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ELECTR!CAL.INSPECTOR RECORD <br />APPROVALS DATE rD/stG COMMENTS Owner-Builder Dcclararion <br />IherehyafTirnrunderpenaltyofperiurythalI6mexempllorn]lheContractors LicenseLawforthefollowingreason(sec7o.lL5llusincss <br />and Profession Code): Any City or County which rcquircs a permit to constnrct. allcr. irnprove. dcrnolish or repair any slructure, pr;rr lo ils <br />issuance. also requires lhc applicant f<rr such permit to filc a signed slalcmcnl lhst hc or she is licenscd puGuant lo thc provisions o.flhc <br />Contractor's Licensed l,aw (( hapter 9. Conrnrencing wrth Seclion 7000 of Divasion I of the Business and Professions Code) or that he or <br />shc is excmpt lhcreFom and lhe basis for lhc allegcd cxemption .Any violation ofScclion 70-11.5 by any applicant for a pcmit subjcds thc <br />rpplicanl lo d cilil 0enalty ofnot more than five hundred dollam ($500). <br />l. as os'ner oflhe proped!. or nry ernployces wilh wages as lheir sole compcns6lion. will do lhe work hnd the s!ucture is not inlended <br />orofferedlorsale(Sec7044.BusinessandProfessionsCode'lheConlrachr'sLicenseLawdoesnolapplytoanownerofthepropeny <br />rvho builds or improvcs lhereon. {nd who does such wo* himselfor herselfor through his or her own ernployecs. provided that such <br />irnprovemenls are nol inlended ot oflercd for sale. If. howevcr. the building or irnprovcmcnt is sold within one year ofcomplction. the <br />Owner-Builder will have lhe burdcn ofproving lhat he or she not build or irnprove for thc pIrpose ofsale). <br />I. as owner oflhe property. arn crclusively contractin8 with liccnscd contraclors to construct lhc projecl ( Sec. 7044. Busin6s and <br />Profession Codc: The Conlraclor's l-icense law doc not apply to an owner of properly who builds or inrproves thereon , and who <br />conkacls for such projects wilh a Contraclo(s) licensed pursuant lo ( ontractor's l.icense l.aw ) <br />I irn c\c,Int qnder Sc.tion <br />,r^r, !?ftf .8,&P <br />;*-P< <br />C lhis renson. <br />I hcrchy alljrm undcr penally ofperjlry onc ofthe follow <br />__l havc and will rnaintain a Ccdific&tc ofConscnt lo Sclf-lnsure for workers'conrpensation, as provided for hy Section lToo oflhe <br />tnbor Codc. for thc pcrfomance olthc work for which lhc pcrmil is issucd. <br />_l have and will maintain workers' compen$lion insurrnce, as required by Seclion 3700 oflhe kbor Code. for the performance oflhc <br />work for which lhis pcrrnil is issued My workers compenstion insumnce arrier ond policy nunrber are' <br />Canier: <br />Policy Nunrber:_ Expircs: _.__-_ <br />(l'his seclion n.ed not be complcted if rf," p*ir is fr fXc fr,rn*.anolt-m l$ tOOl or lcss) <br />_l ccnity lhal in the pcrfomancc of the work for rvhich this pcrmit is issued. I shall nol cmploy any pcreon io any manncr so as lo <br />*:*::'::::-=iK#r#*l, l, l.l. ) ., <br />fines up lo onc hundrcd lhousand dolla6 ($100,000).in sddition to thc cosl ofcompcnsation. damagcs as providcd for lhc Scctioo 30?6 of <br />lhc tibor Codc. inlsest ind atloroey's fe <br />LICENSED CONTRAC'TORS DECLARATION <br />I hereby amnt under penally of perjury lhat I am licensed under provision of ('hapt.r 9 (commencing with Sectfun 7000) of l)ivision 3 of <br />the tlusiness and Profcssions Code. and my license is in full force and effccl. <br />[-iccnse Class: <br />Date: <br />License Nurnber <br />Conlraclor: <br />(ONSTRT)CTION LENDING ACENCY <br />I hcreby affirm und{ pcnalty of pcrjury that lhere is I conslruclion lending rgcncy for the perfomancc of thc work for which this permit is <br />issucd (Sec. 3097. Civ. ('.). <br />Lender's Nanre <br />[-ender's Address <br />APPLICANT'S DECLARATION <br />Demolition Pcnnils-Asbcstos Notil'ication Fcderal ReSulalions ( l itle 40. Pan 6) <br />Requircd l-etler of Notifi cation <br />I ccrtify that the fcdcral regulations rcgardinS asbcslos removal arc not 6pplicablc to lhis project. <br />I ccrtify thal I havc read this application and statc lhal thc abovc infomation is corcc't. I agrcc lo <br />ordinances and Slalc taws relatingfp building comtruction. and hercby 6uthorizc rcprGcnlativcs oft <br />ahovc mcnrioncd properry for[KfI purpos6 <br />Applicent or trgenl sig , , _& __ Dale: <br />permifleenamc(prinr,, <br />- <br />-t S*B{,Oac{ <br />- <br />I cornply silh all ('ity and County <br />this City and ('ounty to enler upon lhc <br />q t, <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter nr/I / <br />FINAL "//1 /tQ a <br />Notes, Remarks, Etc.-?-*)