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ELECTRICAL.I NSPECTOR RECORD '-COMMENTS OWNER BUILDER DELCARATION I h6cby affm und6 p.nslty of pajury that I u crcmpt ftom thc Contrdos' Licmc law for thc following rcmn (Se.7011.5 Busins ard Profsion Codc): Any City or County which rrquirc a pomil to coretruct, alt6, imprcvq dcmolish or rcpBir my structuq Fior to its issuecq d$ rcquir€ thc applicst for such pctrnit to filc a signcd statmot that hc or shc b lictrcd pwanr to thc provisios of thc Cotrtractor's Licdscd lrw (Chapt6 9, Comencing with S*tion 7000 of Division 3 of the EBins md Prcfasiore Codc) or that hc or shc is cxempt thaefrom md thc b6is for the allcgcd exmflion. Any violation of Se'tion 7031.5 by uy spplicmtforapfinitsubjctsthe applicmttoacivilpmltyofmtmorcthilfivchundrcddollffi($500). --1. as owner of the prope'rty. or my employecs with wages as their sole compensation, willdo the work and the structure is not intended or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's License l-aw does not apply to an owner of the property who builds or improves thereon. and who does such wod( himself or herself or through his or her own employees, provided that such improvonents are not intended or offered for sale. If. howsrer. the tuilding or improvement is sold within one year of complaioru the Orvner Builder will have thc burden of proving thd he or she did not build or improve thc pnoperty for the purpose of sale). I _1, as owner of the property. am exclusively contracting with licensed contractors to conslruct the project (Sec. 7044, Business and Profession 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) licensed pursuant to the Contractor's Licerue Law). I -l am exempt under Section-. o,,", WlzS/Zc) DECLARATION I hereby affrrm undcr pcnalty of pcrjury one of the following declarations: _l havc and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the Labor Codc, for the performance of the work for which the perrnit is issued. _l have and will maintain workers' compensation insurance. as requircd by Scction 3700 of the kbor Code, for the performance of the work for which this permit is issued My workers' comperisation insurancc carricr and policy number are: Policy Number: Expires: _l certify that in the performance of the work for which this permit is issued. I shall not ernploy any pcrson in any manner so as to becorne subject to the workers' cornpensation laws of California, and agree that if I should become subject to the workens' compensation provisions of Scction 3700 of the l-abor Code, I shall. forthwith cornply with those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an and civil fines up to one hundred thousand dollars ($100,000). Section 3076 of the Labor Code, interest and attorney's fees. to thc cost the o*", l0 (l? f ?ro r I hereby affirm under penalty of perjury that I arn licenscd of Chapter 9 (commancing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License Class: License Number: CONS'TRU("I'ION LF]N DI NG A(; IiN('}' I hcrcby aflim undr penalty of pqjury that th@ is a construction btrding agqcy for thc pqfomucc of the work for which this pomit is issued (Sec. 3097, Civ. C.). lrnder's Name: t APPLICANT DECLARATION I hcr,*y affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notifrcation Federal Regulations (Title 40. Part6) -Required Later o f Notification _l cerf ify that the lirderal regulations rcgarding asbestos rcmoval are not applicable to this project. with all City and County and County to erter upon the above mentioned property for Applicant or Agent and state in[orrnation *r",, lo/23/Zo S ite-Work _UnEgrground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm lDampers Communications Cable Building Under Slab / Floor /l n/-/Bonding I Grounding / UFER l-WlM gfty,rct 5ru Transformers I Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Roush Ceilinqs (T-Bar Rouqh) Meter Release Rough u I I -'-/ Service Meter Iql%lct 0 wary r? q, FINAL ruvu 'whll00r ,4fr Noteg, RerRarks, Etc.I ,l -- It tt -$, Rev. 08-07-2015 f,_.r, P.C. Carrier:- Drte: Contractor:_ Pernritee name (printY:(- 7fi 1rD '\- VU fY71"