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ELECTRICAL.I NSPECTOR RECORD Rev. 08-07-20 APPROVALS DATE ID/SIG.COMMENTS OWN I,R II I., T I,I)IiR DTiI,CA RA'I.ION I lrereby afhrnr under penalty of prjury tlut I arn exenlpl fmnr the Cbntractoni' License l-aw for the following, reason (Sec.7031.5 Busincss and Prol'cssion Crxlc): Any City or County which rcquircs a pcnnit Lo construct, alter. irnprovc. dcrnolish or rcpair any structurc. prior to its issuarrce. also requires tlrc applicant frrr such pernrit to frle a signed slaternenl that lr or she is licenscd pursuanl to thc prrrvisions of thc Conlractor's l,iccnscd Iaw (Chaptcr 9. Commcncing with Scction 7fiX) ol' Division 3 of thc Bu.sincss and Professions Code ) or that lrc or slrc is exenrpt tlrerefronr and tlre basis lbr the alleged exenrption. Any violatiort of Section 703I .-5 by any applicant for a pennit subjects the applicant to il civil penalty of not more than llve hundred dollars ($5m). _1. as owncr ol'thc' propcrty. or rny crnplovccs with wages as thcir vrlc' com;rcnsation, will do thc work ard thc stnrclure is mt interxled or offered firrr sale (Ser'.7(]$4. Business and Pnrfessions Ctxle: The Contractor's Licensc Law does not apply to an owner of the proprly wlrl builds or inqrroves tlrreon. und wlxr dtrs such wort hinself or lrcrself or ttuough his or her owrr enrployees, providcd that such irnprovt'rncnts arc not intcrxlcd or olfcrcd for sah. Il. howcvcr. tlrc building or fur4rrovcrncnl is mld within onc yr'ar of conrpletkln, tlrc Owrrer Builder will have tlrc burtlen of pruvirrg that lrc or she did not build or inrprove thc prcpcrry for the puqxrse of sile). _1. as owner of the property, anr exclusively colrtracting witlr licensed conlraclors to construct tlre project (Sec. 70,14. Business ard hutbssiou Code: The Contractor's License l.uw drcs rxrt apply t() an owner of prurperty wlro buikJs or inrprlves lhereon. anrl who conllacts for such pro.iccts with a C()ntracl(]r(s) licenscrl pursuant to thc Contractor's Liccnsc Law). -IantexenrptunderSectitrlt-,B.&P'C.tbrtlrisreastltt.I 1.. r... W0 R K l',' ILS' COM PIiNSATI ON DECLARTTTION I hcrcby affirnr undcr pcnalty of pcrjury onc of thc lirllowing dcclaration.s: _l have and will nninlain a Certilicate of Consent to Sell'-lrrure for workers' cornpensation. as provided for by Section 3T0O of the #d; for thc Jrcrlornrancc of thc work lirr which tl^-* pcrrnit is lssucd. by Section 3700 of the l-abor Code, firr lhe Jrcrfornurrce of carier and pLicy numbt'r arc: Policy (r 7O O 3r ZI _l ccrlity that in thc lrrtirrnuncc ol'lhc wolk frrr whiclr tlris pcrrnit is issucd, I shall not cnryloy any llcrson itt arty nlanncr so astobccorncsuhjccttothcworkcrs'conrpensatiorrlawsol'California.andagrccthatiflshouldbecorncsubjccttothc workers' corrr;rnsation provisiorrs of Section 1700 of the Lah.rr Cotle, I slrall, forrhwith conply with thosc provisiotts.. WARNING: Failure to secure workers' cornpensalir)n coverage is unlawful, and shall subject an ernployer to crirninal penaltie.s tnd civil lines up lo one hundred llruusand rlollars ($100.W0t. in addition to tlrc cost of compensatiott, danmges as provided lirr lhe Sc'ction 3076 of Codc, inlc'rcst and atkrrncy's l'ct's. L I 2c l.l('liNSI'.1 ) ('( )N1'R;\("1'( )R DT'CLARATION I lrercby affirrn under pnalty of perjury tlrat I anr licensed under pruvision of Chapter 9 (conurrncing with Section 7000) of Division 3 of the Business and Professions Code. anl rnv license is in full force arxl effect. License 93ca I hcrcby allirrn undcr pcnalty of pcrjury that thcrc issucd (Sec. 3097. Civ. C.). a8crrcy pcrlbrmance of thc work lirr which this Srcrrnit is ["ender's Nanrc: lrnder's Addrcss: A PPI,ICA NT DECI,ARATION I hcrchy aftirnr undc'r pcnalty of pc{ury onc of thc lirlkrwing tlcclarations: Dcrxrlition Pernrits-Asbcstos Notification l:cdcral Rcgulntions (Titlc 40, Pafl(, _Rcquircd Lcttcr of Notification _l ccrtily that thc fcdcral rcgulations rcgarding _l ccrrify that I havc rcad this applicalion ordinanccs and Statc Laws rclating to above rrcntioned pruperty for Applicant or Agenl l'ermilcc namc ( Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding I Grounding I UFER Transformers Torqueincr Sub-Panels \ Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Roush Ceilinss (T-Bar Rouqh) N/eter Release Rouqh Service N/eter t^FINAL /z/oqho?.O ^/,.w-t?t4 ^/ Notes, Remarks, Etc.r it\ Jrcrmit is tlrc ahrvc infornution is corrcct. I agrce to City and County and ( arxl hcrcby authoriizc reprcsentatives of this o? upon thc