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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNI.],R B I.' II,DT:R DIiI,CA RAI'ION I hereby affirnr urrder penalty of prjury that I un exerupt frorn the Contractors' License [:w for the following reason (Sec.7031.5 llusincss arxl Prolbssion Codc): Any City or County which requircs a pcrrnit to construct, altcr. itnprovc. dcrnolish or rcpair any structure. prior to its issuance. also retluires tlre applicart lbr such pernrit to file a signed stalenrnl lhat lr or she is licensed pursuanl to thr. provisions of tlr Contractor's l,iccnscd law (Chaptcr 9. Comrncncing with Section 7000 of Division 3 ol'thc Business and Professions Code) or that lrc or slrc is exentpt tlrerefronr ard tlp basis tilr tlrc alleged exenrptiotr. Any violation of Seclion 703 I .5 by any applicant for a ;xnnit subjects the applicant to a civil penllty of not nrore than five hundred dollars ($5tXt1. _1. as owncr ol'thc propcrty. or tny crnploycc.s with wages as thcir solc compensation, will do the work ard the structurc is rnt irrtendctl or offbred for stle (Sec.7H4. Business arxl Prufessions Ctxle: The Contraclor's License Law tlocs not apply to an owner of the prcpefly wln buikls or inrproves tlrreorL arxl wlxr does such work himself rlr lrcrself or througlt his or her own entployees, providcd that such irnprrvcnnnts are rx)t interxlcd or oll'crt'd for salc'. Il. howcvcr. thc building or improvetncnt is sokl within onc ycar ofconrphtion, the Owner Buikhr will have the burden of pnrving that lr or she did not build or improve ttre propclty for the purprse of sale). _1. rs owner of the pn)pefly, anr exclusively contructing with licensed conlraclors to construct tlre project (Sec. 7G14. Business arxJ hulessittr Code: The Contractor's License Law does not at)ply to an owner of property wlxl builds or intproves thereott. and who conlracts lor such pro.iccts with a Contractor(s) licenscd pursuant t() thr'Contraclor's Liccnse Law). -l anrexenrpt untler Sectiort-, B. & P.C. ttlr tltis reason. Date: WORKTiRS' COTII PIiNSATION DECLARATION I hcrcby allirnr untlcr pcnalt.v of pcr.iury onc of thc tirlkrwing tlcclarations: _l have and will nuintah a Ceflilicate of Colrsent to Sell'-lnsure for workers' conrperuation, as pruvided for by Section 3700 of the Latxrr Cotlc, for thc Jrcrf<rnrmncc of thc work lirr which tltc pcrntit is lssucd. _lhaveanrlwill nraintainworkers'conrperrsationinsurarrce,as requiredhySection3T0Ooflhel-atxrrCode,ftrrlheperfornurtrceof thc work lbr which this lrcrnrit is issuccl. My workcrs' conrl^-llsation insurancc carricr arxl grlicy nunthcr are: Policy Number: Expires: _l ccrrity that in tlrc lrcrltrrnuncc of lhc wolk f<rr which tlris pcrnrit is issucd, I shall not cnploy auy pcrsotl in any manncr so astobccorncsubjccttothcworkL'rs'conrpcnsationlawsofCalifornia.attdagrccthatif l.shouldbccotncsubjccttothc workers' corulrcnsation provisions of Section 3700 of the Labor Cotle, I shall, forthwith conrply with thosc provisions.. WARNING: Failure to secure workers' colnpensation coveruge is unlaw[ul, and shall subject an employer to criminal pcnalties urd civil lines up to one hurdred thousand dollars (S100.(}()0t. in addition to llrc cost of contpelsalion. danrages as provided for lhe Section 3076 of thc [atxrr Ctxlc, intercst and attorncv's fce's, Date: Applicant: LICENSED CONTRACTOR DI'CLARATION I hercby affrnr untler pnalty of perjury tlut I anr licens,qJ under provision of Chapter 9 (contnrncing with Section 7000) of Division 3 of the Business and Professions Code. anJ rny licensc is in full force and effect. License Class: Licetse Numbcr: Date: CONSTRUCTION LENDING AGENCY I hercby at'lirrn undcr pcnalty of prcrjury that thcrc is a conslruction lcnding agercy for thc Srcrlormancc of the work lbr which this pcrrnit is issucd (Sec. 3097. Civ. C.). knder's Nanrc: APPI,ICANT DECI,ARATION I hrchy erflirnr undcr ;xnalty of pcrjury onc of thc folktwing dcclarations: Dcnrolition Pcrrrrits-Ashc'stos Notification Fcdcral Rcgulations (Tille 40. Pan6) -Rcquircd l*ttcr of Notificatittn _l ccrtily that thc fcderal rcgulation.s rcgarding asbcstos rcrnnval iuc not applicablc to this project. _l ccrrify tlrat I havc rcad this application iuxl statc that lhc ahrvc infornration is correct. I agrcc to conrply witlr all City and County ordinanccs and Statc L,aws rclating to building construction. and hcrcby authorize rcprcsentatives of this City and County to entcr upon thc above nrentioned properly for inspection purposcs. r\ lllllicarrt or Agtrrt Date:- 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 I Groundino I UFER llt -k) Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment It t tlq a0 Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh)tl N/eter Release t(,(UJ DftA'9P I Rough Service N/eter rl FINAL Ir a]Dffi# Notes, Remarks, Etc.ll lev. 08-07-201 Pcrmitcrc namc (print): DryTY