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ELECTRICAL.INSPECTOR RECOR D APPROVALS DATE ID/SIG.COMMENTS 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 Bondins I Groundins I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinos (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) Meter Release Rough Service [\Ieter I tl-- t FINAL t\Lq o0 Dtt6rl?f Notes, Remarks, Etc.\l OWNIi,R BUII,DER DIiLCA RATION I hercby affrnr untler penalty of perjury that I am exempt frcm the Contracloru' License law for the following reason (Scc.7031.5 Busincss and Prol'cssion Codc): Any City or County which requires a pcrrnit to construct, alter, itnprovc. demolish or repair any structure, prior to its issuance. also requires the applicart for such pcrnrit to file a signed statement that lr or she is licensed pur$ranl to thc pmvisions of thc Contractor's Licenscd kw (Chapter 9, Commencing with Section 7000 of Division 3 of the Busincss and Professions Code) or that he or she is exempt therefronr and tlre basis for tlre alleged exemption. Any violation of Section 7031.5 by any applicant for a pennit subjects the appticant to a civil pcnalty of not rnore than five hundred dollars ($500). _1. as owner of thc propcrly. or my cmployces with wages as their sole compcnsation, will do the wcnk and thc structure is not intenlcd or ofTered for sale (Sec.7U4. Busincss and Profcssions Cotle: Thc Contractor's Licensc [-aw does not apply to an owner of the property who builds or improves thereorl and wlxr does such work himself or herself or through his or her own employees, providcd that such improvenrcnts arc ff)t intendcd or olTcred for sah. ll. howcver. thc building or inprovctrcnt is sold within onc ]aiu of completkrru thc Owner Buildcr will have thc burden of proving ttrat hc or shc did not buikl or improve thc propcrty for thc purposc of sale). _1. as owner of the propetly, am exclusively contracting with licenscd conlractors to construct thc projcct (Scc. 7044, Businers and Pnctbssi<xr Code: The Contractor's License Law does not apply to an owner of property who builds or improves lhereon. and who conracts for such projccts with a Contractor(s) liccnsed pursuant to the Conuaclor's Licensc [aw). -l am exenrpt urrder Sectirrn-, B. & P.C. lbr this reason. f 1...... W( )RKl.lRS' COI\! l'ltNSA'l'l(JN DECLARATION I he'rcby atTirm undcr pcnalty of perjury onc of thc following dcclarations: _l have and will nnintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Scction 3700 of the l,abor Codc, for the performancc of the work for which tlrc pernft is issued. Q hor. u,,,I 3700 of the labor Code, ud grolicy number iue: o^ for lhe grcrfornrar--e of thc work tbr Policy 7 o 1/ol /xd-I ,) ..rrify rhat in tlrc pcrfirrnuncc of tlrc work for which this pcrmit is issucd, I shall not cmploy any pcrson in any manner so as to bccomc subjcct to thc workers' compensation laws of California. and agrce that if I slnuld becotnc subject to thc workers' conrpensation provisions of Section 3700 of the Labor Cotle, I slmll, forthwith conrply with those provisions.. WARNING: Failure to secure workers' compensation coveruSe is unlaw[ul, and shall an employer to criminal penahias and civil fuies up lo one hurrdred thousarrd dollars (S100,000). in addition to danuges as provided for lhe attorney's fees. I hercby affirnr under pnalty of perjury that I ant licenscrl provision of Chapter 9 (comnrcncing with Section 7000) of Division 3 of the Business and Professions Code. arxl rny licensc is in full forcc and effect. 5)5 CONSTRUCTION LENDING AGENCY I hcrcby affirm under penalty of pcrjury that therc is a construction hnding agcncy for the pcrlbrmance of the work l'or which this permit is issued (Sec. 3097. Civ. C.). l.cnder's Name: l-cnder's Address: A PPI,ICAN'T DECI,ARATION I trrchy aflirnr undcr Jrcnalty of pcrjury one of the following dcrlarations: Dcnxrlition Permits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40, Part6) _Rcquired l.cttcr of Ntxification _l certily that thc fcdcral rcgulations rcgarding asbcstos rcmovalarc not applicablc'to this projtrt. statc tlrat lhc uhrvc inlbrnuliorr is corrcct. I agrcc to conrply with all City and County authorizc rcprcscntativcs of this City and County to above rrrcntioned property for inspection Applicant or Agenl I'crnrilce tranlc purF)scs. k uprn thc 08-07-201 5 insurance, as (