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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OWNER BUII,DER DI'I,CARATION I hereby affrnr under penalty of perjury that I anr exenlpt from the Contraclors' License l-aw for thc following reason (Sec.7031.5 llusincss and Prol'cssion Codc): Any City or County which requircs a permit to construct, alter, itnprovc. demolish or rcpair any structure, prior to its i.ssuance. also requires the applicant for such Jrernrit to file a signed staternent that lr or she is licensed pursuant to rhe provisions o[ thc Contractor's l,icenscd law (Chapter 9, Comrncncing with Section 70fi) of Division 3 of thc Busincss and Professions Code) or tlrat lre or she is exempt therefrom and tlre basis frlr the alleged exemption. Any violation of Section 7031.5 by alry applicant for a pennit subjects the applicant to o civil pennlty of not more than five hundred dollars ($5tlO1. _1. as owner of thc property. or tny ernployces with wagcs as their mlc compcnsation, will do thc wcnk and the structure is not intentled or offered frrr sale (Sec'.7044, Business and Professions Ctxlc: Thc Contractor's Licensc Law does not apply to an owner of the proper"ty who builds or improves therulq ud who does such work hinself or lrerself or througlr his or her own entployees, provided that such irnprovcnrcnts arc not intendcd or ofiercd for sah. Il. however, 0rc building or improvelrrcnt is sold within one )aar of complction, the Owrrr Buikler will have thc bunlcn of proving th{ he or she did not build or inprove t}re propaty for thc purposc of sale). _1. a.s owner of the property, am exclusively contracting with liccnscd conlraclom to construct thc project (Scc. 7(X4, Business arxJ Prrotbssion Code: The Contraclor's License Law dtxs not apply to an owner of property who builds or intproves thereon. and who contracts for such p,rojccts with a Contracto(s) licenscd pursuant to thc Conuaclor's Licensc l-aw). -l anr exempt under Section-, B. & P.C. for this reasott. WORKI,ILS' COM PI:NSATI ON DECLARATION I hcreby allirnr undcr pcnalty of pcrjury one of thc lbllowing declarations: _I have and will nuintah a Certilicate of Consent to Self-lnsure for workers' contpensation, as prcvided for by Section 3700 of the l,arpl Codc, 1#,rrt for the lrcrfonnance of the work lbr which thc pennit is issucd. will by Section 3700 of the [:bor Code, for lhe perfornrarce of can'icr iurd gxllicy nunrber arc: Policy _l ccrrity that in tlrc lxrfornuncc of tlrc work ftrr which this permit is issued, I shall not cmploy any person in any manncr so as to bccorne subjcct to the workcrs' comgrcnsation laws of California. and agrce that if I should becomc subjcct to the workers' conrpensation provisions of Section 37fi) of the labor Code, I shall, forthwith conrply with thosc provisions.. WARNTNG: Failurc to sccure workers' compensation coverage civil fines up to orrc lrundred thousand dollars ($100.000t. itt is unlawful, and shall iln itttd cost of the .Scction of thc Labor Codc. intcrcst and attorney's [ccs. I hereby afl-rrnr under penalty of perjury that I ant licens,ed provision of Cha;lter 9 (conurrcncing with Scction 7000) of Division 3 of the liusiness and Professiorrs Code. anl rnv license is in full forcc arxl effect. License )ryft \ I hereby aflirrn undcr pcnalty of grcrjury thu thcrc is a construction lcnding agcncy for the pcrfonnancc of thc work lbr which this pcrrnit is issuerl (Sec. 3097, Civ. C.). Lender's Narne: APPI,ICANT DECI,ARATION I luc$y aflirnr undcr pcnalty of pcrjury onc of thc following declarations: Dcnrclition Pcrmits-Ashcstos Notification Federal Rcgulations (Titlc 40, Part6) Rcquircd l,cttcr of Notification rcmoval are not applicablc to this projcrt. atxrvc infrrrnutiort is corccl. I agrcc to conply witlr all City antl County above mentioned prcperty for inspection purposcs. Alrylicant or I'crmilee nanrc authorize reprcscntativcs of this Cily and County to enter upon thc Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq / Groundino I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouoh) N/eter Release Rough Service N/eter ll ,l _./lt FINAL It \tr a Deffi T Notes, Remarks, Etc. \ Rev. 08-07-201 5 I insuratrce. as is issuctl.workcrs' \ to ,rr", V-{*)