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APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor rl 7lBondinq I Groundinq / UFER 7 1ti 7 Dtw<6 / Transformers I / Torqueing Sub-Panels Air Conditioners tt o Roof Top Equipment l?.I bA*'Y 7 Factory Wired Unit l- l Walls (Conduit) Walls (Rouoh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh)I I I N/eter Release IZ 11 I UDtYB fr l- | Rough Service N/eter tl FINAL }tA:w Y) Notes, Remarks, Etc./rt I)I.]I,CARATION I hereby affrnr under penalty of prjury that I arn exenrpt from the Cbntractos' License [:w for the following reason (Sec'.7031.5 Ilusincss and Prol'cssion Codc): Any City or County which requircs a pcnnil to construct, alter. itnprove. demolish or rqrair any structure, prior to its issuance. also requires the applicant for such pernrit to file a signed slatenrnt that lre or she is licerrscd pursuanl to thc provisions of thc Contractor's l.iccnsed taw (Chaptcr 9. Commcncing with Section 7fi)0 of Division 3 of the Business and Professions Code) or that lr or she is exentpt therefronr and tlrc basis for tlre alleged exenption. Atry violation of Section 7031 .5 by any applicant for a pennit subjects the applicant to a civil pcnalty of not more than five hundrcd dollars ($stltt). _1. as owncr ol'tltc or my crnployecs with wagcs as thcir srrle compensation, and Profe.ssions Ctxle: Tlrc Contractor's willdo thc work and thc structure is not Liccnsc l-aw does not apply to an owner ofBusiness thc property wlxr builds or inprows thereon, and wlro does such work himself or lrcrself or through his or her own entployees, providcd that such improvclrrcnts arc not intcndcd or ollcrcd for sah. ll. howevcr, the building or inprovenrcnt is sold within one ycar of conrpletioru tlrc Owrrer Buikbr will travc thc bunlen of pmving ttrat hc or she did not buikl or inprove ttrc propcrty for thc puqposc of sale). _I. as owner of the propeny, amexclusively contracting with liccnscd contracloni to conslruct thc project (Sec. 7044, Business arxl Protession Code: The Contractor's License Law dtxs not apply to an owner of property who builds or improves thereon. and who contracts for such proi.cts with a Contractor(s) liccnscd pursuant to the Conuaclor's Liccnse law). -l anr exenlpt under Section-, B. & P.C. tbr this reason. WORKERS' COM PETTSATION DECLARATION I hercby alfirm under pnalty of perjury onc of thc following declarations: _l have and will nraintain a Certificate of Consent to Self-lnsure for workers' compensation, as pruvided for by Section 3700 of the Labor Codc, for the Jrcrlonnance of the work for which thc perndt is issued. Anhave anrl will rnaintain workers' conqrensation insurance, as rcquircd by Section 3700 of rhe L-abor CorJe, for the grcrformarrce of '?h:l work tbr which this pcrmit is issuc'd. My workcrs' compensation insurance carricr and plicy numhcr are: A Policy +l(l.lrrr _l ccrtify that in thc prfornnnce o[thc work for which this pcrmit is issucd, I shall not enrploy any lrcrson in any manner so as to bcconrc subjcct to thc workers' compcnsation laws of California. and agrce that if I should bccornc subject to the workers' conrlrnsation pruvisions of Section 3700 of thc L-abor Code, I shall, forthwith cornply wilh thosc provisions.. WARNING: Failure to srcure workers' compensation coverage is unlawful, and shall subject an employer to criminal penaltics and civil lines up to one huudred thousand dollars ($100.000). in additiort to the cost of compensation, danrages as provided for the Scction 3076 of the Co<le, intcrcst and attorncy's I hercby affrnr under pnalty of perjury that I anr licenser,l under provision of Chapter 9 (conmrcncing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full forcc and effect. Licen.se Nunrber:&s+ CONS'TRUC'TION I,EN I)ING AG T]NCY I hcrcby al'lirrn undcr pcnalty issued (Sec. 3097. Civ. C.). lrnder's Nanrc: ol'pcrjury that therc is a construction hnding agency for the pcrforrnance of thc work for which this Jrcrrnit is APPI,ICANT DECI,ARATION I lrcrcby affirnr undcr pcnalty of pcrjury onc o[ thc folklwing dcclarati<lns: Denxrlition Pcrmits-Ashestos Notification Fcdcral Regulations (Titlc 40. Part6) -Rcquircd lrttcr of Notification ccrtily that thc l'cdcral rcgulations rcgarding asbcstos rcmoval arc not applicablc' to this prcject. tlral havc rcad this application iurd statc that thc abovc inlirnrration is corrccl.agrcc conrply with ull City ancl County ordinanccs and Statc [,aws rclating abovc rncntioned property for Applicant or Agent Permitee to building construction,afiJ hcrcby authorize rcprcscntativcs o[ this cilv and County to t:ntcr urr)n thc ELECTRICAL.INSPECTOR RECORD \ Rev. 08-07-201 5 I 111 r) \