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r A O ELECTRICAL.I NSPECTOR R ECOR D APPROVALS DATE ID/SIG.COMMENTS OWNI'R BUII,DER DIiI,CA IIATION I hereby affrnr under penalty of perjury that I anr exenlpl fronr the Contractors' Licensc [:w for the following reason (Sec.7031.5 Busincss and Prolbssion Code): Any City or County which requircs a permit to construct, altcr. improvc, demolish or repair any structure. prior to its issuance. also requires the applicant for such prnrit to file a signed slaterrcnt that lr or she is licerrsed pursuant to the provisions of the' Contractor's l,icenscd law (Chapter 9. Commcncing with Section 7fi)0 of Division 3 of the Business and Professions CorJe) or that he or she is exenqrt therefronr and tlre basis for tlre alleged exenlption. Any violation of Section 7031.5 by any applicant for a permil subject.s the applicant to o civil penulty of not more than five hundred dollars ($stttl). _1. as owncr ol'lhc propcrty. or my crnployccs with wagcs as their solc compensation, will do the wcn* and the structure is not intcrxletl or offered for sale (Sec.7M4. Business and Professions Code: The Contraclor's License Law does not apply to an owner of the progrcrly wlp builds or improve.s therurq auxl wln tltrs such wo* himself or lrerself or through his or her own employees, providcd that such improvcmcnts iuc not intendcd orollered for salc. Il. trrwevcr, thc building or inprovcnpnt is sold within one )tar of completkrn, the Owner Builder will have thc burden of pnoving ttrdt he or she did rxlt buikl or impmve tlrc propeny for thc purpose of vdh). _1. as owner of the ptoperly, am exclusively contracting with licen.scd contractoni to construct the pruject (Sec. 7(Xl. Business and PnrtLssion Code: The Contractor's License Law dtxs not apply to an owner of property who builds or improves thereon. and who contracts for such projccts with a Contractor(s) liccnscd pursuant lo thc Contractor's Liccnsc law). -lantexenDtunderSection-,B.&P.C.forlltisreason. Dete: WORKI,TTS' COM PtsNSATTON DECLARATION I hcrcby aflirm undcr pcnalt.v of pcrjury onc of thc tirllowing declarations: _l have and will nuintafur a Certilicate of Consent to Self-lrrsure for workers' con4rcnsalion, as provided for by Seclion 3700 of the Labor Code, for thc perforrrunce of thc work for which thc pcrurit is issued. _l have and will nraintain workers' conrpen"sation insurance, as required by Section 3700 of the l-abor Code, for the pcrf<lrnutrce of thc work for which this lrcrnrit is issucd. My workcrs' conqrensation insurancc carricr and policy numbcr are: Policy Numbcr: Iixpires: _l ccrtity that in thc lrcrfornuncc of thc work for which this prmit is issucd, I shall not cmploy arry pcrson in any manncr so astobcconrcsubjccttothcworkcrs'conrpcrrsationlawsofCalifonria.andagrcethatiflshouldbccorresubjccttothe worliers' conrlrrrsatiorr provisiorrs of Section 3700 of the Labor Code, I shall, forthwith conrply with those provisions.. WARNING: Failure to secure workers' compensation coverdge is unlawful, and shall subject an employer to criminal pcnaltics and civil fines up to one lruntlred thousand dollars (S100,000). in addition to tlrc cost of compensation, danrages as provided for thc Scction 3076 of the Labor Codc, intcrest and attorney's [ces. //2/4 I hercby affirnr under penalty of perjury that I anr licensetl under provision of Chapter 9 (conrnpncing with Section 7000) of Division 3 of the Busincss and Professions Code. arxl rny licensc is in full forcc and effect. License l\... ^.Contractor:!/ .unrr{,\..n,I",n" ."ni" I hcreby aflirm under penalty of perjury that there is a construction lending agency for the performarrce of thc work lbr which this pcrmit b issucd (Scc. 3097, Civ. C.). l,ender's Nanre: Lrnder's Addrcss: APPI,ICANT DECLARATION I hcrcby arffirm under pcnalty of pcrjury one of the following dcclarations: Dcnxrlition Pernrits-Asbcstos Notilication Fedcral Regulations (Tille 40, Pan6) _Required kttcr of Ntilification _l certily that thc fcdcral rcgulations rcgarding asbcstos rermval iue not applicable to this project. _l ccrtify that I have read this application and statc tlrat thc ahove informalion is corrcct. I agroe to conrply ordinanccs and State l-aws rclating to building construction, and hercby authorizc represcntatives of this City with all City and County to cntcr upon tl^. above mentioned property for Applicant or Agent Pcrnritcc nanre purPo:scs. and o Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor A,.r-a, Bonding / Grounding / UFER l['7? 7rt)uz44 Tmdr Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) Meter Release Rough AI ts? Service lMeter il'i0./O U@t*Ot iff FINAL tl-u-)o lJ.{u/,trzrv Notes, Remarks, Etc. cru"r, { -/ d LicenseNumber: 6-f;A: Z