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ELECTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hacby affm undcr poalty of pqjury that I m excmpt from thc Contractor' Liccmc Law for thc follorving rcen (5(.7031.5 <br />Buines od Profcssion Codc): Any City or County which rcquira a pamit to costruct. alt6. improvq dmolish or rcpair my <br />strucluc. prior to its issuucc, dm rpquiro the applicmt for such pcrnit to filc a signsd stalmmt thal hc or shc is licemcd pmuant <br />to thc prcvisiom of the Contractor's Liccnsed l:w (Chapttr 9. Conmcncing with Setion 7000 of Division 3 of thc Buins md <br />Prof*ions Codc) or that hc or shc is qmpt tha€from md thc besis for the allcgcd crmFion. Atry violstion of Sccrion 70-l1.5 by any <br />applicantforapcmitsubjctsthc applicmttoacivilpenattyofnotmorcthmfivchundrcddollus($500). <br />-_1. <br />as owner of the property. or my employees with wages as their sole compensation. will do the rvork and thc structure is not <br />intended or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's License Law does not apply to an orvner of <br />the property who builds or improves thereon. and who does such wort himself or herself or through his or her orvn employees. <br />providd that such improvements are not intended or offtred for sale. lf. horvev€r. the building or improvemcnt is sold within one )car <br />of complaiorL the Orvner Builder will have the hrrden of proving that hc or she did not build or improve the propa'ty for the purpose of <br />salc). <br />____1. as owner of the propoly. am exclusively contracting with licensed contraclors to construct the project (Sec. 7044. Business <br />and ttofession Code: The Contractor's License Law does not apply to an owner of property rvho builds or improves thereon. <br />and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License Law). <br />_l am exempt B. &.P.C. for this tl)rlc:q Lv * <br />I)D(ll,AltrVI'l0N <br />I hereby alTirm under penalty of perjury one of the following declarations: <br />-l <br />have and rvill maintain a Cenifrcate of Consent to Self-lnsure for rvorkers' compexsation. as provided for by Section 3700 of the <br />Labor Code. for the performance of the rvork for rvhich the perrnit is issued. <br />-l <br />have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code, for the pcrformance of <br />the work for which this permit is iszued. My workers' compensation insurance carrier and policy number are: <br />Carrier: <br />Policy Number: Expires: <br />_.-l certify that in the performance of the work flor which this permit is issued. I shall not employ any person in any manner <br />so as to become subject to the work€rs' compensation laws of California. and agree that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvith cornply u,ith those provisions.. <br />WARNING: Failure to sccure rvorkers' compensation is unlawful. and shall subject an onployer to criminal petr,alties and <br />civil fines to one hundred thousand in addiliqn to the cost of compensation. <br />,:,5',- <br />as provided for the <br />Section Labor Code. interest and <br />72'dl o(t <br />I hereby affirm under panalty of perjury that I am licensod under provision of Chapter 9 (commencing with Sc'ction 7000) of Division 3 <br />of the Business and Professions Code. and my license is in flull force and effect. <br />Date: Contrector:_ <br />W <br />I hccby alfrm undu pcnalty of pqjury that th6c is 8 srutruclion loding agmcy for thc p€rformcc of lhc work for which this p6mit b <br />issued (Sa. 3097, Civ. C.). <br />l-ender's Name: <br />Lender's Address: <br />APPLICANT DECLARATION <br />I horby affirm under penalty of perjury one of the following declarations: <br />Demolition Permits-Asbcstos Notification Federal Regulations (Title 40. Part6) <br />_Required letter of Notification <br />-l <br />ccrti& that the federal regulations regarding asbestos removal are not applicable to this project. <br />-l <br />certi& that I have read this application and state that the above information is correct. I agree to comply with all City and County <br />ordinances and State Larvs relating to and hereby represmtatives of this City and County to etter upon tlrc <br />above mentioned property for <br />Applicant or Agent <br />Permilee nRme (print): <br />V <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm I Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Roush) <br />lvleter Release <br />Rough <br />Service Meter /I -- <br />FINAL /t 721*oo -rffi ) <br />T ./Notes, Remarks, Etc. <br />L <br />License Class: License Number: