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APPROVALS DATE ID/SIG.J COMMENTSa Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm lDampers Communications Cable Buildinq Under Slab / Floor I I ttl Bonding I Grounding / UFER r ltO ")C)Mv!qA,6r Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment \ Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Rough Ceilinqs (T-Bar Rouqh)./ Meter Release [t',(r'w IJ,ryd,W6 i6\ Rouqh Service Meter r// F!NAL 'Yb'7'{)twuW t5tr Notes, Remarks, Etc. ) I hscby affm unda penalty of pc{ury that I m acmpt from thc Contraclon' Licere trw for thc followitrt Itotr (Se.7031.5 Buin6s md Profcsion Code): Any City or County which rcquire a pemit to @Ntruct, altq, imprcvq danolish or repair uy structuq Fior to its issumcc. also rcquira thc applicot for such pcmit to filc a signcd star@6t that hG or $c b licoscd pmusnt to thc provisiom of thc Contmtor's Liccnsed kw (Chapto 9, Commmcing with Sction 7000 of Division 3 of the Busincs md PrcfNionsCodc)orthathcorshciscxcmptthqcfromodthcbssisforthcallcgcdumption. AnyviolationofSctionT03l,5byany for a permit subjects the applicant to a civil penalty of not more than hve hundred dollars ($500). als owner of the property. or my ernployees with wages as their sole compensation. will do the work and the structure is not intendcd or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's License l-aw does not apply to an owner of the property who builds or improve theron, and who does such work himself or herself or through his or her own employees. provided that such improvonants are not intended or offered for sale. If. howerrer. the building or improvemcxt is sold within one ycar of complaion. the Orvner Builder will have the hrden of proving ttrat he or she did not build or improve the propoty for the purpose of sale). _1. as owner of the properly. am exclusively contracting with licersed contractors to construcl the project (Sec. 7044, Buiness and hnftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Contracto(s) licerued pumuant to the Contractor's License [aw). -l am exempt under Section-. B. & P.C. for this rcason. arr".? -^ ?-.2O 5o$e a ZP.,ufn n rir$ a o llr r r xFar-utl DECLARATION I hereby affrrm under penalty of pcrjury onc of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers'cornpensationr as provided for by Section 3700 of the L^abor Code, for the pcrformance of the work for which the pcrrnil is issued. _l have and will maintain workers' compensation insurancc. as required by Section 3700 of the l-abor Code, for thc pcrformance of the work for which this permit is issuod. My workers' compexsation insurance carrier and policy number are:t that in the performance of the work for which this permit is issued, I shall not anploy any person in any manner to the workers'conrpensation larvs of California.and agrec that ifr should bccome subject to the provisions of Section 3700 of the Lalrcr Code.shall.forthwith cornply rvith those provisions.. WARNING: Failure to secure workers' cornpensation covcrage is unlawful. and shall subject an onployer to crirninal poralties and civil fines up to one hundred thousand dollars ($100,000). in addition to the cost of compensation, darnages as provided for the Section 3076 of the Labor Code. interest and attorney's fecs. f DECI-ARATION I hercby affrrm under penalty of perjury that I am licensed under provision of Chaptcr 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class: License Number: CONSTRUCTION LEIIDING AGENCY I hrcby alfm unda pcnalty of pcrjury that thc is a onstrucrbn knding ag6cy for thc pqfol]mcc of thc wrk for which this pqnit i3 issucd (Se. 3097, Civ. C.). kndo's Nmc: Lender's Adclress: APPLICANT DECLARATION I trereby aftirm under penalty of perjury onc of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) _Required Later of Notification _l certify that the federal regulations regarding asbestos removal are not applicable to this project. above mentioned property for inspection purposes. or Agent Pernritee nAnle \ ELECTRICAL.I NSPECTOR RECORD Rev. OB-07-2015 Carrier:- Dale: Contrrctor: and ,' 2