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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNI'R BU II,DIIR DEI,CAITATION I hereby affrnr under penalty of perjury that I anr exempt from the Cbntractors' License l-aw for the following rea$n (Sec.7031.5 Busincss and Prol'cssion Codc): Any City or County which requircs a pcrmit to construct, altcr, improve, dcmolish or rcpair any strucrure, prior to its issuance. also requires the applicant for such Srcmrit to file a signed staterncnl that lre or she is licenscd pursuant to thc provisions o[ thc Contractor's l,iccnscd law (Chapter 9. Cornmcncing with Section 7fiX) of Division 3 of the Business and Professions Code) or that lrc or she is exempt therefrom and tlre basis for tlre alleged erenrption. fuiy violation of Section 7031.5 by any applicant for a pennit subjects the applicant to ir civil pcnalty of not nrore than fivc hurxlred dollars ($500). _1. as owncr ol'tlrc. propcrty. or rny ernployees with wagcs as thcir sole compcnsation, intemlid or offered ftrr sale (Sec.70{4, Business and Pnrfes.sions Ctxle: The Contractor's Licensc l-aw docs not apply lo an owncr of the prcprty wlm builds or improves tltreoq arxl wlp doqs such work himself or lrerself or througlt his or her own enrployees, providcd that such irnprovenrcnts are not intcnded or ollercd for salc. Il, howcver, thc buiHing or inprovcnrnt is soH within onc )aar of completion, the Owlrcr Builder will have thc burden of proving thd he or shc did nrt buikl or inrprove tlrc property for thc purposc of sale). _1. as owner of the propetly, am exclusively contracting with licensed conlractors to conslruct lhc project (Sec. 70+4. Busincss arxl Pru[.sskrn Code: The Contractor's License Law does not apply to ar owner of property who builds or intproves thereon. and who contracts lor such projccts with a Contrack)r(s) liccnscd pursuant to ttrc Contractor's Liccnse Law). -l anr exenlpt under Section-, B. & P.C. lbr this reason. Date: WORKIIIIS' COM PI,,NSATION DECLARATION I hercby affirnr under penalty of pcrjury onc of thc lirlkrwing dcclarations: _l have and will nurintain a Certilicate of C<lnsent to Self-lnsure for workers' conrpensation, as pnrvidcd for by Section 3700 of the Labor Code, lor thc pcrfonnarrcc of thc work for which thc pcnnit is issued. 3700 of for the perfornunce of auxl prlicy afc: Rhq \z(Policy r- I _l ccrrify that in thc Jrcrfornuncc of tlrc work for which this prcrmit is issuc'd, I shall not cnrploy any pcrson in any manncr so as lo become subjcct to the workers' cornpcnsalion laws of California. and agree that if I should become subjcct to thc workers' conr;rensation provisions of Section 3700 of the Labor Code, I shall, forthwith conrply with thosc provisions.. I WARNING: Failure to secure workers' civil fines up to orrc lrundred tkrusand Scction 3076 of the lakrr Codc, intcrcst colnlrclrsirtion is unlawful, and shall subject an employer to criminal p:nalties and addition to the cost of competsation, danrages as provided for lheln and l'ccs. I hercby affirm under pnalty of prjury tlrat I ant licensed untler 9 (corrunencing with Section 7000) of Divrsion 3 of the Business and Prol'essions Code. and my license is in full forcc and effect. Licensc I hcrcby al'lirm undcr pcnalty of pcrjury that thcrc is a construction issued (Sec. 3097. Civ. C.). agcrcy for the perlbrmancc of thc work l'or which this pcrrnit is lrnder's Nanrc: APPI,ICANT DECI,ARATION I trrcby aflirnr undcr pcnalty of pcrjury onc of the following declarations: Dc nrolit ion Pernrits-As hc'st os Notilicat ion Fcdcral Rcgu lat ions (Tit lc 40, Part6) -Rcquired l,cttcr of Notifrcation asbcstos rcmoval arc not applicablc' to this projcct. that thc ahrvc inlbrttntiott with all City and County and County to cntcr upon thc above tncntioned propeny for Applicant or Agent Pcrnrilcc nonlc and Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildins Under Slab / Floor Bondinq / Groundinq I UFER Transf ormers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit)\ Walls (Rouqh)7'7-n UrY'r[0 Ceilinos (Hard & Soffit Rouqh 'f -7*U Ceilinqs [-Bar Rouqh)1u27ry Idpll)l N/eter Release v I\ / Rough Service Meter FINAL Notes, Remarks, Etc. Bev. 08-07-201 5 / I luvc rcatl this