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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding I Grounding I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) N/eter Release Rouoh Service JVleter FINAL //,Za ,Zo P-, A /St lf'tzrrS * krl Notes, Remarks, Etc. OWNE,R BUILDER DIiI,CA RATION I hereby affrnr under penalty of prjury that I arn exenrpt from the Contractors' License law for the f<rllowing reason (Sec.7031.5 Business and Prolbssion Codc): Any City or County which rcquircs a pcrmit to construct, altcr. i:nprove. dcmolish or repair any strucrure, prior to its issuance. also requires the applicant for such grernrit to file a signed statenEnt that lr or she ls licensed pursuanl to the pmvisions of thc Contraclor's l,icenscd l.aw (Chaptcr 9. Commcncing with Section 7000 of Division 3 of thc Busincss and Professions Code) or that lre or she is exempt tlrerefronr arxl tlre basis for the alleged exenption. Any violation of Seclion 7031.5 by any applicant for u perrnit subjects the applicant lo a civil pcnalty of not more than five hundrcd dollars ($stltt). _1. as owner ol'thc propcrty. or my cmployccs with wagcs as thcir snle compcnsalion, willdo the wcnk and thc stnrcturc is not interxled or offeretl ftrr sale (Sec'.78+. Business and Professions Ctxle: Thc Contraclor's Licensc Law docs not apply to an owner of the property wlxr builds or inrproves thereou, and wln does such work himself or lrerself or through his or her own entployees, providcd that such irnprovcrrcnts are not intcndcd or olhred for sale. Il, howevcr, thc building or irrprovcrrcnt is sold within onc ycar of completkrn, thc Owner Builder will havc thc burden of pmving ttrat he or she did not buikl or impnove tlrc propcrty for thc purposc of sah). _1. as owner of the property, am exclusively contracting with liccnsed contraclors to construct the project (Sec. 7(X4, Business arxl hrolbssiorr Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracls for such projccts with a Contractor(s) liccnsed pursuanl to the Contraclor's Liccnsc Law). -l am exempt under Section-, B. & P.C. for this reason. WORKERS' COMPENSATION DECLARATION I lrt'rcby atlirnr undcr pcnalty of pcrjury one of tlte t'ollowing dcclarations: _l have and will nuintah a Certilicate of Consent to Self-lnsure for w<lrkers' cortqEnsation, as provided f<lr by Section 3700 of the Labor Codc, for the Jrcrfornurrcc of thc work for which thc Jrcrmit is issued. _l have and will nuintain workers' conqrcnsation insurance, as required by Saction 3700 of thc l-abor Code, for tlrc perfornrarce of thc this 1rcrrrilt is issucd. My workcrs' con4rcrxation insuramcc can'icr and plicy numbcr iue: Policy -{0rz/tr _l ccrrify that in tlrc pcrfornuncc of thc work for which tlris pcrmit is issucd, I shall not cmploy any lrcrson in any manncr so as to bcconrc subjcct to the workcrs' comgrcnsation laws of Califomia. and agree that if I should beconre subject to the workers' conrlrcnsation provisions of Section 3700 of the Labor Code, I shall, forthwith comply wilh those provisions.. WARNTNG: Failure to secure workers' comlrcnsation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one lrundred thousand <lollars ($100.000). in addition to lhe c<lst of competrsation, danrages as provided for the I hcreby affirrn under ;rcnalty of perjury that I anr licensetl untler pruvision of Chapter 9 (contnrencing with Section 7000) of Division 3 and effect. o*", l'l?')o:b coNS'l'RU("ilON LENpIN(; AGFrNCY I hcrcby allrrm undcr p^-nalty of pcrjury that thcrc is a construction hnding agcrrcy for the pcrlbrrnarrcc of the work lbr which this pcrmit is issued (Sec. 3097, Civ. C.). Lcnder's Name: A PPLICANT DECI,ARATION I hxcby aflirnr under pcnalty of pcrjury one of thc following declarations: Dcnnlition Pcrnrits-Asbcstos Notification Fcdcral Rcgulations (Title 40, Part6) -Rcquired [rttcr of Notification _l ccrtily that thc fcdcralregulations asbcstos rcmoval iuc not applicable to this proi'ct. -l ccrtily tlut I havc rcad this with all City and County County to entcr upon thc above rnentioned property for Applicant or Agent Pcrmitcc namc that thc rcprcscntativcs ev. 08-0 -201 5 of the Business and Professions Code.and rny {t20t3c t ,(