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ELECTRICAL.I NSPEGTOR RECORD APPROVALS DATE ID/SIG GOMMENTS Owncr-Builder Dcclsation : I hereby affirm undcr penalty ofperjury that I m cxempt fom thc Contractors' Liccnse Law for thc following rcuon (scc.70};5 Dcs'incss od Profession Code): Any City or County which rcquires a pcmit to construct, alter, improve, dcmolish or rcpair my structurc. prior to iE issuance, also requires thc applicmt for such pemit to filc a signcd statement that he or she is liccnscd pursuut to thc provisions ofthc Contractor's Licensed Law (Chaptcr 9, Commcncing with Section 7000 ofDivision 3 ofthc Busincss ild Profcssions Codc) or that hc or shcisexempttherefromudtheb6isfortheallegedcxemption AnyviolationofSectionT03l.5byanyapplicutforapcmitsubjcctsthe applicant to a civil pcnalty ofnot morc than fivc hundred dollars ($500). _1, m owner of thc propcrty, or my cmployces with wagcs s their solc compcnsation, will do the work and thc structurc is not intcnded or offercd for salc ( Scc.7044, Busin6s md Profcssions Codc The Contractor's Liccnsc Law docs not apply to m owncr ofthe propcny who builds or improvcs thercon. ild who do6 such work himsclfor hemclfor through his or her own cmployces, provided that such improvementsarcnotintcndcdoroffercdforsale If,howevor,thcbuildingorimprovcmcntissoldwithinoneycdofcompletion,the Owner-Builder will have the burdcn ofproving that hc or shc not build or improvc for thc purposc of salc) _1, c owncr of thc propcrty, m cxclusivcly contreting with Iicensed contractors to construct thc projcct ( Scc. 7044, Busincss ild Profssion Code: Thc Contrrctor's Licensc Law does not apply to an owncr ofproperty who builds or improvcs thscon , md who conracts for such projects with a Conractor(s) liccnsed pursumt to thc Contractor's Liccnsc Law.). _l am exempt under Section _,B & P C for this reroon Datcr -owncr, - WORKERS COMPENSATION DECLARATION I hereby affim under pcnalty ofperjury one ofthc following dcclarations: _lhavemdwillmaintainaCertificateofConsenttoSelf-lnsurcforworkers'compcnsation,6 providcdforbySection3T00ofthe Labor Codc, for the pcrfomace of thc work for which thc pmit is issucd. _l have od will maintain workers' compcnsation insurmcc, c rcquircd by Scction 3700 ofthc Labor Codc, for the pcrformancc ofthe work for which this pmit is issued. My workcrs' compcnsation insurilcc cmier od policy numbcr ac: Policy Numbcr: Expiru: 4d;::not bc complcted if thc pmit is for Onc hundrcd dollas {$ 100} or lcss) thc pofomancc of thc work for which this is issucd. I shall not cmploy any pmon agrcc that ifl should bccomc subject to in manncr so 6 to bccmc subjcct to thc workcrs ' compcnsation laws of compcnSation 3700 ofthe Labor Code,with thosc provisions. WARNING,to sccurc worke6' compcnsation coveragc is unlawful, ud shall an cmploycr to riminal pcnaltics and civil fincs up to onc hundrcd thousmd dollm ($100,000),in addition to thc cost of thc Labor Codc. intcrcst md attomcy's fccs. damagcs r provided for the Section 3076 of LICENSED CONTRACTORS DECLARATION I hereby affirm undcr pcnalty ofperjut] that I m licenscd undcr provision ofChapter 9 (commencing thc Busincss md Profcssions Code, ud my liccnsc is in full forcc ud cffcct with Section 7000) of Division 3 of Date I hcrcby affim under penalty ofpcrjury rhat thcrc is a construction lcnding agcncy for thc pcrfomoce ofthc work for which this pcmit is issucd (Scc. 3097, Civ. C.) Lcndcr's Nmc: Lendcr's Addlcss: APPLICANT'S DECLARATION Dcmolition Pcmit$-Asbcstos Notification Fcderal Rcgulations (Titlc 40, Pat 6) _ Rcquircd Letter ofNotification _l ccnify that the federal regulations rcgarding Gbcstos removal ae not applicable ro this projcct -Zdry lr"r.tn^vc rcad this ild statc that thc abovc infomation is corcct. I agrce to comply with all City dd County ordinanccs md Statc Laws to building construction, and hereby abovc mcntioncd propcny ^:::ry,, purPoses. rcprocntativcs of this City to cntcr upon the Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains )4f<5 L l>-' Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER Transformers Torquing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release Rough Service Meter FINAL l.l'b-zo w( lo, Notes, Remarks, Etc x?f$