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ELECTRICAL.I NSPECTOR RECORD () -rt nQ n7 1n,t s. APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION ' I hseby affum undtr pmlty of perjury that I m cxmpt from the ContractoE' LiceN law for thc following |@n (5(.7031.5 Busins ard Profesion Codc): Any City or County which rcquts a pcmh to coNtruc1. altq. improvq dcrnolish or rcpair my structue, frior to its issuucc, also require the applicot for such pcmit to filc a siSncd statmot that hc or shc is licffcd plmut to thc provisios of thc Contrsctor's Licased taw (Chaptc 9. Commcncing with S(tion 700O of Division 3 of thc Busine ud Prof*sionsCode)orthathcorshcisexcmptthccfromadthcbasisforthcallegedcrmption. AnyviolationofS6{ion703l.5byany applicail for I prmit subjccls thc applicilt to a civil penalty of not more thil five hundrcd dollus ($500). _1. as o\\'ner of the property. or my employees with wages as their sole compensation. rvill do the work and the structure is not intended or offered for salc (Sec.7044. Business and hofessions Code: The Contraclor's License Law does not apply to an owncr of the properry who builds or improves theron. and who does such wolt himself or herself or through his or her own employees, providd that such improvancnts are nol intendd or offered for sale. l[, howwer. the building or improvemert is sold within one ]â‚¬ar of cornplaion. the Orvner Builder will have the burden of proving tha he or she did not build or irnprove the propa'ty for the purposc of sale). -1. as owner of the propcrty. am exclusively contracting rvith licensed contractors to construct the gnoject (Sec. 7M4. Business and ttoftssion Code: The Contractor's License Law does not apply to an orvner of property who builds or improves thereon. and who contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License Larv). _l am exempt under & P.C. for this reason.,? I hereby a{Tirm under penalty of perjury one of the _l have and will maintain a Ceflificate of Consent to for rvorkers' cornpensation. as provided for by Section 3700 of the Labor Code. for the perfonnance of the work for which the pennit is issued. -l have and rvill rnaintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the perlormance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Policy Number:Exoires: _l cerrify that in the perfornrance of the work for u'hich this pernrit is issued. I shall not ernploy any person in any manner so as to become subject to the rvorkers'compensation las's of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall. forrhrvith comply with those provisions.. WARNING: Failure lo secure rvorkers' compensation coverage is unlarvful. and shall subject an anployet to criminal penalties and compensation. damages as provided for thein addition to the cost of Section -3076 of the interest and I hereby affrrm under penalty of pajury that I arn provision with Section 7000) of Division -3 of the Business and Professions Code. and rny license is in force and Liccnse Class:-I-icense Number: I)alc: W I hrcby allirm undr pcnalty of pqjury that thqe is r construction lending agacy for thc pqfomucc of thc work for which this pqmit b issucd (Se. 3097. Civ. C.). Lender's Narne: Lender's Address: APPLICANT DEC LARA'IION I hereby affrrm under penalty of perjury one of the follorving declarations: Dernolition Permits-Asbcstos Notification Federal Regulations (Title 40. Pan6) -Required Letter of Notiflrcation ra -l cerrify that the federal regulations regarding asbestos removal are not applicable to this project.a rvith all City and County and County to entef, upon the above mentioned property for Applicnnt or Agent Permilee nflme (print): purposes. Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm I Dampers Communications Cable Buildins Under Slab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilinss (T-Bar Rouqh) Jvleter Release Rough Service Meter ./I FINAL ////7/z*4,o 4)4h4 o Notes, Remarks, E(c. t l\--l 1,.- "^'"''Df 4'201 7 Carrier:_ (lontractor: MtAify that I have read this application ordinances and State Laws relating )