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b .ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OWN l:R ltL, ILIXIR I)I.:LCA RATION I hcreby affirnr under penulty of prjury that I aru exenrpt fronr the Contractoni' Licerxe law f<rr the following rea$n (Sec.7031.5 llusincss and Prol'cssion Codc): Any City or County which re<luires a pcrrnit to construct, alter. itnprovc. dcrnolish or rcpair any structure, prior to its issuance. al.so requires the applicant frrr such pernit to frle a sigrrcd statetrrcnt that lre or she ls licensed pursuant to lhc provisions of thc Contractor's l.iccnsed I^aw (Chaptcr 9. Commcncing with Scction 7fi)0 of Division -j ol'thc lJusincss and ProfessionsCrde)ortlutlreorstreisexemPttherefronrandtlrebasisfortlrcallegedexentpliott. AnyviolationttfSectionT03l.5byany applicnnt for a pennit subjects the applicanl to l civil penalty of not tx)re than five hundred dollars ($5(ru). _1. as owner ol'tlx. pror*-rly. or tny qnptoyecs with wagcs as thcir solc'comlrcnsation, willdo thc work and the structure is mrt interxletl or offered for sale (Sec.7Gl4. Business antl Pnrfessions Ctxle: Tlrc Conlractor's Licensc l-aw does nol apply to atr owner of the pnrperly wlltr builds or in4xrves tlpruru, and wlxr doe.s suclt work himself or lrerself or ttuough his or her own entployees, providc.d that such irnprovc'rrrcnts arc rrrt interxlcd or olTcrcd for salc'. ll. hnwcvcr. Orc building nr irtprovctrcnt is sold within onc yL'ar of conrphtion, ttre Owner Builtler will lrave the burtlen o[ pnrving thal he or she did not buikl or improve the pnrpcrry for the purgrse of sale). _1. as owner of tlre propefly, unr exclusively contracting with licensed contraclors to construct tlre and holbssirxr Cotle: The Colttruclor's License Law does rurt apply to an owtrcr <lf prolrcrty who (Sec. 7(Xq. Business and who conlracls [<rr such pro.ic'cts with a Contractor(s) licenscd pursuant to thc or inrproves lhereon. taw). _l anr exenll)t uttder &l'L'ils()ll. DECLARATION I hcrchy afl'irrn undcr penalty of pcrjury onc o[ thc tirllowing declaralions: _lhaveanr.lwill nraintainaCertilicateofConsenttoSelt'-hrsurefrrrworkers'contpensation,as providedftrrbySection3T00oftlre Latxrr Codc, for thc 1rcrlorrtrancc o[thc work lbr which thc prnril Ls issucd. _l have arrd will nraintain workers' corupensalirur insurunce. as required hy Section 3T00 of the [:bor Code, f<rr llrc lxrfornutrce of thc work tilr whiclr this lrcrnrit is issucd. My workcrs' conrpersation irsurancc can-icr ruxl grlicy nunrhcr arc: Policy Numbcr: ExPires: _l ccrlify that in tlrc;xrlirrrtnncc of tlrc work frrr which this pcrmit is i.ssucd. I shall not cnlploy atly t)crson in any nlanncr .\o astobccorncsubjccttotheworkers'conlpcrrsatiorrlawsofCalil'ornia.andagrccthatif lshouldhecolr--subjecttothe workers' conrlrnsation provisiors o[ Section 3700 of the Labor Cotle, I shall, firrthwith contply with tlrose provisions.. WARNING: Failure to secure workers' conrpensiltion coverage is unlawful. and illl and civil lines up lo ()tte hurtdred thousattd dollars (S100.000t. itt to the lhe .Scction 307(r o[latxx'intcrcst and attorney's l'ccs. IZ "l I hereby affirnr under ;rcnalty of perjury that I arn licerrsed under pnrvision 9 (conrnrncing witlr Section 7000) of Division 3 \ of the Business and Professiorrs Code. and rny license is in full force and effect. License Class: License Number:'- CONSTRUCTION LENDING AGENCY I hereby at'lirrn undcr pnalty of grcrjury that thcre is a construction lcnding agcncy for the pcrformance of thc work l'or which this permit is issued (Sec. 3097. Civ. C.). l.cnder's Nanrc: Lrrrder's Address: APPI,ICA NT DECLARATION I lrrchy afirnr untlcr 1^-nalty of pcrjury one of thc folkrwing dcclarations: Dcnxrlition Pcrnrits-Asbc'stos Ntxification Fcdcral Regulations (Titlc 40, Part6) -Rcquircd l-cttcr of Notificatkrn _l ccrtily that tlrc fcdcral rcgulations rcgarding asbcstos rcrrxx'alarc not applicablc to this projcct. ' -l cc'rlily ttrat I luvc rcatlthis ordinanccs and Statc Laws relating to abrlve nrentioned property for Applicarrt or Agerrl l'crnrilec nanlc stalc lllat lllc autk)rizc Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq / Groundino I UFER ta ,ola))bt[em Transformers Torqueing Sub-Panels Air Conditioners I a Roof Top Equipment V)lnr 17 lDl'?Io UtrttM :a Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinos (Hard & Soffit Rouqh Ceilings (T-Bar Roush) lVleter Release Rouqh Service N/eter I t FINAL t2 idvr Dkzrtla.l I Notes, Remarks, Etc. Hev. 08-07 201t ae -.- L IZ