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ELECTRICAL-I NSPECTOR R ECOR D <br />C)^', n0 n7 ?n{ f <br />APPROVALS DATE ID/SIG COMMENTS OWNER BUII.DER DELCARATION <br />I hcrcby aflirm urdcr Fnrhy of perjury lhlt I M excmpt lmm thc Conlracton' Liccnsc hw for thc following rea$n (Se.7031.5 <br />Busincss and Profcssion Codc): Any City or County which rcquircs a [rcrmit lo construct. ulter. improvc. dcmolish or rcpair ony <br />structurc. prhl lo its issume. also rcquircs thc applicanl for such Frmit lo fih a signed slalcmnl lhat hc or shc is liccflscd pumuall <br />to thc pmvisions of thc Contractor's Liccnsd hw (Chsptcr 9. Commncing silh SBlion 7000 of Division 3 of lhc Busincss and <br />Prclcssions Codc) or lhat hc or shc is crcmpt thcrcfnrm and thc basis for lhc allegcd cxcmplion. Any violalion of Sction 703 1.5 by any <br />.pplicantforaJErmitsubjcctsthe applicanttoncivilpcnaltyofnotmorclhanfivchundrcddollars($500). <br />a <br />_1. as owncr of thc proJrcrty. or nly ctnployces with wages as thcir solc conrpcnsation. will do thc work atxl thc structurc is not <br />inlcrrded or ()ffcrcd for salc (Scc.7044. Busincss and Profcssiorrs Codc: 'l'hc Contraclor's Liccnse [;tw docs not apply to att owttcr o[ <br />the pr)pcrty who builds or impro\cs thercnn. and who docs such urrrk himsclf'or hersclf or through his or hcr own cmployces. <br />provided that such iltrprovcrr.nts arc nol intcndcd or olfcrcd for sah. It. howcver. thc huikling or intprovcnrcnt is sokl within onc )eur <br />of cornplction. thc Owncr Builtlcr will havc thc burclcn of proving that he or shc did not build or itttprove thc prnpory for thc purJnscof <br />suh). <br />_1. usowncrof thc propcrty. amcxclusivclycontracting with liccnscd conlraclorstoconslrucl thc pnrjcct (Sec. 7(X4. Busincss <br />and ltotbssion Codc: 'l'hc Contraclor's License Law docs nol apply to fln owncr of proJrcrty who huilds or improvcs lhcreon. <br />and who conlracts lbr such pr)jccts with a Contractor(s) licenscd pursuant lo lhc Conlractor's Liccnse Law). <br />-lamcxcnrptundcrSeclion-.B.&P.C.lilrthisreason. <br />I )ale.( )rr lrcr: <br />WORKERS' COI\I PENSATTON <br />DECLARATION <br />I hcrcby alfirm undcr pcnalty of perjury one of thc folkrrvirrg dcclaralions: <br />_lhavcandwill nuinlainaCcrtificatcofConscrrttoScll-lnsurclirrworkcrs'compcnsation.as providedforbyScction3Tfi)ofthc <br />Lrbor Cule. firrr thc yrcrfornrancc of thc work for which thc permit is issucd. <br />-l <br />have and will rnainlain workcrs' conrpcnsation insurancc. as rcquircd by Sccl ion 3Tfi) of the l-abor Code. lbr thc pcrtortnance ol' <br />. lirr which thirs pcrrnit is issucd. N'ty u'orkcrs' conrpcnsation insurancc carricr and policy nuntbcr arc:Ng*.S.'rL EAS <br />lhc work <br />Policy ) <br />_l ccrtily thal in the pcrfrrrnmncc o[thc u,ork frrr which this pcrnrit is issucd. I shall not crnploy any pcrson in any nlanncr <br />so as lo hcconrc suhjcct to lhc rvorkcrs' conrpcnsation lau's of California. and agrcc thal if l should bccomc subject to thc <br />workcrs' cotnpcnsfltion provisions of Scction 370O of the Latxrr Codc. I shall. forthwith conrply rvith thosc provisions.. <br />IVARNIN(i: [:ailurc to sccure u'orkcrs' cornpcnsation covcrilgc is urrlarvlirl. arrtl shall subjccl att cntploycr to crintinal Jrcnallies ttt<l <br />civil fincs up to onc hundrcd thousand dollars (Sl(X).UX)). in adtlitiorr lo the cost of contpcnsalion. danragcs as provided t'or thc <br />l'ccs.::::"u:il' ? :" :" :;:::, : <br />I hcrcby allirm undcr pcnaltyof pcrjury thal I arn liccnscd under provision of Chaptcr 9 (cotnnrcncing with Scction 7fim) of Division 3 <br />of the Busincss and Prcfcssions Codc. attd nty liccnsc is in full tirrcc and cll'cct. <br />[-iccrrsc <br />Dale: _ <br />1to55t <br />b-141 l,Yl1hanrca-l('oltlrtclor: <br />C(TNSTRUC I'ION LNNDING ACENCY <br />I hcrcby aflirm undcr lrnulty of Frjury that thm is o onstruction hnding sgercy for lhc pcrformamrc of lhe work for which lhis lErmit is <br />issucd (Sec. 3097. Civ. C.). <br />[rndcr's Numc: <br />knder's Address: <br />I hcr.ty aflim undcr lrcnally of Frjury orc or,* nffi <br />Dcrmlition Permits-Asbcstos Notification Fcdcral Rcgulations (Tillc 40. Parl6) <br />-Rcquircd <br />lrltcr of NotifEstion <br />-l <br />ccnify that thc fcderrl regulutions rcEarding lsbestos rcrmvol arc nol dpplicahlc to this prejcct. <br />_l ccnify that I have rcad this application ard stale that thc otnvc infomultrn is coret. I a8f,e to comply wilh all Cily and Coutrly <br />ordimnccs and Statc hws rclating to building construction. ard hcreby ruthorizc rcprcsntativcs oflhis Chy and Counly lo cntcr uFrn lhc <br />H*,::-.ffi,:"' -"fUL4 Go*di\- **, b n-l? <br />Pcmrremmc(prinr):-- - ---LUb@ <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq I Groundinq I UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />N/eter Release <br />n <br />Rouqh ^\ <br />Service N/eter t\ <br />FINAL v-\\-7/a V.T ylt <br />Notes Re Etc. <br />161-l'l