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ELECTRICAL.I NSPECTOR R ECOR D APPROVALS DATE ID/SIG.COMMENTS ,,n", ro*i?ffi1'l3l',L'.1*lH'f}* law ror the rorrowins reason (sec.703r.5 Business and Profession Code): Any City or County which requircs a pcrmit to construct, altcr, improve, demolish or repair any structure, prior to its issuance. also requires the applicant for such pcnrrit to file a signed statemenl that lre or she is licenscd pursuant to the provisions of thc Contractor's l-iccnsed l-aw (Chaptcr 9. Commencing with Section 7UX) of Division 3 of the Business and Professions Code) or that lrc or she is exenrpl therefrom and tlrc basis for the alleged exenption. Any violation of Section 7031.5 by any applicant for a pennit subjects the applicant to a civil penalty of not more than five hundred dollars ($stttt). _I. as owncr ol'the propcrty. or my crnployccs with wages as their sole comgrcnsation, will do the wrnk and thc struclure is not interxled or offered for sale (Sec.7U4. Business and Professions Code: The Contractor's Liccnsc l-aw does not apply to an owner of the pro5rerty wlxr builds or in{rrorr.s thereon, and wlxr does such work himself or lrerself or through his or her own entployees, providcd that such improvcments arc not intended or ollcred for sah. Il, howcvcr, tlre building or funprovennnt is sold within one year of complctioru thc Owner Buildcr witl havc thc burden of proving that he or she did not buikl or inrprove the propaty for thc purpose of sale). _1, as owner of the propeny, am exclusively contracting with licen.scd contractors to conslruct thc project (Sec. 7044, Business arxt Pnolbssion Code: The Contractor's License Law dtrcs not apply to an owner of proJrerty wtto builds or improves thereon. and who contracts for such projccts wilh a Contracto(s) liccnscd pursuant to the Contractor's Licensc Law). -IantexemptunderSectiort-,B.&P.C.fortlrisreas<ln. WORKERS' COM PE.IISATTON DECLARATION I hereby aftirmundcr penaltyof pcrjuryonc of the fbllowing dcclarations: _l have and will nuinlain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work lbr which the permit is issued. _l have and will nraintain workers'compensalion insurance, as required by Section 3700 of the l-abor Code, for the performance of thc work for which this prnrit is issucd. My workcrs'insurancc carrier arxl gxllicy number arc: q Policy s t1 r llos\ _l ccrrify that in thc lrcrfornrancc of thc work for which this pcrmil is issucd, I shall not cmploy any pcrson in any manncr so as to bccorr subjcct to thc workers'compcnsation laws ofCalifornia. and agree that if I should becorp subject to the workers' conrpensation pnrvisions of Section 3700 of the Labor Code, I shall, forthwith conply with thosc provisions.. WARNING: Failure to secure workers' compensation coverdge is unlawful, and shall civil fines up to orre hundred tlrousand dollars ($100.000). in addition to the cost of subject an employer to criminal penalties and danuges as provided for lhe attorncy's fccs. I hereby affirnr under penalty of perjury tlrat I anr licerr.rcd under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Busincss and Professions Codc. ard my license is in full force und effect. License \D Number: CONSTRUCTION LENDING AGENCY I hcrcby al'lirm undcr penalty of pcrjury that thcre is a construction lending agcncy for thc pcrlbrrnancc of the work ltrr which this permit b issued (Sec. 3097. Civ. C.). lrnder's Name: lrnder's Addrcss: A PPI,ICA NT DECI,ARATION I Mry allirm undcr penalty of pcrjury onc of the following dcclarations: Dcmolitkrn Pernrits-Asbcstos Notificati<rn Fcdcral Rcgulations (Titlc 40, Part6) _Rcquircd l-cttcr of Notification _l ccrtify that thc fcdcral rcgulations rcgarding asbcstos rcmoval iuc not applicable to this projcct. _l ccrtily that I luvc rcad this application ard statc tlrat lhe atxrve informalion I agrcr to conply with all City and County ordinanccs and Statc laws rclating to building construction, and hcreby of this City and County to entcr upon thc above rnentioned pn)perty for Applicant or Pcrnritcc nanlc ** uofts/aD Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor Bonding lGrounding I UFER Transformers Torqueincr Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouoh)lo LX '7//D4W Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) N/eter Release Rouqh Service l\Ieter I ,, FINAL lr aYitrrgt Notes, Remarks, Etc.I Rev. 08-07-201 5 Yl1t)