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ELECTRICAL-INSPECTOR RECORD COMMENTSAPPROVALSDATEID/SIG. Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safetv /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under SIab / Floor tl Bonding I Grounding I UFER tzt lo Dfftrz 7 Transf ormers I Torqueinq Sub-Panels Air Conditioners Iolk)Roof Top Equipment t7l UTVT 7 Factorv Wired Unit I Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh)lt Meter Release 'D|Y,E-2 7 Rouqh Service Meter ,l FINAL lz-t lol-1.,') bll^*ry Notes, Remarks, Etc.t / OWNE,R B UII,DIiR DI,LCA RATION I hereby affnnr under penalty of perjury that I arn exempt fronr the Contractors' Licensc law for the following reason (Sec.7031.5 lJusincss and Prolbssion Code): Any City or County which rcquircs a pcrmit to construct, alter. irnprove, dcmolish or rcpair any structure, prior to its issuance. also requires the applicant for such grernrit to fih a signed staterncnt that he or she ls licenscd pursuanl to thc provisions of the Contraclor's l,icenscd Law (Chapter 9. Commcncing with Section 7UD of Division 3 of the Busincss and Prot'essions Code) or that he or she is exenrpt therefrom and tlre basis for tlre alleged exemption. Any violation of Section 7031.5 by any applicant for a pnnit subjects the applicant to a civil penalty of not more than five hundred dollars ($5tttt). _1. as owncr ol'thc. propcrty, or tny crnployccs with wagcs as their sole comlrcnsation, wil! do the work and the structure is not interxlcd or offeretl for sale (Sec.7B+. Business anrl Profcssions Corlc: The Contractor's License l-aw does not apply to an owner of the property wlrc builds or improves tlrcrerrn, aurd wlxr does such work himself or lrerself or tluouglr his or her own employees, provided that such irnpnrvcnrcnts are rmt intendcd or olTerc{ for salc. If. howcver. thc building or inprovenrcnt is sold within onc }car of completion, thc Owner Buikler will have the bunlcn of pruving that hc or she did not buikl or improve thc propaty for thc purpose of sale). _1. as owner of the propeny, anr exclusively contracting with liccnscd contractom to construcl thc project (Sec. 7044. Business and h,ofession Code: The Contractor's Licerrse Law does not apply to an owner of pro5rcrty who buil<ls or improves lhereon. and who contracts for such prcrjccts with a Contractor(s) liccnscd pursuant to thc Contractor's Licensc law). -l anr exempt under Section-, B. & P.C. lbr tltis reason. WO RK I.]ITS' COI}T PIiNSATION DECLARATION I hcrcby aflirnr undcr pcnalty of pcrjury one of tl'tc tbllowing declarations: _l have alxl will nraintain a Certilicate of Consent to Self-lnsure for workers' conrgrcnsation, as pnrvided f<lr by Section 3700 of the lahor Code, for thc Jrcrfonrurrcc of thc work for wNch thc perrnit is issucd. _l have alrd will nraintain workers' conrpensation insurarrce, as required by Seclion 3T00 of the l-:bor Code, for lhe performance of thc work tbr which tlris prnrit is issucd. My workcrs' conrJrcn.sation insurancc carricr urd prlicy nurnbcr arc: Policy Number: lixpires: _l ccrrify that in tlrc ;rcrfornuncc of thc work for which this pcrmit is issucd, I shall not cmploy any pcrson in any manncr so as lo bccornc subjcct to thc workers'cotnpensation laws of California. and agree that if I should becorrc subject to the workers' conr;rnsation provisions of Section 37fi) of the Labor Code, I shall, forthwith conrply with tlxrse provisions.. WARNTNG: Failure lo secure workers' colnpensation coverag,e is unlawful. and shall subject an employer to criminal penalties and civil fines up to one hundred tlxrusand dollars ($100.0001. in arldition to tlrc cost of comgrcnsalion, dannges as provided for the Scction 3076 of the Labor Codc, intercst and attorncy's I'ecs. LICENSED CONTRACTOR I)T]CI,ARA'I'I()N I hercby affrnr under pnalty of pcrjury that I anr licensctl under provision of Chapter 9 (conrnrncing with Section 7000) of Division 3 of the llusiness and Professions Code. and my license is in full force and effect. License Class: License Number: CONSTRUCTTON LENDING AGENCY I hcreby aflirrn undcr pcnalty of pcrjury that thcrc is a conslruction hnding agency for the perfiormance of the work for which this pcrmit is issuetl (Sec. 3097. Civ. C.). [,ender's Name: [rnder's Addrcss: A PPI,ICANT DECI,ARATION I hctcty allimr under pcnalty of pcrjury onc of thc following dcclalations: Dcnrolition Pcrnrits-Asbestos Notification Fcdcral Rcgulations (Titlc 40, Part6) Rcquircd lrttcr of Notification _l ccrtify that thc fedcral rcgulations regarding asbcstos rcmoval arc not applicablc to this projcct. _l certify tlrat I luvc rcad this application and statc tlrat thc atxrvc information is correct. I agre,c to comply with all City antl County ordinances and State [.aws rclating to building construction, and hcreby auttnrizc represcntativcs of this Cily and County to cnter upon thc above rrrcntioncd propeny for inspection purposes. Applicant or Agent l\^r,.. Permitcr namc (print): 08-07-201 5 t2) talu