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APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />h tvro'&:Bondinq / Groundinq I UFER l^""do aAd <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs [-Bar Rouqh) <br />N/eter, Release <br />t/)la"r lc,l'2a htJailfri frg' <br />Rough <br />Service Meter <br />FINAL lAt0s AfurQ,,A,Y <br />Notes, Remarks, Etc. <br />OWNI'R BI.'U,DIiR DIiI,CARATION <br />I hereby affirnr under penalty of perjury that I am exenrpt frcm the Contractors' License [:w for the following reason (Scc.7031.5 <br />llusincss and Prolbssion Codc): Any City or County which requires a perrnit to construct, altcr. itnprovc. dernolish or repair any <br />structure, prior t<l its issuance. also requires the applicaurt for such pernrit to file a signed statemcnt that he or shc is licensed pursuant <br />to thc pmvisions of the Contractor's l,iccnsed law (Chapter 9. Commencing with Section 7000 of Division 3 ol'thc Busincss and <br />Professions Code) or that lrc or she is exenpt therefronr and tlre basis for tlre alleged exenption. Any violation of Section 7031.5 by any <br />applicant for u pennit subjects thc applicant to a civil penalty of not morc than five hundred dollars ($500). <br />_1. a-s owncr ol'the profrcrty. or my crnployecs with wages as thcir sole compcnsalion, will do thc work and thc structure is rnt <br />intcrxled or offered ftrr sule (Scc.7tNa. Business anrl Professions Code: The Contractor's Licensc Law does not aPPly to an owner of <br />tlrc property wlp builds or inrproves tlrreon, auxl wlro dtrcs such work hinself or lrerself or through his or her own entployees, <br />provided that such improvcrnnts are not intendcd oroffcrcd for sale. If. hnwcvcr, the buiHing or Lrprorcrrcnt is sold within one ycar <br />of conrplctioru the Owrrcr Buildcr will have the burden of provirrg tlut hc or she dirl not buikl or improve 0rc propary for thc purpose of <br />sale). <br />_1, as owner of the prcpcny, am exclusively contracting with licenscd conlractoni to conslruct thc project (Sec. 7(X4. Business <br />arxl Prulbssion Code: The Contractor's License Law dt>es not apply to an owner of proprcrty who builds or intproves thereott. <br />and who contracts for such projccts with a Contractorls) licenscd pursuant to the Contractor's Liccnse L:w). <br />_l anr exempt under Section-, B. & P.C. lbr this reason. <br />WORKI.,RS' CO[\T PENSA,I.ION <br />DF]CLARATION <br />I hcrcby aftirm undcr penalty of pcrjury one of thc lbllowing dcclarations: <br />_l have and will nnintafut a Certiticate of Consent to Self-lnsure for workers' compensation, as provided for by Scction 3700 of the <br />Labor Code, for thc performance of the work for which thc permit is issucd. <br />_l have and will nuintain 3700 of thc l-abor Code, for lhe grerfornurrce of <br />and policy numbcr arc:thc work ftrr this <br />Policy / <br />_l cerrify that in thc ;rcrfornuncc of thc work frrr which this pcrmit is issucd, I shall not cmploy any lrcrson in any manner <br />so as to beconr subjcct to thc workers'compensation laws of Califomia, and agrce that if I stnuld beconrc subject to the <br />workers' conrlrcnsation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with thosc provisions.. <br />WARNING: Failure to secure workers' compensation covemge is unlawful, and shall subject an cmployer to criminul penaltks and <br />civil fines up to one hundred thousand dollars ($100.000), in addition to the cost of comgrcnsation, danrages as provided f<lr the <br />,:j:"Y',J'ru)'.ry;;) <br />and attorrcy's <br />I hercby aflrnr under pnalty of perjury that I anr licenscd of Chapter 9 (conrnrcncing with Section 7000) of Division 3 <br />of the Business and Professions Cotle. arxl rny license is in full force and effect. <br />Licertse e/'o/o + 4 Nurnber: <br />CONSTRUCTION LENDING AGENCY <br />I hcreby alfirm undcr pcnalty of pcrjury that therc is a construction lcnding agency for the pc'rformance of the work l'or which this permit is <br />issued (Sec. 3097. Civ. C.). <br />[.cnder's Name: <br />APPI,ICANT DECI,ARATION <br />I h:cby affrnr undcr Jrcnalty of pcrjury onc o[ thc following dcclarations: <br />Dcnrolition Pcrnrits-Asbcstos Notification Fcdcral Rcgulati<lns (Titlc 40, Part6) <br />Rcquircd [.cttcr of Notification <br />_l ccrtify that thc l'cdcral rcgulations regarding asbcstos rcmoval arc not applicablc to this projcct. <br />inlbrnralion is corrccl. I agrcc to conply witlr all City and County <br />above mentionetl property [<rr inspection purposes. <br />Applicant or Agent <br />Irernritec nAnlc <br />auttrorizc represcntativcs <br />ELECTRICAL.INSPECTOR RECORD a <br />Rev. 08-07-2015 <br />'/4. <br />city and county to cnter upgn thcro,AtA-