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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq I Groundinq I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) N/eter Release Rouqh Service Meter -'4, /)hr7 /q,rzF!NAL D n.&114 )('Notes, Remarks, Et6.I I hereby affirnr under penalty of perjury that I an exenrpt from the Cbntractors'License l-aw for the following reason (Sec.7031.5 Busincss and Profcssion Codc): Any City or County which rcquires a pcrrnit to construct, aher. improvc, dcmolish or repair any structure, prior to its issuance. also requires tlre applicant for such Jrernrit to file a signed statcment that ltc or .she is liccnscd pursuanl to thc provisions of thc Contractor's l.iccnscd law (Chaptcr 9. Commencing with Section 7fi)0 of Division 3 of thc Busincss and Professiorrs Code) or that lrc or she is exen4rt therefrom and tlre basis for tlrc alleged exenption. Any violation of Section 7031.5 by any applicant for a pennit subjects the applicant to a civilpenaltyof not more than five hundred dollars ($5{ltt1. _1. as owncr ol'thc propcrly. or my cmployecs with wages as their solc compcnsation, willdo the work and the structure is not irrterxlctl or offeretl for sale (Sec.7M4. Business antl Professions Code: The Corrtraclor's Liccnse Law docs not apply to an owner of the property wlxr builds or improves therurn, und who does such work hinrself or herself or lhrough his or her own enrployees, provided that such irnprovcmcnts arc not intended or ollercd tor sale. lf, however, thc building or inprorrrrrcnt is sold within one )rar of compbtion, thc Owner Buiklcr will have thc burtlcn of proving tlrr lre or she did mt buikl or inrpmvc 0rc propctty for thc purposc of sdle). _1. as owner of the propertyt am exclusively contracting with liccnsed contractors to construct thc project (Sec. 7044, Business and hol'ession Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon. and who contracts for such projects with a Contractor(s) liccnscd pursuant to thc Contraclor's Liccnsc l-aw). -l anr exempt under Sectiorr_, B. & P.C. lbr tlris reason. WORKIERS' CONIPENSATION DECLARATION I hcrcby affirm undcr pcnalty of pcrjury onc o[ thc tbllowing dcclarations: -l have and will nraintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Saction 3700 of the Lahor Codc, for thc grcrforrnance of thc work lbr which the grcrrnit is issued. arrd will nraintain workers' conrpensalion insurance, as required by Seclion 3700 of the [:bor Code, for the perfomrarrce of My w<lrkcrs' comJrcnsation insuiancc carrier arxl grclicy nunrbcr are: l'>olicy o c t l, _l ccrlify that in lrcrtirrnuncc of tlrc work for which this pcrmit is issucd, I shall not cmploy any pcrson in any nnnncr so as to bccorrrc subjcct to thc workcrs' compensation laws of California. and agrce that if I stnuld becorr subjcct to the workers' conrlrnsation provisiom of Section 3700 of the Labor Code, I shall, forthwith conply with those provisions.. WARNING: Failure lo secure workers'compensation coverage is unlawful. and an employer to criminal penaltics and civil tines up to one hundred tlpusand dollars ($100.0001. in to tlrc cost danuges frrr the Scction 3076 of thc Lahor Codc. intcrcst and attorncy's l'ccs, I hercby affirnr untler penalty of perjury that I arrr licensed with Section 7000) of Division 3 of the Business and Pnrfiessions Code. arrd my is in lull force and e[[ect. e C Nunrber: I hercby allirrn undcr pcnalty of pcrjury that thcrc issued (Sec. 3097. Civ. C.). Lrnder's Name: agcncy for thc pcrlbrmancc of thc work lbr which this perrnit is Lrnder's Address: APPI,ICANT DECI,ARATION I lr:rcby ullirnr undcr pnalty of pc{ury onc of thc lirlkrwing dccl;u'ations: Dcnxrlition Pcrnrits-Asht'stos Notification Fcdcral Rcgulations ('[itlc 40, Part6) lrttcr of Notification ccrtily that thc fcderal rcgulations rcgartling asbcstos rcmoval arc not applicablc to this projcct. ccrtily tlrat havc rcad this applicalion anrl stalc that thc abovc with all City and County and County to enter upon thcandStatclawsrclatingtobuilding above rnentioned property for inspcction r/Aplllicant or Agcnt Pcrnrilec construction.arxl inlbrnulion o Rev. 08-07-201 5 t is corrcct.agrc"c to