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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work -T lr^D Underground l'q"N VM{ tl wutt Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding I Grounding I UFER l//?q/ru SUoils;aru Transformers Torqueino It il ^ r-1 Sub-Panels lll7.5l ,r{.,'{f,htbt Jrt il,l Air Conditioners lt Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinss (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) JVleter Release Rough Service [Vleter lt ^,\.t'a FINAL ltlul,il,Dtuilili$zJ0 Notes, Remarks, Etc.I ) I hereby affirrn under penalty of prjury that I arn exenlpt from the Contractors' License l-aw for the following reason (Sec.7031.5 Busincss and Prolbssion Codc): Any City or County which requircs a permit to construct, altcr, irnprovc, dcmolish or repair any struclure, prior to its issuance. also requires tlre applicant for such grernrit to file a signed statemenl that lre or she is liccrrscd pursuant to the provisions of thc Contractor's l,icenscd law (Chaptcr 9. Commcncing with Section 7fi)0 of Division 3 of thc Business and Professions Code) or that he or she is exempt therefrom ard tlrc basis for tlre alleged exenrption. Any violation of Section 7031.5 by any applicant for a pennit subjects the applicant to a civil penalty of not more than llve hundred dollars ($5001. !t t. it.s owner ol'the propcrty. or tny crnployccs with wagcs as thcir sote compensation, willdo the work and rhe structure is not irrtentlxl or ofTcretl for salc (Sec'.7M4. Business and Prufessions Corlc: The Contraclor's Licensc Law tlocs not apply to an owner of the pruperty wlxr txrilds or inrproves thereon, and wlro doqs such work hirnself or lrerself or lhrouglr his or her <lwn enrployees, providcd that such improvcrnents iuc rnt intcnded orolfercd for sah. Il, however, tlrc building or inp,rovenrcnt is sold within one year of completi<ln, the Owner Buikler will have the burtlen of proving that he or slrc did not build or improve 0rc propcrty for thc purposc of sale). -1. as owner of the property, am exclusively contracting with licen.scd conlracloni to construct the project (Sec. 7044, Business arxl Pnrtb.ssion Code: The Contractor's License Law dcrcs not apply to an owner of property who builds or improves thereon. and who conlract.s for such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Licen"se l-aw). _l anr exempt urxler Sectiorr_, B. & P.C. tbr \ DECLARATION I ltcrcby aftlrm undcr pcnalty of pcrjury one of thc lbllowing dcclarations: -l have arxl will nuintain a Certiticate of Consent to Self-lnsure for workers' comlrcnsation, as provided for by Section 3700 of the labor Code, for the perfonnance of thc work lbr which thc permit is issucd. -l have arrd will nuintain workers' conrpensation insurarrce, a.s required by Section 3700 of the Labor Code, for the perfonrurce of thc work for which this pernilt ls issucd. My workers' comgrcnsation insurance carricr arxl pmlicy number are: Policy tfi."nify rhat in thc prlbrn'Hncc of tlrc work firr which this prmir is lssuctl, I shall not cnploy any F,crson in any manner :ro astobeconrcsubjccttotheworkcrs'cornpen.sationlawsofCalifornia.andagrecthatiflshouldbcconrsubjecttothe workers' conrlrnsation provisions of Section 3700 of thc Labor C<xle, I shall, forthwith comply with those provisioru.. WARNING: Failure lo secure workers' cornpensation coverage is unlawful, and shall subject an cmployer to criminal pcnalties and civil fines up to one hundred tlxrusand dollars ($100.000). .Scction 3076 of thc Latnr Coclc, intcrcst and attorrrcy's l'ccs. in arldition to of compensalion, danrages as provided for the I hereby affirnr under pnalty of perjury that I anr licensed under provision of Chapter 9 (conrmencing with Section 7000) of Division 3 of the Business and Profcssions Code. and my licensc is in full forcc and effcct. Licensc Nunrber: CONSTRUCTION LENDING AGENCY I hcrcby allirrn under pcnalty of pcrjury that thcrc is a construction lcnding agcncy for thc pcrformancc of the work ltrr which this pcrmit is issued (Sec. 3097. Civ. C.). [-ender's Narne: knder's Address: APPI,ICANT DECI,ARATION I trcrcby aflirnr undcr p-nalty of pcrjury onc of thc folkrwing dcclarations: Dcnplition Pcrnrits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40, Part6) _Rcquired l.cttcr of Notification _l ccrtify that thc fcdcral rcgulations rcgarding ashstos rcmoval arc not applicablc to this proirct. ccrtily tlrat I havc rcad this application and statc that lhc abovc inlbrnration is corrcct. I agrcc to conrply with all City and County ordinances and Statc Laws rclating to building constructiorL and hcrcby authorizc rcprcscntativcs of this City and County to cntcr upon thc above rnentioncd propeny for inspcction or Agenl l'crnritec nanre a,t^,c Bev. 08-07 ,a Sienature: ,