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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNI',R BUILDER DELCARATION I hcreby affrnr under penalty of prjury that I arn exenrpt from the Contractors' Licensc [-aw for the following reason (Sec.7031.5 Busincss and Profcssion Code): Any City or County which rcquires a pcnnit to conslruct, alter. irnprovc. dcmolish or repair any structure, prior to its issuance. also requires the applicant for such grernrit to frh a signed slaternent that he or she ls licenscd pursuanl to thc provisions of tlre Contractor's Licenscd l,aw (Chaptcr 9, Commencing with Scction 7fi)0 of Division 3 of thc Business and Professions Code) or tlut hc or she is exenpt therefronr and tlre basis for tlre alleged exenption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than llve hundrcd dollars ($500). _1. as owncr ol'thc property, or my employces with wagcs as thcir solc compcnsalion, will do thc work and the structure is not interxlcd or offered for sale (Scc'.7H4. Business and Profcssions Ctxle: Ttre Contractor's License [-aw docs not apply to an owncr of the progrerly wlxr builds or funproves thereoq and wlro does such work himself <lr lrerself or lhrough his or her own entployees, providcd that such ilnprovelncnts arc not intcndct or olTcrcd for salc. Il. howevc'r, thc building or inprovcmnt is snld within one )car of completiotl tlrc Owner Builder will havc the burden of proving that he or she did not build or improve tlre propcrry for lhe purpose of sale). _1. as owner of the property! am exclusively contracting with liccnscd conlractoni to construct thc ptojcct (Sec. 7044. Busincss and hrofession Code: Tlre Contractor's License Law does not ap;rly to an owner of progrcrty who builds or improves thereon. and who contracts lor such projccts wilh a Contractor(s) licenscd pursuant to thc Contractor's Licensc taw). _l anr exempt under Sectitur-, B. & P.C. tbr tltis reasott. Date: WORKI.' RS' COM PIiNSATI ON DECLARATION I hcrcby aftirm undcr pcnalty of pcrjury onc of the lblkrwing dcclarations: _l have and wilt nuintafur a Certilicate of Consent to Self-lnsurc for workers' con4rensalion, as provided for by Scction 3700 of the Lahor Codc, for the pcrlonrunce of thc work lbr which thc permit is issued. _l have and will nraintain worker.s' conrpensation in.surarrce, as required by Section 3700 of thc [:bor Code, for the performatrce of thc work lor !;.-rntit is My lnsurance calncr prlicy nunrbc'r are: I o ( /s.t ( Policy a a _l certify that in tlrc prlbrnnncc o[tlrc work for which this pcrmit is issued, I shall not cmploy any pcrson in any manner so as to bccorrc suhjcct to thc workcrs' conrpensation laws of California. and agree that if I should becomc subjcct to the workers' conrpensation provisions of Section 3700 of the labor Code, I shall, forthwith conrply with thosc pr<lvisions.. WARNING: Failure to secure workers' comlrcnsation coverdge civil fines up to one hundred thousand dollars ($100.000). in , is unlawful, and shal! subject an employer to criminal pcnaltics and t()compermation, danrages as provided for tlre Scction 3076 of and DT'CI,ARATION I hereby affirm under pnalty of perjury that I anr licensed under provision of Chapter 9 (conmrcncing with Section 7000) of Division 3 of the Business and Professions Code. and rny liccnsc is in full force urxl eftec\ )B 6Licensew CONSTRUCTION LENDING AGENCY I hcreby aflirm under pcnalty of perjury thu thcre is a construction lending agency for the pcrformancc of thc work lbr which this pcrmit is issued (Sec. 3097, Civ, C.). I-ender's Name: lrnder's Address: APPI,ICANT DECI,ARATION I trcrchy aflirm undc'r pcnalty of pcrjury onc of thc following declarations: Dennlition Pernrits-Asbc'stos Nrxification Fcdcral Rcgulations (Title 40, Part6) -Rcquircd lrttcr of Notifrcation _l ccrtify that the fcdcral rcgulations rcgarding asbcstos {*nOrttrat I havc rcad this applicarion arxl statc tlrat rlte rernnval arc not applicablc to this projcct. abovc infornution is comcct. I agrc.c to contply I represcntatives ol' this city with all City and County and County to cnter upon thc abovc rnentioned pruperty for Applicant or Agent Pcrmitec namc purF)ses. authorizc Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding I Grounding I UFER Transformers I /U, Torqueing q (o ,?/)9ffrY / Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls u Walls (Rouoh) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) N/eter Release Rouqh Service N/eter (A ,l-2./ FINAL il YID DItr-{D / Etc.-z o q 7l/7fl -^P I Flev. 08-07-201 5 \ *,"o1 /oq/*o?-s