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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS O1VNER BUILDER DEI,CARATION t hqeby aflim und6 pqalty of pojury that I m cxmpt ftom thc Contlaclos' Licffi taw for thc following lt@n (Se.7031.5 Busin6s ild Prcfasion Codc): Any City or County which requirc a pamh to costruct, alt6, improvc, dmolish or rcpai ily structw. prbr to its isuoce, also rcquirc thc applicmt for such pcmit to filc a signcd statmot thal hc or dE is licmâ‚¬d pwsnt to thc provisios of the Contractor's Licenscd lrw (Chaptq 9, Comcncing with Sction 7000 of Division 3 of thc Busine ud Prcfcsions Code) or that hc or shc is cxcmpt thqcfrom ed thc bais for thc allcgcd qmption, Any violation of S6{ion 7031.5 by ily applicantforapcmitsubjetsthe applicanttoacivilpcnaltyofnotmorcthafivchundrcddollm($500). _1, s owner of thc property. or my employees with wages as their sole compensation, will do the work and the stnrcturc is not intended or offered for sale (Sec.7044, Business and hofessions Codc: The Contractor's License Law does not apply to an owner of the property who builds or improves ther@n. and who does such work himself or herself or through his or her own employecs, provided that such improvonents are not intended or offered for sale. I(, however. the building or improvement is sold within one ytar of complaion, the Orvner Buildcr will have the burden of proving tha he or she did not build or improve the propoty for the purpose of sale). _1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Btsiness and hofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves lhereon, and who contracts for such projeds with a Contracto(s) licensed pursuant to the Contractor's License Law). -l am exempt under Section-, B. & P.C. for this reason. WORKERS' COMPENSATION DECLARATTON I hereby aflinn under pcnalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the 'ff::-for thc performance of the work for which the perrnit is issued. 3700 of the labor Code, for the pei'formance of the work for and policy number are: poricy*"^*.FPa)Lll3C'l-t ( Expires:-l-( ! _l cerri$ that in the perfonnance of thc work for which this permit is issued. I shall not employ any pcrson in any manner so as to become subject to the workâ‚¬rs'compensation laws of California, and agree that if I should become subject to the workers' cornpensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an onployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000), in addition to the cost of compensation. damages as provided for the Section 3076 of the tabor Code, interest and attorney's fees. ll.rtn. LICENSED CONTRACTOR DECT.ARATION I hereby affrnn under penalty of perjury that I am licensed under p,rovision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effcct. Licensect^u, T- C tO License Nurnbcr:lc>L1+L('( W I hmby smm undtr pcnalty of pqjury thd thsc is a condruciion knding agocy for thc psfomcc of thc mrk 6r which thb pqrnh is issucd (Sc. 3097. Civ. C.). . tgrdq's Nme: Lender's Address: , APPLICANT DECLARATION I herdry affinn under pcnalty of perjury one of thc following dcclarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Requircd Later of Notification -l cdiry that thc Hqal rcgulatioB rcgoditrg cbctos moval ae not applicsble to this prcjet. -l cqtiry that I havc sd this application dd stalc that thc sbovc infomstion is corol. I agre to comply with all City ed County ordirucB ud Statc laws claring to buildin&Eorotrucrion. ad hqcby authorirc rcFMtativ6 of tNs City md County to @lE upon thc above mqtioncd prcpcny for irepcfion nr6s ApprcmrorAsqrs r"n rrn /# . on , 7- 7C) - 70 ,"-U**rrrr*rl Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire AIarm I Dampers Communications Cable Buildinq Under SIab / Floor ,I I Bonding I Grounding / UFER -W-[N lt ltq ?i wz Transformers lt Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Rough Ceilinss (T-Bar Rouqh) Meter Release lfr 7 I Rouqh I zl Service Meter t,l-7 7 FINAL Irl (4 6 7 >(WZ 7 Notes, Remarks, Etc.I t Rev. 08-07-2015 a -' )o-zODate:_ ,W I , -