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ELECTRICAL.I NSPECTOR RECORD nO n7 '>r\4 R APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DET,CARATION I hacby affm unda pcrulty of pcrjury that I m qmpt ftom thc ContracloB' Licsc taw for thc following rqc,n (Ss.7031.5 Bwincs and Prcfasion Codc): Any City or County which rcquirc a pe'rnit to coNtruct. altq, improvq &molish or rcpair uy structm. prior to its issmcc. also rcquirB thc applicut for such pcmit to filc I signcd statmmt that hc or shc b licosâ‚¬d plllswt to thc prcvisiom of thc Contmctor's Lienscd tlw (Chapt6 9, Commmcing with Sction 7000 of Division 3 of thc Busins ud PrcfsioBCodc)orthsthcorshcisqcmptthcrcfromsdthcb8isforthcallcgcdcxanptior. AnyviolationofSetionT03l.5byuy applicutforapcnnitsubjetsthc applicanttoacivilpcnsltyofnotmorcthilfivchundreddollm($500). _1. as owner of the property, or my employecs with wages as their sole compensation. willdo the work and the structtre is not intended or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who hilds or improvc theron. and who does such work himself or herself or through his or her own employees. provided that such improvanents are not intendod or ofltred for sale. If. howct â‚¬r. thc building or improvement is sold n'ilhin one yâ‚¬ar of complaion. the Or,vner Buildcr will have the burdcn of proving tha he or shc did not build or improve thc propo'ty for thc purposcof sale). _1, as owner of the property, am exclusively contracting with licemed contractors to construcl the projecr (Sec. 7044. Business and Proftssion Code: The Contractor's License Law does not apply to an owncr of property who builds or improves thereon. and who contracts for such projer1s with a Contracto(s) licensed pumuant to the Contractor's License Law). -l am exempt under Section-. B. & P.C. for this reason. flo I a. WORKERS' COMPENSATION DECLARATION I hereby allirm under pcnalty of pcrjury one of the follorving declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section -3700 of the l-abor Codc, for the performance of the work for which the pcrmit h issued. _l have and will maintain workers' compensation insurance. as required by Section 1700 of the Labor Code. for the performance of the work for which this permit is iszued. My workcrs' compensation insurance carrier and policy number are: Policy Expires: _l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation larvs of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the l-abor Code. I shall. forthrvith comply rvith those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an onployer to crirninal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compcnsation. darnages as prot'ided for the Section 3076 of the Labor Code. interest and attorney's fecs. A -^ll^^-.. LTCENSED CONTRACTOR DgCI.ARATiON I hereby affrm under penalty of perjury that I am licenscd under provision of Chaptcr 9 (commencing rvith Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License Dolo'(lontractor: W I h@by affm undq pcoahy of pcrjury tha th* i! a sndruction btrding agmy for thc pafomncc of thc rcrk for which this pcmit b isuod (Se. 3(x)7. Civ. C.). kndr's Nmc: Lender's Address: APPLICANT DECLARATION I hoeby affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notilication Federal Regulations (Title 40. Part6) -Required Letter of Notification _l certi& that the federal regulations regarding asbestos removal are not applicablc to this project. ti0t, certig/ thar I have read rhis apptication and state that thc above with all City and County and County to enter upon theordinances and State Larvs relating to building construction. above mentioned property for inspection Applicnnt or Agent x'Zuve t*JD Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Roush) Meter Release FXPi RED Rough NFC I 0 'lU'i,J Service Meter FINAL SAMC 6.4J,:utr, cc6, oc Notes, Remarks, Etc. { Carrier: Liccnsc Numbcr: Pernrifee nsnre (prinl): {-