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ELECTRICAL-INSPECTOR R ECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor Bondinq I Groundino I UFER Transformers Toroueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouoh) Ceilinos (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) JVleter Release Rough Service [/eter FINAL Notes, Remarks, Etc. OWNER BUILDER DIII,CARATTON I hereby affrnt under penalty of perjury that I arn exenlpt frorn the Contractors' License law for the following reason (Sec.7031.5 Busincss and Prol'cssion Codc): Any City or County which requircs a pcrmit to construct, alter, irnprove, demolish or repair any structure, prior to its issuance. also requires the applicant for such pemrit to file a signed statemenl that lrc or she is licensed pursuant to the provisions of thc Contractor's l-iccnsed law (Chapter 9, Commencing with Section 7000 of Division 3 of the Business and Professions Code) or that lrc or slrc is exempt therefiom and the basis for tlre alleged exentption. Any violation of Section 7031.5 by any applicant for a perrnit subjects the applicant to a civil penalty of not more lhan five hundred dollars ($5001. _1, as owner ol'tlre property. or my ernployecs with wages as their sole compcnsation, will do the work and the stnrcture is not intendetl or offeretl for sale (Sec.70+a. Business and Professiorts Code: The Contractor's License Law docs not apply to an owner of tlre propelty who builds or improves thereon, and wlxr does such w<lrk himself or lrerself or through his or her own entployees, provided that such improvcnrcnts arc not intcnded or ollercd for sale. Il, howcver, the building or improvcment is sold within one year of conrpletion, ltre Owrrcr Buikler will have the burden of provfurg thx he or she did not build or improve the property for the purpose of sale). _1, as owner of the property, am exclusively contracting with licensed contraclors to construct the project (Sec. 7044. Business and hotbssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contractor(s) licenscd pursuant to thc Contraclor's License Law). -l anr excnlpt uttder B. & P.C. tbr this reason. WORKIIIIS' COMPENSATTON DECLARATION I hercby affirm under pcnalty of perjury one of tl'tc lbllowing declarations: _l lmve and will nnintah a Certilicate of Consent to Self-lnsure for workers' compelxation, as provided for by Section 3700 of the Labor Code, for thc pcrformancc of the work lbr which the permit is issued. _I have and will maintain workers' conrpensation insurance, as required by Section 3700 of the Labor Code, for the perfonnarrce of thc work for this pgrmit is issued. My workcrs'comlrcnsation insurance can'icr and prulicy number are: a t) Policy _l ccrtity that in tlrc lrrfornnncc of thc work for which this pcrnrit is issucd, I shall not cnrploy any lrcrson in any manner so as lo become subject to the workers'compcnsation laws of California. and agree that if I should becorrc subject to the workers' corulrnsation provisiorx of Section 3700 of the Labor Code, I shall, forthwith comply with those provisiotts.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to thousand dollars ($100,000). in addition to tlte cost of danuges as provided for lhe Section 3076 intcrcst and attorncy's lbes. I hereby affirnr under pnalty of perjury that I arn licensed under provision of Chapter 9 (cortrnrencing with Section 7000) of Division 3 of the Business and Code. and my license is in full force and effect. License Number: / C0NSTRUCTION LENI)ING AGENCY I hcrcby aflirrn undcr pcnalty of perjury that thcre is a construction lending aSency for the pcrlbrrnance of the work lbr which this permit is issuetl (Sec. 3097, Civ. C.). lrnder's Name: APPI,ICANT DECI,ARATION I trcrcby aftirnr undcr pcnalty of perjury one of thc following declarations: Demolition Permits-Ashcstos Notification Federal Regulations (Titlc 40, Part6) -Required Lcttcr of Notification _l ccrtity that the fcdcral rcgulations rcgarding asbcstos rernoval arc nol applicable to this project. ard state tlrat thc ahovc inlbrnration is correct. I agrcc to conrply witlr all City and County above rnentioned property for Applicant or Agent I'crnritcc and hercby authorize rcpresentativcs of 4 08-07-2015 t \i.\ff