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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hocby affm undo panalty of pcrjury thar I m exempt ftom thc Contracto$' Lic6c liw for thc following reaSoo (Sc.7031.5' Busincs ad hofeion Codc): Any City or County which rcquirs a pqmit to construct, alts, imptovq donolish or rpair uy structue. prior to its isuucc, also requirc the applicet for such pemit to filc a signcd stalmot that hâ‚¬ or shc is licoscd pwmt to thc provisioE of thc Contr4tor's Liccnsed liw (Chapts 9, Commcncing with Setion 7000 of Division 3 of the BEins md Prcfsions Codc) or that he or shc is crempt thqcfrom od thc b6is for thc allcgcd cxmFion. Any violation of Scrba 7031.5 by aqy applicantforapemitsubjststhc applicanttoacivilpcnsltyofnotmorcthmlivehundrcddollas($500). _1. as owner of the property. or my etnployees with wages as their solc compensation. will do the rvork and the structLre is not intended or offered for sale (Sec.7044. Business and hofessions Code: The Contractor's License Law does not apply to an owner of the propoty who builds or improves thcreon, and who does such work himself or hersclf or through his or her own employccs, provided that such improvanents are not intended or offerod for sale. I[, however, the building or imp,rovement is sold within one yerr of complaion. the Orvner Builder will have the hrdcn of proving that he or she did not build or improve the propcrty for the purpose of sale). --[, as owner of the properly. am exclusively contracting with licensed contractors to construct thc project (Sec. 7M4, Business and Profession Code: The Contractor's License Larv does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Licensc Law). -l am exempt under Section-. B. & P.C. for this rcason. Date: WORKEtrLS' CONTPENSATION DECLARATION I hereby allinn under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for worketrs' compensation. as provided for by Section 3700 of the Labor!ode, for the pcrformance of the work for which the perrnit is issued. fi*"and will maintain workers' compâ‚¬nsation insurance, as required by Scction 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workcrs' compcnsirtion insurance carrier and policy numbr are:L 1a;ofoo Fr rLL?r Policy e -1 \[-l-z _l cerri& that in the perforrnance of the work for rvhich this perrnit is issued, I shall not employ any person in any miulner so as to become subject to the rvorkers'conrporsation laws of California. and agree that if I should becorne subject to the workers' compensation 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 cmployer to criminal penalties and civil fines up to one hundrcd thousand dollars ($100,000), in addition to the cost of compensation, danages as provided for the Section 3076 of the Labor Codc. interest and attorncy's fces. Date:,l....1:^^-.. LTCENSED CONTRACTOR DECT..ARATION I hereby affrm under penalty of pcrjury that I am licensod under provision of Chapto 9 (comrnencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License -CtO Number:to Lq.Qqc(--/f- Z 0 ('onlraclor: W I h6cby afhm undq pcmlty of pqjury thst thqc is 8 @nsrructbn kading agocy for thc pefomcc of thc wrk for which this pqmit b issucd (Se. 3097, Civ. C.). l-ender's Name: Lender's Address: AIETICANIDECIA8AIION I hatby affim uoda pcnalty of pcjury onc of thc following dclantiom: Dcmolition P6mit$Asb6tos Notificstion Fcdoal Rcgulations (Titlc 40, Psd6) -Roquircd ldtq of Notificdion _l ccri& that thc fcdqsl rcgulstioB rrtildirg Bb6tos moval m oot @licablc to this prcjcl. tb csri$, tha I luvc â‚¬d this applic8tion dd ststc thd thâ‚¬ abovc itrfomariotr is cord. I agr to @mply with aU City and Couty 6rtruucc ud Statc l:m rclaing to tuilding coEtnrctioq a[d h@by adhorirc rcp(eilativa of this City md Couty to otq upon thc above mentioned property for Applicant or Agcnt Permitee purposes. 0^{ d{'26 Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Buildins Under SIab / Floor Ir ,t Bondinq I Groundins / UFER lt tq ?,)ft+,ffi Transformers I Torqueincl Sub-Panels Air Conditioners ,t ,t Roof Top Equipment tr n 'l/0 Factory Wired Unit 1 Walls (Conduit) Walls (Rouqh) Ceilinss (Hard & Soffit Roush Ceilings (T-Bar Rough)I I ,l A Meter Release (r1 7/))wa 7 , ' I Rouqh Service Meter rl .l 1 h FINAL t('[v )VL{"/ Notes, Remarks, Etc.| '\ Rev. 08-07-2015 Exoircs:t / Cuu