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ELECTRICAL.INSPECTOR RECOR D <br />APPROVALS DATE ID/SIG,COMMENTS oWNER BUII,DER DEI,CARATION <br />I hcrehy affirm undcr FEnally of pcrjury lhd I am excmpl frern thc Conlraclors' I-iccnsc l:w for lhc folkrwing rca$n (Scc.703l 5 <br />Busincss {nd Prolcssion Codc): Any City or County which rcquircs a pcrnrit k} conslruct. altcr. improve. dcmolis} or rcpair dny <br />slruclurc. priT to its issuancc. also rcquircs lhc ilpplicant for such lErmil to filc { siSncd stalcmnt lhol hc or shc is liccnrcd pnrsuant <br />to thc pftrvisk,ns of the Conrractor's Lien$cd Lrw (Chaptcr 9. Comnrcncing with Sstion 70(D of Division 3 of thc Busincss "ild <br />ProfcssionsCode)orthallrcorsheiscrcmptthcrcfromandthcbasisforthcallcgcdcxcmption. AnyviohtionofScclionTO-jl.5byany <br />applictrrl for d lEnrrit subjccts lhc npplicant to a civil pcn{ltyoflot morc than fivc hundrcd dollars ($5U)). <br />_1. as owncr of thc propcrty. or nly employces wilh wagcs os thcir solc cornpcnsation. will do thc work alld lhe structurc is not <br />intcnded or olTcrcd lbr salc (Sec.7044. Busincss and Profcssions Crxtc: Thc Conlraclor's Liccnse Law docs not apply lo an owncr of <br />thc propcrty who builds or improvcs thcrrnn. and who docs such work hirnsclf or hcrscll'or through his or her own employees. <br />providcd that such irnprovenrnts are not intcndctl or olTercd for salc. ll. howcvcr. thc buiklirrg or itnprovcnEnt is sold within onc ycar <br />of conqrlction. thc Owner Builclcr will havc thc burdcn of provirrg thal hc or shc did not huild rtr improve thc propcrty t'or thc purposc of <br />sah). <br />_t. as owncr of thc propcrty. am exclusivety conlracting with liccnscd conlraclors lo conslruct lhc projcct (Scc. 7W. Business <br />antl Prufbssign Codc: Thc Contractor's Liccnsc l-aw docs not apply lo an owncr of propcrty who builds or improves thercon. <br />and who contracts for such projccts with a Contractor(s) liccnscd pursuant lo thc Contractor's License taw). <br />-l <br />ant cxernpl undcr Seclion-. B. & P.C. tbr this rcason. <br />l)lte:()rr ner <br />WORKERS' COIVIPF'NSA'IION <br />DT.,cLARATION <br />I hcrcby tlfirrrr undcr pcnalty of pcrjury ortc of thc f<rllowing dcclarations: <br />_l have and witl rnaintain a C'crtificatc o[Conscnt to Sclf-lnsurc lirr workcrs'compcttsation. as providcd for by Scction 3700 of thc <br />Latxrr Crdc. for thc perfornuncc of thc work firr which thc pcrrnit is issucd. <br />-l <br />havc and will tnaintain u'orkcrs' contJrcnsatirtlt ittsurancc. as hy Scctiorr 37U) of thc l,ahor Codc. ftlr lhc pcrlbrttutttcc of <br />lhc work for which this perrnit is issucd. My workcrs'carricr and policy nuntbcr arc: <br />Policy <br />-l <br />ccrtify lh:rt in thc pcrlorrrtancc ol'thc work which this perrrrit is issuccl. I shall nol ctttploy any pcrson in any milnncr <br />of Califirrnia. and agrcc that if I should bcconrc subjccl to theso as to beconrc subfcl to thc workcrs'contpcnsalion laws <br />wgrkcrs' cotnpcnsation provisions of .Scctiorr 37(X) of thc Labor Co<lc. I shall. tbrthwith corttply with thosc provisions'. <br />WARNING: l'ailurc to sccurc workcrs' <br />civil fincs up lo onc hundred lhousand <br />cornpcrtsltion is unlarvfirl. tnd shall subjcct an erttploycr to crintinal pennltics and <br />addition to thc cosl of cotnpcnsation. danmgcs as providcd for thctll <br />Scctiott <br />I )ale: <br />'lL <br />I hcrcby affirnt uttdcr pcnalty of pcr.iury that I ant licenrccl provision of Chapler 9 (comlncncing with Section 7000)of Division .3 <br />of thc Busincss alrd Prot'cssions Codc. and rny licensc is in tull frrrcc and cfl'ccl. 1 <br />&(\s(.\q <br />Liccnsc <br />Date: <br />Nurnhcr: <br />\\a <br />I hcrchy affirm undcr IEMlty of lrcrjury lhnl therc is a snslruclion lcnding ogcmy for lhc tcrformance oflhc work lor which lhis lErmil is <br />issued (Sec. 3097. Civ. C.). <br />bnder's Nartrc: <br />l.ender's Address: <br />APPLICANT DT'CLARATION <br />I trcrcby affinn under penalty of pcrjury onc of thc following dcclarations: <br />Demolition Pcrmits-Asbestos Notification Fedcral Rcgulations (Title 40. Part6) <br />-Required <br />lrtter of Notification <br />_l ccrtity that thc feclcral rcgulations rcgarding asbcstos rcntoval are nol applicablc to this projcct. <br />I ccrtitv rhat I havc rcatl this application and statc that thc atnve inlbrnration is corrcct. I agrec to cornply with all City and C--ounty <br />ordinanccs and .Statc laws rclating to construction. arrd hercby authorizc rcprcscnlalivcs of this City and County ltl cnler uJxrn lhc <br />abovc rncnliortc<l propcrty ltrr <br />Allplicanl or Agcnl \4 <br />Penrritt'e nanrc ( prilrl ):Arl <br />-e-,"',. (>a\\ S U <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs [-Bar Rouqh) <br />Nleter Release .tA <br />Rouqh VN.Flt)' <br />Service N/eter /y\\, <br />FINAL 0 - l9-h ,\"ullt\ <br />Notes Re Etc. <br />?,na na Dn"ir <br />I-"t-70