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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underoround Pole Bases Lioht Standards Spas, Pool, Fountains Signs (monument) Life Safetv /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildins Under Slab / Floor Bondinq I Groundino I UFER Transformers Torqueino Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) lVleter Release Rough It A Service [Vleter 11l;Lllt.lM^ -,,,'ryrrvlK FINAL | -l l0l '3-v/V la*"t tvlt 7 Yv Notes, Remarks, Etc.I OWN I'R B I.'II,I)ER DEI,CA RATION I hereby aflinn under penalty of prjury that I am exenrpt frorn the Contraclors' License [:w for the followilrg reason (Sec.7031.5 Busincss and Prolbssion Codc): Any City or County which requircs a pcrmit to construct, alter, irnprove, demolish or rcJrair any structune, prior to ils issuance. also requires the applicart for such Jrenuit to file a signed state[Enl that lr or she is licenscd pursuant to thc. provisions of t!rc Contractor's l,iccnscd Iaw (Chapter 9. Commcncing with Section 7000 of Division 3 ol'the Busincss and Professions Codet or that lu or she is exenqrt therefrom and tlp basis for tlr alleged exenption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to o civil penalty o[ not tnore than five hundrcd dollars ($5tltl). _1. as owncr ol'ttrc proFrty. or my crnpkryecs with wagcs as thcir solc compensation, willdo the wcnk and thc stnnure is not intendcd or offered ftrr sale (Sec.7044. Busincss and Professions Code: The Contractor's Liccnse Law does not apply to an owner of thc pmperty wlxr builds or inrproves thcretxL and wlro dtrcs such work himself or lrerself or ttuough his or her owtr enrployees, providcd that such irnprovcrnents arc not intcndcd orollcrcd lor salc. Il. however, thc building or funprovemcnt is sold within one ycar of conrphtion, the Owner Builder will have thc bunlen of proving tlut hc or she did rct buikl or inpmve 0re propoty for thc purpose of sale). _1. as owner o[ the propefly, am exclusively contracting with liccnsed contractors to construct the project (Sec. 7(X4, Busincss and hotessi<rn Code: The Contractor's License Law <loes not apply to an owner of property who builds or improves thereon. and who contracts for such projccts with a Contractor(s) liccnscd pursuant to the Contractor'.1.[-iccnsc [:w). _l anr exenlpt urxJer & P.CJor I t... ^. DECLARATION I hereby affirm under penalty of perjury one of tlte following declarations: _I have ard will nraintain a Certificate of Consent to Self-lrrsure for workers' conrpensation, as provided for by Se,ction 3700 of thc Labor Code, for the grcrfornunce of the work for which the permit is issued. _l have and will maintain workers' compensation insurance, as reguired by Section 3700 of thc l-abor Code, for the perfornrance of the work for which this permit is issucd. My workers' compensation insurance carrier ud policy number are: Carrier: Policy _l ccrrity lhat in thc lrcrfornunce of thc work for which this pcrmit is issucd, I shall not cnrploy any lrcrson in any mannct so astobccorrcsubjccttothcworkers'cornpcnsationlawsofCalifornia.andagrcethatiflslnuldbecotnesubjccttothe workers' conrlrcnsatiorr pnrvisions of Section 3700 of the Labor Cbde, I shall, forthwith conrply with those provisions.. WARNING: Failure to secure workers'compensation coverdge is unlawful, and shall subject an to criminal pcnalties and civil lirres up to otre hundred thousand dollars ($100.000). in to the cost of compeusation,as provided for lhe Scction 3076 of thc latnr Codc, intcrcst and attorncy's l'ces. Date: I hercby affirm under pnalty of perjury that I anr licensetl (conrnrncing with Section 7000) of Divisiorr 3 of the Business and Professions Cotle. and my license is in full forcr and efifect. License Class: License Numbcr: CONSTRUCTION LENDING AGENCY I hcreby all'irm undcr pcnalty of pcrjury that thcrc is a construction hnding agency for the pcrlbrmancc of thc work for which this pcrmit is issued (Sec. 3097. Cir'. C.). l.elrder's Nanre: APPLICANT DECI,ARATION I hrchy aftirnr untlcr pcnalty of pcrjury onc of thc folkrwing dcclarations: Dcmolition Pcrnrits-Asbcstos Notification Fedcral Rcgulations (Title 40, Part6) -Rcquired lrttcr of Notification _l ccrtily that the l'cdcral rcgulations regarding asbcstos rcrrxrval arc not applicablc to this projcct. _l ccrtily thal I havc rcatl this application ilxl statc tlrat thc abovc inlirrnution is cogl1it. I agrcc to conrply with all City and Courtty ordinanccs and Statc [,aws rclating to o[ this City and County to cntcr upon thc above rnentioned property for Applicant or Agent Pcrmitce namc and Date:[L-1-LO 08-07-201 5