefronr and the basis for the alleged exenrption. Any violation of Section 7031.5 by any applicant for a pennit subjects the applicant to a civil penalty of not more than live hundred dollars ($500t. _1, as owner ol'thc property. or my employccs with wages as their sole compcnsation, willdo the work and the structure is not interxlctl or offered for sale (Scc.70,14. Business anrl Profcssions Code: The Contractor's Licensc [-aw docs not apply to an owner of the pnrgrerty wlro builds or inproves tlrereorl arxl wlro doe.s such work himself <lr lrerself or through his or her own entployees, provided that such improvcrrcnts are rnt intendcd orolTercd for sale. If, however, tlrc hrilding or inprovenrnt is sold within onc )tar of conrpletiorl thc Owner Buildcr will havc the burden of proving that hc or strc did not buikl or inrprove thc propaty for thc purposc of sah). _I. as owner of the properly, am exclusively contracting with liccnscd contractors to constn ct thc projcct (Sec. 7044. Busincss and hofession Code: The Contractor's License Law does not apply to an owner of proprty who builds or improves lhereon. and who conuacts for such pro.iects with a Contractor(s) licenscd pursuanl to the Conuaclor's License kw). -IantexemptunderSectiott-,B.&P.C.lbrthisreas<rn. WORKER,S' COMPENSATION DECLARATION I hereby aftirm undcr penalty of perjury one of the following declarations: _l have and will nraintain a Certificate of Conscnt to Sclf-Insure for workers' comJrcnsation, as provided for by Scction 3700 of the I-abor Code, for thc performance of the work for which the prmit is issued. _I have and will nuintain workers' conpensation insurance, as required by Saction 3700 of thc l-abor Codc, for thc perfornunce of thc work for which this Jrcrmit is issucd. My workers' compensation insurancc carrier and policy number are: Policy _l ccrrify that in tlrc lrlfornuncc o[thc work for which this pcrnrit is issucd, I shall not employ any lrcrson in any manncr so as to becomc subject to thc workcrs' compcn$ation laws of Califomia. and agree that if I slnuld bccorne subject to thc workers' compensation provisions of Section 3700 of the labor Crxle, I shall, forthwith comply with thosc provisions.. WARNING: Failure to sccure workers' compensation coverage is unlawful, and shall subject an cmploycr to criminal pcnahies and civil fines up to one hundred thousand dollars ($100.000). in addition to lhe c<lst of compcrsation, danuges as provided for the Section 3076 of thc Labor Code, intcrcst and attorrrcy's fecs. LICENSED CONTRACTOR DECI.ARATION I hercby affrm unrler pnalty of perjury that I anr licensctl under provision of Chapter 9 (conurrncing with Scction 7000) of Division 3 of the liusiness and Professions Code. and my license is in full force and effect. License Number: Date: CONSTRUCTION LENDING AGENCY I hereby affirm undcr pcnalty of perjury that thcre is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ. C.). lrnder's Name: APPI,ICANT DECLARATION I tucby aflirm undcr pnalty of pcrjury onc of thc following declarations: Dcmolition Pernrits-Asbcstos Notification Fedcral Regulations (Titlc 40, Part6) -Rcquircd l,cttcr of Notifrcation _l ccrtily that thc fedcral rcgulation.s rcgarding asbcstos removal are not applicable to this project. _l ccrtify tlrat I havc read this applicalion uxl statc tlral thc abovc information is corrcct. I agrec to comply with all City and County ordinanccs and Statc [.aws rclating to building construction and hercby authorizc reprcscntatives of this City and County to enter upon thc abovc rncntioned property for inspection purposcs. Applicarrt or Agent Date:- Pcrmitee name (print): Site-Work Underqround Pole Bases Light Standards Spas. Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor , Bondinq I Groundino I UFER q 2t ?0 Df i"\tfl 5 naul.rn (Wf) Transformers Torqueinct Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit)I I Walls (Rouqh)().hru6 7 Ceilings (Hard & Soffit Roush Ceilinss (T-Bar Roush)I t Meter Release '18 Lo etrryd I I Rouqh I I Service Meter a l tPs% FINAL I I Notes, Remarks, Etc Rev. 08-07-2015 L il l5 l7)_