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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWN IO,R BUII,DTiR DI'LCARATION I hercby affrnr under penalty of perjury that I anr exenrpt fronr the Contractors' Licensc l-aw for the following rcason (Sec.7031.5 Busincss and Prol'cssion Codc): Any City or County which rcquires a pcrmit to construct, altcr. itnprove, demolish or repair any structure, prior to its issuance. also requires the applicant for such pemrit to frh a signed statemenl that lr or slrc is licenscd pursuant to the provisions of thc Conlractor's l.iccnscd l:w (Chapter 9. Commcncing with Section 7fiX) of Division 3 of thc Busincss and Professions Code) or that he or she is exen4rl therefrom and tlre basis for the alleged exenption. Any violation of Section 7031.5 by any applicant for u pennit subjects the applicant to a civil penalty of not morc than five hundrcd dollars ($500). _1. as owncr ol'thc propcrty. or my crnployees with wages as thcir sole compcnsation, will do the wrnk and the struclure is not intendetl or offered ftrr sale (Sec'.7044. Business and Professions Code: The Contractor's Licensc Law does not apply to an owner of the prcperty wlro builds or improves tlrcrarn, arxl wlro does such work himself or herself or through his or her own enrployees, providcd that such improvc'mcnts are not intcnded or ollcrcd for sale. It, howevcr, thc building or imp,rovenrcnt is sold within onc )â‚¬ar of conpletion, thc Owner Buil&r will luvc the burden of proving that hc or she did not builJ or impmve tlre property lor thc purposc of sah). _I. as owner of the propetly, am exclusively contracting with liccnscd contractors to conslrucl thc project (Sec. 7044, Business and Pnrtl.ssion Code: The Contractor's License Law dms not apply to an owner of property who builds or improves thereon. and who contracts for such projccts with a Contractor(s) licenscd pursuant to thc Conuactor's Licensc Law).i _l anr exernpt ultder B. I 1...,.. DECLARATION I hereby aflirm undcr penalty of perjury one of the lbllowing declarations: _l have and will nraintain a Certificate of Coruent to Self-lnsure for workers' conryrcnsation, as provided for by Scction 3700 of the lahor Code, for the pcrforrnance of thc work for which the pcrmit is issued. _l have and will maintain workers' comfrcn.sation insurance, as required by Section 3700 of lhe l-abor Codc, for the perfornrance of the work for which this pcrmit is issucd. My workers' compcnsation insurance carrier and policy number are: Carrier: Policy Nunrber: lixpires: _l ccrrify that in thc ;^-rfornuncc of tlrc work frrr which this pcrnrit is issucd, I shall not enploy any pcrson in any manner .so as to becornc .subject to thc workcrs' compcnsation laws of California. and agree that if I should becotne subject to thc workers' contlrnsation provisions of Section 3700 of the Labor Cotle, I slrall, forthwith conply wilh thosc provisions.. WARNING: Failurc to secure workers'compensation coveruSe is unlawful, and shall subject an to crirninal Srenalties and civil lirres up to one hurrdred lhousand dollars as provided for the Scction 3076 otthc [:bor Codc. intcrest and attorncy's Date: I hercby affirnr under penalty of perjury that I ant licensed 9 (corrunencing with Scction 7000) of Division 3 of the Business and Professions Codc. alxi mv license is in full force arxl effect. License Class: Licensc Nunrber: Date: CONSTRUCTTON LENDING AGENCY I hercby aflirm undr-'r pc.nalty of perjury that therc is a construction hnding agency for the pcrlorrnancc of the work l'or which this pcrmit is issued (Sec. 3097. Civ. C.). lrnder's Nanre: frnder's Address: APPI,ICANT DECI,ARATION I hreby affrnr undcr penalty of pcrjury onc of the folkrwing dcclarations: Dcnrolition Pcrnrits-Asbcstos Notification Fcderal Rcgulations (Tillc 40, Part6) _Rcquired lrttcr of Notification _l ccrtily that thc fedcral rcgulations rcgarding asbcstos rcmoval are not applicablc to this projcct. _l ccnily tlul I havc rcatl this application iud statc tlral thc atxrvc inlbrnution is corccl. I ordinanccs and Statc [,aws rclating to building constructi()n. and thc ab<lve rncntioned property lor Applicant or Agent I'crnritec C *r", [1--7- ?C Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under SIab / Floor Bondinq I Groundinq I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouoh Ceilinos [-Bar Rouoh) Meter Release Rouqh tl I Service N/eter llllK/2o lffurfu 7D- FINAL tLl)hl?n l.Llryr a 7tf-fK( Notes, Remarks, Etc.I Rev. 08-07-201 5 addition to llrc cost of City and County