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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNI'R BUII,DER DIELCA RATION I hcreby affrnr under penalty of prjury that I anr exempt fronr the Contractors'License [:w for the following reason (Sec,7031.5 Busincss and Prol'cssion Codc): Any City or County which requires a pcrrnit to construct, alter, improve. demolish or repair any structure, prior to its issuance. also requires the applicant for such pernrit to filc a signed slaterncnt that hc or she is licensed pursuanl to thc provisions of thc Contractor's l,iccnsed law (Chapter 9. Comrncncing with Section 70fi) of Division 3 of thc Busincss and Professions Code) or tlrat lrc or she is exenpt therefronr and tlre basis for tlre alleged exenption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($stltl;. _1. as owncr ol'thc propcrty. or my ernployecs with wagcs as thcir solc compcnsation, willdo thc work and thc structurc is rnt interxlcd or ofTered for sale (Sec.7044. Business and Profcssiorus Code: The Contractor's License law does not apply to an owner of the proprry wlxr builds or improves thereorr" uxl wln doqs such work himself or lrcrself or ttuouglr his or her own employees, providcd that such improvenrcnts are rnt intcndcd orollcrcd for sah. Il. hcrwever. ttrc building or inprovcnrcnt is sold within onc )aar of completion, tlrc Owncr Builder will have the bunlen of proving that he or she did not builtl or impnove thc properry for thc purpose of sah). -1. as owner of the propefly, am exclusively contracting with liccnsed conlraclors to conslruct thc project (Sec. 7044, Business arxJ Plolessbn Code: The Contractor's License Law does not apply to an ownâ‚¬r of property wtto builds or improves thereon. and who contracts for such projccts wilh a Contractor(s) licensed pursuant to the Contractor's Liccnse l-aw). -IanrexemptunderSection-,B.&P.C.lbrtlrisreas<rn. Date: WORKERS' COM PT:IISATION DECLARATION I hcreby affirm undcr penalty of pcrjury one of thc following declarations: _I have and will nraintain a Certilicate of Coment to Self-Insure for workers'conrpensation, as prcvided for by Section 3700 of the I-abor Code, for the perforrnance of thc work for which thc permit is issucd. -l have and will maintain workers' compensation insurance, as required by Section 3700 of thc l-abor Code, for thc perfornunce of the work for which this permit is issucd. My workers' cornpensation insurarrce carrier uxl policy numbcr are: Carrier: Policy ( ccrtify that in tlre lrcrfornuncc of thc work for which this pcrmit is issucd, I shall not cmploy any lrcrson in any manncr .so as to bccornc subject to thc workers' conrpcnsation laws o[ California. and agrce that if I should bccomc subject to thc workers' conrlrnsation provisions of Section 3700 of the Labor Cotle, I shall, firrthwith conply wilh thosc provisions.. WARNING: Failure to liecure workers' compensation coverage is unlawful, and shall subject an employer to criminal penaltics and civil fines up lo one hundred tlrousand dollars ($100.000). in cost of comperrsation, danrages as provided for the attorncy's [ccs. I hercby affirrn under pnalty of perjury that I ant licensed Chapter 9 (conunencing with Section 7000) <lf Division 3 of the Business and Professions Code. and my license is in full force and effect. License I hcreby al'lirrn under pcnalty of perjury that thcrc issued (Scc. 3097. Civ. C.). lrnder's Nanrc: agcncy perlbnnancc of thc work lbr which this Jrerrnit is Lrnder's Address: APPI,ICANT DECI,ARATION I trcrcby irftirnr undcr penalty of pcrjury <lnc of thc folkrwing dcclarations: Dcnrolition Pcrnrit.s-Asbcstos Nt[ification Fcdcral Regulations (Titlc 40. Part6) Required [rttcr of Notification _I ccrtily that thc fcdcral rcgulations rcgarding a-sbcstos removal arc not applicable to this project. _l ccrtily that I luvc rcad this application and statc tlut with all City and County ordinanccs und Statc Laws rclating to building and County to above rEntioned propcrty for inspcction Applicant or Agent Pcrmitcc nonlc I upon thc Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Fire Alarm / Dampers Communications Cable Buildins Under Slab / Floor Bondins / G6ilndinb / UFER It 2f nm a twLl Transformers \"-l Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) N/eter Release Rough Service Nleter rl - L; ,?t {L UFT r) FINAL tt:L{q9 O Dtq xJ t:it^ \ Lrl Notes, Remarks, Etc. Bev. 08-07-201 5 Life Safety /Low Voltage and hcrcby authorizc rcprescntativcs ofthis a