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ELECTRICAL.I NSPECTOR RECORD n0 n7 1n -! fr, APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hocby alfm undr pcralty of pctjury th8t I m exmpt from thc Conlraclos' Licme [:w for the following rcmtr (Se.7031.5 Buincs ad Prcfcssion Codc): Any City or County which rcquirc a pcrmit to costruct, altq. improvc. &nolish or repair uy structw. prior to its issuacc, also rcquirc thc sl,plicmt for such pcmit lo lilc a signcd statmot thd hc or sh€ b licds€d p|met lo the provisiom of thc Contractor's Liccnscd law (Chaptq 9. Commcncitrg ivith SctioD 7000 of Division 3 of thc Busin* ild Profsions Code) or that hc or shc is cxcmpt thqefrom ed the b6is for thc allcged cxmpion. Any violation of Scclion 7011.5 by any applicantforapanitsubjetsthc applicsnttoacivilpenaltyofnotmorelhofivehundreddollus($500). _1. 6 oms ofthc propcrty. or my mployG with wag6 6 thcir mlc compwtion. willdo th€ work ard thc stnrtrc is not intodcd or oftcrcd for slc (Sc.7044, B6ines ud Prcfwions Codq The Contractor's Lico* Irw doc not apply to an ownE of thc propcrty who builds or imprcvc thcm1 ild who dG such wr* himsclf or hmclf or thrcugh his or ha om cmployc. providcd that such impmvamts rc not intadcd or offrod for slc. I[, howd6. thc building or imprcvmot is pld wthin onc ]q of complaion. the o\rnq BuiLds will havc thc burdqr of proving thd hc or shc did rct build or imprcrc thc popo'ty for thc purpo*of $lc). _.1. as owner of the property. am exclusively contracting u'ith licensed contractors lo construct the project (Sec. 7044. Business and Profession Code: The Contractor's License Larv does not apply to an owner of propo'ty u'ho builds or improves therctrn. and who contracls for such projects with a Contracto(s) licensed pursuant to the Contractor's License [arv). -l am exempt under Section-. B. & P.C. for this reason. Dnte:_Owner:_ WORKERS' COMPENSATION DECLARATION I hereby affirm under p€nalty of perjury onc ofthe following declarations: _l have and will maintain a Certificatc of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code, for the performance of the work for which the po'mit is issued. _l have and will maintain workers' compensation insurance, as requird by Section 3700 of the labor Code. for the performance of the u'ork for u'hich this Policy _Expires: _l certify that in the performancc of the work which this pernrit is issued. I shall not ernploy any person in any manner if I should be.come subiect to the comply rvith those prouirionr.. Iso as to become subiect to the workers' cornpensation laws of California. and agree that rvorkers' compensation provisions of Section 3700 of the Labor Code. I shall. forrhrvith WARNING: Failure to secure workers' compensation coverage is unlawful. and shall and civil fines up to one hundred thousand dollars ($in addition the Section 3076 of the interes andL I hereby affirm under penalty of perjury that I am provision of Chapter 9 (commencing rvith Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. ) Number: Ll /36 License I hereby afTirm under penalty of perjury that there is a lctrding pei'formance of the rvork for s'hich this permit b issued (Sec. 3097. Civ. C.). Lender's Name: I.cnder's Address: APPLICANT DECLATIATION I hereby affrrm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notification _l certi$ that the lHeral regulations regarding asbestos removal are not applicable to this project. _l certi& that I have read this application and state that the above information is correct. I agre to comply with all City and County ordinances and State Law's above mentioned property for Applicnnt or Agent r l'crrrrilec authorize representatives of this City and County to the Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm I Dampers Communications Cable Buildins Under Slab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouoh Ceilinss (T-Bar Rouqh) Meter Release trYDIE )En r--. Rough nFn tn ?fnn Service Meter l)^4, F!NAL (\il\MG6.{,O,n l,cfi,wI Etc. is issued. My rvorkers' compensation insurance carrier and policy number are: t 1 Dale: \,\?