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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under SlabAOr Bondins lGroNiis / UFER /z'/-2d l/Lcb u) Transformers Torqueing \ Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) N/eter Release Rough Service N/eter \l*t\/) .?a t4 4an F!NAL ,//q e -os lL utt)rvzftA> ?1 '/ Notes, Remarks, Etc. o I hereby atfrnr under penalty of perjury that I anr exenlpt frorn the Contractors' License [:w for the following reason (Sec.7031.5 Business and Prol'cssion Code): Any City or County which rcquircs a permit to construct, altcr, irnprove, dcmolish or repair any structure, prior to its issuance. also requires the applicart for such Jrernrit to file a signed slatement that lte or she is licenscd pursuant to thc provisions of thc Contractor's Liccnscd l:w (Chapter 9. Commcncing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt therefronr arxl the basis for tlre alleged exemption. fuiy violation of Section 7031.5 by any applicant for a pennit subjects the applicant to o civil penalty of not more than five hundred dollars ($500). _1. a.s owncr ol'thc propcrty. or my crnployecs with wages as thcir solc compcnsation, willdo thc work and the struclure is not interrletl or offered for sale (Scc.7@4. Business and Profcssions Code: The Contractor's Liccnsc [^aw does not apply to an owner of the prcgrcrty wlro builds or inproves thereon, and wlp does such work himself or herself or through his or her own enrployees, provided that such improverncnts are not intended oroffercd for salc. If. hcrwevcr, thc hilding or inprovenrcnt is soH within one )rar of conpletion, thc Owncr Buil&r will have the burden of proving tha he or shc did not buikl or irprove thc propaty for thc purposc of sale). -1. as owner of the property, am exclusively contracting with liccnscd conlractors to conslruct thc projcct (Sec. 7044. Busincss arxl Prolbssion Code: The Contractor's License Law does not apply to an owner of property wtro builds or improves thereoru and who conracts for such projccts with a Contractor(s) licensed pursuant to thc Contractor's License l-aw). -IamexemptunderSectiolt-,B.&P.C.forthisreason. WORK T',I(S' CONT PENSA'TION DECLARATION I hcrcby aflirm undcr pcnalty of pcrjury onc of the following dcclarations: _l have and will nraintain a Certificate of Consent to Self-ln.surc for workers' conrJrcnsation, as provided for by Scction 3700 of the Labor Code, for the lrcrfonnancc of the work for which thc pcrmit is issued. and will lnaintairr 3700 of the I-:bor Code,for tlrc perfonrunce of wlrich euxl gxrlicy nu lrrtrt'r arc: Policy Z3o _l ccrtity that in thc pcrlbrnrancc of thc work firr which this prnrit is issucd, I shall not cnrploy any pcrson in any manncr so as lo bcconre subjcct to thc workers' compcnsation laws of California. and agree that if I should becomc subject to thc workers' conrlrcnsation provisiorrs of Section 3700 of the Labor C'ode, I shall, forthwith conrply with thosc provisions.. WARNING: Failure to secure workers' compensation coverdge is unlawful, and shall subject an employer to crirninal penahies and civil fines up to one hurrdred thousand dollars ($100.000). in addition to tlrc danuges as provided for thc Scction 3076 thc labor Code. intercst and attorncy's I hercby affirnr under pnalty of perjury that , of the Busincss and Professions Code. and LICENSED CONTRACTOR DIiCI,ARATION I anr licensed under pruvision of Chapter rny license is in full forcc and effect. 9 (corrunencing with Section 7000) of Division 3 r 0+ License I hercby affirm under penalty of pcrjury that thcre issucd (Scc. 3097. Civ. C.). knder's Name: a8ercy performance of thc work lbr which this permit is lrnder's Address: APPI,ICANT DECI,ARATION I trcrcby affrnr undcr pcnalty of perjury onc of the following doclarati<lns: Dcnxrlition Pcrnrits-Asbcstos Notification Federal Rcgulations (Title 40, Part6) _Requircd l-ctter of Notification ccrtily that the fedcral rcgulations rcgarding asbcstos rcmoval arc not applicablc to this projcct. tlrat luvc rcad this application aurd stalc that thc ahlvc irnd Statc Laws rclating tlx: ahrve property lor Aplllicant or Agent Pcrmitcc (tl building construction.and infbrnration Rev. 08-07-201 5 a as by Section CAITrcT ).-l - ) and Counly cntcr upon