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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Siqns (monurnent) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bondinq I Groundins I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush)q lulw _-Prw67 Ceilinqs (Hard & Soffit Rouqh )/ Ceilinqs [-Bar Rouqh) [/eter Release Rough /ttService Meter tl 'lFINALtLl lult0 DIJYL / Notes, Remarks, Etc. OWNIi,R BUTI,DI'R DE,LCARATION I hereby affirnr under penalty of perjury that I ruu exen)pt fronr the Contractors' License Law for the following, reason (Sec.7031.5 Ilusincss and Profcssion Code): Any City or County which rcquires a pcrmit to construct, aller. irnprove. demolish or reJuir any strucrure, prior to its issuance. also requires the applicant for such Jrernrit to file a signed slaternent that hc or she ls licersed pursuant to thc provisions of thc Contractor's Liccnscd l-aw (Chapter 9, Commencing with Section 7fi)0 of Division 3 of the Busincss and Professions Code) or that hc or slrc is exen4rt therefronr arxl tlre basis for tlrc alleged exenrption. Any violation of Seclion 7031.5 by any applicant for a pennit subjects thc applicant to a civil penalty of not nrore than five hundred dollars ($500). llt. ". owncr ol'the propcrty. or tny ernployces with wages as fheir sole compensation, willdo the wcrk and rhe structure is not intendetl or offered for sulc (Sec'.7(X+, Business and Profcssions Cotle: The Contractor's Licensc l-aw does not aPPly lo an owncr of the properry wlxr builds or inryrroves therurn, and wlxr drrcs such work himself or lprself or through his or her own entployees, provided that such irnprovcments arc not intcndcd or ollcred for sale. II, howcver, $e building or improvement is sold within onc ycar of conpletioru the Owner Builder will have thc burden of proving ttrat he or shc did rxlt buikl or improve ttre propaty for thc purposc of yaht. Yl. u, owner of the property, am exclusively contracting wittr licensed contractors to construct thc project (Sec. ?044. Business arxt Protr:ssirur Code: The Contractor's License Law dors not apply to an owner of property who builds or improves thereon. and J, who contracts for such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Licensc kw). under Sectiorr-, B. & P.C. tbr this reasott. I hc'rcby aflirm undcr pcnalty of pcrjur;r onc of thc W(TRKI'IIS' COMPI'NSATION DECLARATTON Iollow ing dcclarations: { , n"r. and will nuintain a Certiticate of Consent to Self-lnsure for workers'comSrcrNation, as pruvided for by Sccrion 3700 of the Lahor Code, for the pcrfonrunce of the work for which the pcrmit is issued. {, n"r. and will nmintain workers' conrpensation insurance, as required by Section 3700 of the l-abor Code, for lhe perfonnarrce of is issucd. My workcrs' conrpensation insurancc carricr atxl plicy nunrber iue: :;""Ht#f".* Policy _l certify that in thc pcrfornuncc of tlrc work for wlrich this pcrmit is issucd, I shall not cmploy any lrcrson in any manncr .v) as to become subjcct to the workers' compcnsation laws of California, and agree that if I should beconre subject to the workers' corrrlrnsation provisions of Section 3700 of the Labor Cotle, I shall, forthwith conrply wilh thosc provisions.. WARNING: Failure to secure workers' compcnsation coverage is unlawful, and shall subject an employer to criminal pcnaltics and civil fines up to one hundred thousand dollars ($100,000). in addition to the cost of compensation, danrages as providcd for the Section 3076 of the latnr Codc. intcrest and attorney's l'ecs.o,.,,'il?-lb nor,.*,,.. {{o4 A/G0(YFAJtt I hcrcby affrnr untler pnalty of perjury rhat I anr licenscd ,i6--*rf Chapter 9 (comnrncing with Section 7000) of Division 3 of the Business and Professiorrs Code. aml my licensc is in full forcc and effect. License Number: CONSTRUCTION LENDING AGENCY I hcrcby al'lirm undcr pcnalty of pcrjury that thcrc is a construction lcnding agency for the pcrformance of thc work ltrr which this pcrmit is issued (Sec. 3097, Civ. C.). [.cnder's Name: APPLICANT DECLARATION I hcrcby affirm under Jrcnalty of perjury one of the following declarations: Dcnxrlition Permits-Asbcstos Notification Federal Rcgulations (Title 40, Part6) _Requircd lrtter of Notification _l ceaify that the fcdcral regulations regarding asbcstos rcrroval arc not applicablc to this prnj€L _l certify that I lnvc read this application and state that thc abovc infornration is correcl. I agrcc to conply with all City and County ordinances and State laws rclating to building construction, and hcrcby auttnrize represcntatives of this City and County lo enter ugrn the above mentioncd properly for inspection purposes. Applicarrt or Agent Pcrnritcc namc 7 08-0 -201 5 *,", t/ zolu