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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under SIab /Ehq\-\ Bondinq I Grou ndtnd I UFER // -2o,?o lLCZ rl Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) N/eter Release Rough Service Meter \// ,r^ t,t //-a-A t2rt t,-.t/r*a*aY FINAL /U7-rv /6416y n L- ry'r7 O '-vts 'v 1 Notes, Remarks, Etc. I hercby affirnr under penalty of prjury that I am exempt fronr the Contractors' License [:w for the following rcason (Sec.7031.5 llusincs.s and Profcssion Codc): Any City or County which rcquircs a pcrmit to construct, altcr. improvc. dcmolish or rcpair any structure, prior to its issuance. also requires the applicant for such Jrernrit to file a signed statcment that lr or she is licelrsed prsuanl to thc provisions of thc. Contraclor's Liccnsed law (Chaptcr 9, Cornmcncing with Scction 7000 of Division 3 of thc Busincss and Prol'essions Code) or that hc or slre i.s exen4il therefronr arrd tlre basis for tlrc alleged exenrption. Any violation of Section 7031 .5 by any applicant for a permit subjects the applicant to il civilpenalty of not more than five hundrcd dollars ($500). _1. as owncr ol'thc. propcrty. or my crnployecs with wages as thcir sole compcnsation, will do thc work and the stnrcture is rrlt interxlal or ofleretl ftrr sale (Sec.704+. Business and Prcfessions Cotle: The Contractor's License Law docs not apply to an owner of the proJrcrty wlxr huilds or inrpnrves thereon, ud wlro does such work himself or lrerself or ttuough his or her own enrployees, providcd that such irnprovcrncnts arc not intcndcd or olTercd for sah. Il. however, Orc building or inprovermnt is sold within one )aar of completiorr, tlE Owner Builder will have thc burden of proving ttra lr or she did not buikl or improvc tlrc propcrty for thc purposc of yalet. -1, as owner of the property, am exclusil'ely contracting with licenscd contractors to construct tlr project (Sec. 7(X4, Busincss arxl Protbssion Code: The Contractor's License Law dors not apply to an owner of property who builds or inrproves there<ln. and who contracts for such projccts with a Contractor(s) liccnscd pursuant to the Contractor's Licensc [aw). -l anr exempt under Section-, B. & P.C. lbr tltis reason. WORKI.]RS' CON{ PENSA'TION DECLARATION I hcrcby aflirm undcr pcnalty of pcrjury onc of thc lbllowing rlcclarations: -I have and will nmintain a Certilicate of Consent to Self-lnsure for workers' comgrcnsation, as providcd for by Section 3700 of thc l.abor Codc, for the pcrformance of the work for which the pcrrnit is issucd. W;:;and Seclion 3700 of the [-abor Code, for the perfonnarrce of rcaricr alxl gnlicy nunrbcr are: lt t /o lhat in thc 1^-rlornrancc ol'thc work frrr which thi.s pcrnrit is issucd, I shall not cnrploy any [rcrson in any manncr and agree that if I shnuld bccorr subjcct to thc shall, forthwith conply with thosc provisions.. so a-s to bccomc subjcct to thc workers'compcnsation laws of California, workers' conrpensation provisions of Section 37fi) of the Labor Code, I r WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an cmployer to crirninal pcnaltics and civil fines up to orrc lrurrrlred thousand dollars ($100.000). in addition to lhe cost of comgrcnsation, danrages as provided for the Section h^.^. 3076 qf thc Latnr Codc, inte'rest lo l\q \uo and attorncy's I hereby affrnr under ;rcnalty of perjury that I anr licensetl 9 (conutrncing with Section 7000) of Division 3 of the Business and Prolessions Code. and rny licensc is in full force urxl effect. Licensc D Number:1b1 +b 14 Ctv CONSTRUCTION LENDING AGENCY I hcreby al'lirrn undcr pcnalty of pcrjury that thcrc is a construction lcnding agcncy for the pc'rlbrrnance of thc work ltrr which this pcrrnit is issued (Sec. 3097. Civ. C.). Lrnder's Nanrc: knder's Address: APPI,ICANT DECI,ARATION I hcrctry aflirnr under pnalty of pcrjury onc of thc following doclarations: Dcnro lit ion Pcrnrit.s-Astrcstos Ntxification Fcdcral Rcgu lat ions (Title 40, Part6) -Rcquircd lrttcr of Ntxification _l ccrtify that thc fcdcral rcgulations rcgarding asbcstos rcmoval arc not applicablc to this projcct. ccrtily that I havc rcad this and statc tlrat thc abovc ordinanccs and Statc laws abovc mentioned property for Applicant or Agent rr)t-\ l'crnritee nanrc building Rev. 08-07-201 5 l)ate: prnrit is issucd. Colttractrlr: