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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OWNE,R BUII,DER DIiI,CARATION I hereby aflrrnr under penalty of prjury that I anr exenlpt fronr the Contractoru'License l-aw for the following reason (Sec.7031.5 Busincss and Prot'ession Code): Any City or County which requircs a pcrmit to construcl, alter, irnprove, demolish or rcpair any structure, prior to its issuance. also requires the a;rplicant for such pernit to file a signed slatement that lre or she is licerrsed pursuant to thc provisions of thc Contractor's Liccnscd kw (Chapter 9. Commcncing with Section 7fi)() of Division 3 of thc Business and Professions Code) or that he or she is exen4rt therefrom and the basis for tlrc alleged exenption. Any violation of Section 7031.5 by any applicant for a gxnnit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001. _1. as owncr ol'thc. property. or my crnployces with wagcs as thcir solc compensation, will do the wcnk and the structure ls rnt intoxletl or offered for salc (Sec.7044. Busincss anrl Profcssions Crxlc: Thc Contractor's Licensc l-aw tlocs not apply to an owner of the property wlxr btrilds or inqrroves lhereon, arxl wlro does such work hinself or lrerself or through his or her own employees, providcd that such improvemcnts arc not intcrxlcd or ollered for salc. Il, howcver, thc building or funproverncnt is sold within onc ytar of completiotl the Owner Builder will have the burden of proving that he or she did not build or improve the properry for the purpose of sale). _1, as owner of the property, am exclusivcly contracting with liccnscd conlractoni to construct the projcct (Sec, 7044. Busincss and Profession Code: The Contractor's License Law does not apply lo an owner of property who builds or improves thereon. and who contracts for such projccts wilh a Contractor(s) licenscd pursuant to thc Contraclor's Liccnse hw). -l anrexempt under Section-, B. & P.C. lbrtltis reason. WORKI'ILS' COM PIiNSATION DECLARATION I hcrcby afl'irnr undcr pcnalty of Srcrjury onc of tlrc tbllowing dcclarations: _I have arxl wilt nraintain a Certilicate of Consent to Self-ln"sure for workers'cornpensation. as provided for by Se,ction 3700 of the labor Codc, for the Jrerformance o[ the work lbr which the prrnit is issued. _l have arrd will maintain workers' conrpen.sation insurance, as required by Section 3700 of lhe [-abor Code, for lhe grcrfornunce of the work tbr which this pernrit is issucd. My workcrs' comJrcnsation insurance can'icr arxl Jxrlicy nuntbcr are: Policy Nunrber: Expires: _l ccrtify that in the pcrfornurnce of thc work for which this Jrcrmit is issucd, I shall not cnrploy any pcrson in any manncr so as to bccornc subject to thc workcrs' compensation laws of California. and agree that if I stnuld bcconp subjcct to thc workers' c<lnrpensation provisions of Section 3700 of the labor Cotle, I stull, forthwith conrply with thosc provisions.. WARNING: Failure lo secure workers'compensation coverage is unhwful, and shall subject an cmployer to criminal grnalties and civil tines up to one hundred thousand dollars ($100.000t. in addition to tlrc cost of competusation, danrages as provided ftrr the Scction 3076 of the l-abor Code, intcrcst and attorrrcy's fces.h) I hercby affinn under ;rcnalty of perjury that I anr licensetl under of Chapter 9 (cornnrncing with Section 70m) of Division 3 of the Business and Professions Code. antl tny license is in lull forcc antl effect. License n^r^.hn I hcrcby al'tirrn undcr penalty of pcrjury that thcrc is a construction lending agency for the perl'ormance of the work lbr which this pcrmit is issued (Sec. 3097. Civ. C.). lrnder's Nanrc: lrnder's Address: APPI,ICANT DECI,ARATION I hxcby allirnr undcr pnalty of pcrjury onc o[ thc following decliuations: Dcmolition Pcrnrits-Asbcstos Noification Fcdcral Regulations (Titlc 40, Part6) _Rctlu ircd [.r:ttcr of Notification _l ceaily that thc fcderal rcgulations rcgarding asbcstos rcmoval arc not applicablc to this projcct. _l certity tlral I havc rcad this applicalion aml statc thal thc atxrvc infornulion is corrcct. I agrrc to conrply rrcprescntativcs of this city with all City and County and County to enter upon theordinanccs and Statc [:ws relating to construction, and hcrcby authorize above mcntioned property for Applicant or Agcnt Pcrmitcc nnnre I^')r,ite, l0^Ll-Lo)c) Site-Work Underoround Pole Bases Lioht Standards Spas, Pool, Fountains Siqns (monument) Life Safetv /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under SIab / Floor Bondinq / Groundins I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinos [-Bar Rouqh) lVleter Release Rough Service N/eter F!NAL /z-?,2O /> c-r:rJua> "Aq Notes, Remarks, Etc. Rev. 08-07-2015