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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OWNIiR B I'II,DER DI'I,CA RATION I hereby aflirnr under penalty of prjury that I anr exenrpt from the Contracton' Licensc [-aw for the following reason (Sec.7031.5 Busincss and Prol'ession Codc): Any City or Countv which rcquircs a pcrrnit to construct, altcr. itnprove. demolish or repair any structure, prior to its issuance. also requires the applicant for such Jrcmft to lih a signed statenrcnl that lr or she is licelrscrJ pursuanl to thc provisions of thc Conlractor's l,iccnscd l^aw (Chaptcr 9. Comrncncing with Scction 7000 o[ Division 3 of the Busincss and Professions Code) or that he or she is exen4rt therefronr and tlrc basis for tlre alleged exenrption. Any violation of Section 7031.5 by any applicant for uperrnit subjectsthc applicant to acivilpenaltyoInot morethan five huntlred dollars ($5Ull. _1. as owncr ol'the proFrrty. or my etnpkryces with wagcs as thcir solc compcnsation, will do the work and thc structurc is nol intended or offered for sale (Sec'.7H4, Business anrl Prolessiorrs Code: The Corrtractor's License Law does nol aPPly to an owncr of the proprty wlm htrilds or inrproves thereon, and wlp does such work himself or lrerself or through his <lr her own entployees, provided that such improvc'rncnts arc not intcndcd or ollcrcd for salc. Il. howcvcr, tltc buildhg or inprovetrcnt is sold within one )aar of conplctkln, the Owner Buikhr will havc the bunlen of proving that he or she did not buikl or improve 0rc propaty for thc purgrsc of sah). _I. as owner of the property, am exclusively contracting with licensed conlraclors to construct thc project (Sec. 7044, Business and Prrofcxsion Code: The Contractor's License Law does not apply to an owner of property who builds or intproves thereon. and who con[acts for such projects with a Contractor(s) liccnsd pursuant to the Contractor's Liccnsc kw). _l anr exenlpt under B. & P.C. lbr this reason. f 1... ^. WORKIiR,S' COM PEIISATION DECLARATION I hcrcby alTirm under pcnalty of perjury one of thc following declarations: _l have and will nmintain a Certiticatc of Consent to Self-lnsure for workers'compensation, as provided for by Section 3700 of the L:bor Codc, for the Srerlornmncc of thc work lbr which thc pcrrnit is issucd. _l have and will maintain workers' con{rensalion insurance, as required by Section 3700 <lf the l-abor Code, for the perfornrance of the work for which this prmit is issucd. My workers' crrmpcnsation insurance carrier ud policy numbcr are: Policy Number: Expires: _l ccrtify lhat in thc lxrtirrnunce of thc work f<rr which this pcrmit is is.sucd, I shall not cnploy any [rcrson in any mannct so as to bccollrc subjcct to thc workers' conrpcrrsation laws of California. and agree that if I should becomc subjcct to thc workers' conUrnsation provisions <lf Section 3700 of the Labor C'ode, I shall, forthwith cornply with those provisions.. WARNING: Failure to secure workers'compensation coverage is unlawful, and shall subject an employcr to criminal pcnaltics and civil fines up lo one lrurrdred thousand dollars ($100.UX)1. .Section 3076 of the Labor Codc, intcrcst and attorncy's lbcs. lll Io the danuges as provided for lhe D^,", ?n z{ ?zd I hereby affirnr under penalty of perjury that I anr licensetl under pnrvision of Chapter 9 (contmencing with Section 7000) of Division 3 of the Business and I'rol'essiorrs Code. and rny license is in full force und elTect. Licensc ,,,-, 74/ -JA CONSTRU(]TION LENI)ING AGENCI' I hercby al'linn under pcnalty of pcrjury that thcre is a construction hnding agency for thc Jrcrlbrrnancc of the work for which this pcrmit is issuerl (Sec. 3097, Civ. C.). Lender's Nanre: lrnder's Address: A PPI,ICA NT DECI,ARATION I hcrcby allirnr under pcnalty of pcrjury onc o[ thc fbllowing dcclarations: Dcnxrlit ion Pcrnrits-AsbL'st()s Notification Fcdcral Rcgu lat ions (Titlc 40, Part6) -Rcquircd lrttcr of Notilication _l ccrtily that thc l'cdcral rcgulations rcgarding esbcstos rcrnovat arc nol applicablc to this project. -l certily that I luvc rcarl this application arxl atxlvc informaliort is correct. I agrcc to conrply witlr all City antl County ordinances and Statc Laws rclating to building rcprcscntatives of this City and County to cnter upon thc ubove nrcntioned properly for inspection Applicant or Agent Pcrnritec nomc lnrinl l. and *r",72/-Z? Site-Work Underground 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 Torqueino Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit)A Walls (Roush)T -Ti'-z XrdAt Ceilinqs (Hard & Soffit Rouoh ( Ceilinqs [-Bar Rouoh)(t -%,-7rrl vJL'\rt N/eter Release I \ Rough Service [/eter FINAL yJ,u 1L Notes, Remarks, Etc. t Rev. 08-07-201 5 h A b