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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underoround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildins Under SIab / Floor a I Bondins I Groundinq / UFER DnatT Transformers Torqueing Sub-Panels Air Conditioners I Roof Top Equipment DKWT Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinss (Hard & Soffit Rouoh Ceilinss [-Bar Rouqh)I I N/eter Release UZl1,tt 'f\trktt Rough Service lMeter lt .2 FINAL b{+v2 7 Notes, Remarks, Etc.I I t I hereby affirnr urrtler penalty of perjury that I arn exenrpt fronr the Contractors' License Law foi'the followingi reason (Sec.7031.5 Busincss and Prolbssion Code): Any City or County which requires a pcrmit to construct, altcr, irnprovc, demolish or repair any structure, prior to its issuance. also requires the applicant for such pernrit to file a signed statement that lre or she is licensed pursuant to the provisions of tlrc Contractor's Liccnsed Law (Chaptcr 9, Cornrncncing with Section 7fiX) of Division 3 ol'thc Busincss and Professions Code) or that he or she is exempt therefronr and tlre basis for tlrc alleged exenrption. Any violation of Section 7031 .5 by any applicant for a pennit subjects the applicant to a civil penalty of not rnore than five hundred dollars ($500). _1. as owncr ol'thc propcrty. or rny crnployecs with wagcs as thcir sole compensation, willdo the work and the structure is not intended or offered for sale (Sec'.7(X4, Business and Professions Code: The Contractor's License Law does not apply lo an owner of the property who builds or improves therurn, and who does such work himself or lrerself or through his or her own enrployees, provided that such improvclncnts are not intended or offcrcd for sah. Il, however, the building or improvernent is sold within one year of completion, tlrc Owner Builder will have the burtlen of proving that he or she did not build or improve the property for the purpose of sale). _I, as owner of the property, am exclu.sively contracting with licensed contraclors to construct the project (Sec. 7044, Business and Protbssion Code: The Contractor's Licerrse Law does not apply to an owner of property who builds or intproves thereon. and who contracts for such projccts with a Contractor(s) licensed pursuant to thc Contractor's License taw). -IantexemptunderSection-,B.&P.C.fbrtlrisreason. I hereby alTirm under pcnalty of _I have and will nmintain a Certilicate of Consent to Selt'-lnsure for workers' cort4rensation, as pmvided for by Section 3700 of the Labor Code, for thc pcrformance of thc work for which the permit is issued. insurartce, as by Seclion 3700 of the [,abor Code, for the perfornunce of work is conryrcnsation caricr and plicy number are: CAYl Policy - LC) that ln thc ;rcrformancc of thc work f<rr whiclr this pcrmit is of California. issucd,shall Ir()t cmploy any pcrson irr any nlanncr to bccomc subjcct to the workers'cornpensation contpensation provisions of Section 3700 of laws and aSrcc that if r should becomc subject to thc workers'the Labor Code,shall,forthwith comply with tlpse provisions.. WARNING: Failure to secure workers' cornpensation coverage is unlawful, and shall subject an employer to criminal penalties and dollars ($100.000). in addition to the cost of danmges as provided for lhe and I hercby affirrn under pnalty of perjury that I anr licensed 9 (conurrcncing with Sectbn 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. C t)q1T1 6 U D ao a\t)ar CONSTRUCTION LENDING AGENCY I hcreby al'llrm undcr ;rcnalty of perjury that thcrc is a construction lcnding agency for the perlbrmance of thc work ltrr which this perrnit is Civ. C.). Lrnder's Address: APPI,ICANT DECLARATION I hcrcby aft-rm undcr pnalty of pcrjury onc of the following declarations: Demolition Pernrits-Asbcstos Notification Fcderal Rcgulations (Title 40, Part6) Required lrtter of Ntxification _I ccrtity that thc I'edcral regulations rcgarding a.sbestos rcmoval are not applicablc to this project. luvc rcatl this a;r;rlication urd statc that thc ahrvc infbrmation and Statc Laws rclating above rrrentioned propeny Applicant or Agent Pcrnritcc nanrc for to construction, and hereby -201 c so