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ELECTRICAL.I NSPECTOR RECOR D APPROVALS DATE ID/SIG COMMENTS OWNIiR B UII,DI'R DEI,CARATION I hereby affirnr under penalty of perjury that I arrr exenlpt fronr lhe Contraclors' License l-aw for the following reason (Sec.7031.5 Business and Profession Codc): Any City or County which rcquircs a pcnnit to construct, alter. improve. demolish or repair any structure, prior to its issuarce. al.so requires the applicart for such pernrit to file a .signed slatement that trc or she is licenscd pursuant to thc pmvisions o[ thc Contraclor's l,iccnscd l:w (Chapter 9. Commencing with Section 7fi)0 of Division 3 of the Busincss and Professions Code) or that lre or she is exenrpt tlrrefront arrd tlrc btrsis for the alleged exenptbn. Any violation of Section 7031.5 by any applicant for a pennit subject.s the applicant to a civil penalty of not more than five hundred dollars ($stltt). _I. as owncr ol'the propcrty. or rny crnployccs with wagcs as thcir sole compcnsation, will do the wcrk and thc struclure is not interxlcd or offeretl for sale (Sec.7(X4. Business and Profcssions Cotle: Thc Contractor's License l-aw does not apply to an owner of the progrerty wlxl builds or improves theretn uxl wlxr dtxs such work himself or herself or through his or her own enrployees, provided that such improvcrrcnts arc not intendcd orollcred for sah. Il. howcvcr, t]E hilding or inprovenrcnt is sold within onc ]tar of completioru the Owncr Buikler will havc thc burden of prcving thd hc or shc did mt buikl or inrprove 0rc propaty for thc purpose of sale). _1. as owner of the properly, am exclusively contracting with licenscd conlracloni to conslruct thc project (Sec. 7(X4, Business arxl Prrofession Code: The Contractor's License Law dtrs not apply to an owner of property who builds or improves thereon. and who contract.s for such projccts with a Contractor(s) liccnrcd pursuant to thc Conuaclor's License L:w). -l anrexempt under Sectiorr-, B. & P.C. for tltis reason. WORKERS' COMPtsNSATION DECLARATION I hcreby affirm undcr penalty of perjury onc of tlrc tbllowing declarations: _I have and will nnintailt a Certilicate of Consent to Self-lnsure for workers' con'rpensation, as provided for by Section 3700 of tlte L-abor Code, for the Jrcrforrnance of the work lbr which thc pcrmit is ilssucd. _l have and will nraintain workers'conrperrsalion insurartce, as by Section 3700 of the [:bor Code, for the grcrfonrunce of , carrier nrd Jxllicy numbcr arc:thc work for this prnrit is issuctl. My workcrs' I )^l(Policy t o! _I ccrtify that in thc lrcrfornuncc of thc work for which this pcrmit is issued, I shall not employ any pcrson in any manncr so as to bccorrc subjcct to thc workcrs' conrpcnsation laws of California. and agrcc that if I should become subject to the workers' compensation provisiorrs of Section 3700 of the Labor Code, I stull, forthwilh comply with those provisiotu.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal pcnalties and civil fines up to otrc hurdred tlrousand dollars (S100,m0). in addition to tlrc cost of compemation, danrages as provided for the DIICLARATION I hereby affrnr under penalty of pcrjury that I anr licensctl undcr pruvision of Chapter 9 (conrrrcncing with Section 70m) of Division 3 of the Business and Professions Code. and rny licensc is in full force and effect. Nunrber:?IL CONSTRUCTION LENDING AG ENCY I hcrcby allirm undcr pcnalty o[ pcrjury that thcrc is a construction hnding agcncy for the perlbrmance of the work for which this permit is issued (Sec. 3097, Civ. C.). lrnder's Nanre: [.cnder's Addre.ss: A PPI,ICANT DECT,ARATION I hcreby affrm undcr Jrcnalty of pcrjury onc of thc folkrwing dcclarations: Demolition Pcrmits-Asbcstos Notification Fedcral Rcgulations (Title 40, Part6) Rcquired lrtter of Notification _l certify that thc fedcral rcgulations rcgarding asbcstos rcmnval arc not applicable to this prolrt. _l ccrtify tlrat I have rcad this application uxl state tlrat thc atxrvc infornration is corrcct. I agrcc to conply with all City and County ordinanccs and State [.aws rclating to building constructioru and hcreby auttnrize represcntatives of this City and County to cnter upon thc above rrcntioned propeny for inspection Applicant or Agent Pcrmitec nanre D,i.S4ffi)ibT Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor Bondinq I Groundino I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) *ll'v"uv Ul?tv rU N/eter Release tl Roush V pnrb 1t6 Service lVleter FINAL I l-25'Ze >(t/y Alotes, Remarks, Etc.,r A a a t, )IYW ft t/fl Rev. 08-07-201 5