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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNI,R B I.'II,DT'R DI.:I,CA RATION <br />I hereby affintr untler pcnalty of prjury that I anr exenlpt fronr the Contracloni' License [:w for the followitrg reason (Sec.7031.5 <br />tiusincss and Prol'cssion Codc): Any City or County which rcquircs a perrnit to construct, altcr. irnprovc. dcrnolish or rcpair any <br />structure, prior to its issuance. also re<luires the applicant lor such ;rcnuit to file a signed slatenrcnl that lre or she is licensed pursuant <br />to the provisions of tlrc Contractor's l,iccnscd Law (Chaptcr 9. Cornmcncing with Scction 7OU) ol' I)ivision 3 of thc Busincss and <br />ProfessionsCodetortlratlrcorslrcisexenqrttherefronrarxltlrebasisforthallegedexentptiott. AnyviolationofSectionT03l.5byany <br />apptictnt for a ;rnnit subjects the applicunt to a civil penalty of not more than five hundred dollars ($5m). <br />_1. as owner ol'thc propcrty. or my crnployccs with wages as thcir solc compcnsation. will do the work arrd the stnrcturc is not <br />interxletl or offered for sale (Sec.7(X4. Business antl Profcssiorrs Code: The Conlractor's License Law does not apPly to an owner o[ <br />the proJrrty wlxl builds or improves tlrcre<ln, aud whr dtxs such work ltimself or lrerself or tkough his or her owlt entployees, <br />providcd that such irnprovc.rrrcnts arc not intcrxlcd oroll'crc'd lor salc'. ll. howcvc'r, thc buikling or furprovcnrcnt is sold within one ]car <br />of conrpbtioru tlre Owrrcr Builtlcr will have the burtlen of prr;ving that he or shc tlid mt buikl or inprove the prcpcrty for thc purpose of <br />sale). <br />_1. irs owner of the prolrctly, itm exclusively contracting with licensed conlraclors t() conslrucl the pruject (Sec. 7(X4. Business <br />arx.l holcssi<tr Code: The Contractor's License Law does not apply to an owner of property who builds or intproves tltereolt. <br />and who c()nlracts for such pr<rjccts with a Contractor(s) liccnscd pu]suant to thc Contractor's Liccnsc Law). <br />-IalttexemptunderSectitrtt-,B.&P.C.tbrtlrisreas<rn. <br />1 1.. . ,.. <br />WORKE,RS' COMPENSATION <br />DECLARATION <br />I hercby atTirm under pcnalty of pcrjury onc of the following dcclarations: <br />_l have and will nnintain a Certilicate of Consent to Self-lnsure for workers' con4rensation, as provided for by Section 3700 of the <br />Lahor Codc, for thc Jrcrfortnancc of the work [or which tltc pcrnilt is Lssued. <br />_l have and will rnaintain workers' conrpensation insurance, as required by Section 3700 of the l-abor Code, for the perfornutrce of <br />thc work f<lr which this lrcrnrit is issucd. My workcrs' conrpcnsation insurancc sarrier uxl gnlicy nunrbcr are: <br />LL -LO u -q-L )Policy <br />_l ccrrily thut in tlrc lrrtirrnnncc o[thc work frrr which this pcrmil is issucd, I slrall not cnlploy auy lrcrson in any nlanncr <br />.so as to bccornc suhjcct to thc workcrs' cornpcrrsatiorr laws of California. and agrcc that if I should becolne subjcct to thc <br />workers' conr;rensation provisiorrs of Section 3700 of the Labor Code, I slrall, firrthwith cornply with those pruvisions.. <br />WARNING: Failure to secure workers' compensation coveruge is unlawful. and shall subject an employer to critninal penalties and <br />conqrcrsation. danuges u; provided for thecivil lines uP lo one huttdred tlxrusand dollars (Sl00.U)o). in addition to of <br />,Scction 3076 of thc Lrtxrr Culc, intcrcst and attorro*y's <br />u",", [l -\Q'?3 <br />I hereby affirnr untler lrcnalty of perjury tltat I ant licensed pruvision of Chapter 9 7000) of Division 3 <br />of the Busine.ss and Professions Code. aril rny license is in lull ftrrce atxl el'fect. <br />Liccnse <br />Date: <br />r o3n520 <br />tl -\q -z D <br />CONSTRUCTION I.}:NDIN(; AGIiNCY <br />I hercby aflirm under pnalty of pcrjury that thcrc is a construction lcnding agency for the pcrformancc of thc work l'or which this permit is <br />issued (Sec. 3097. Civ. C.). <br />[.cnder's Nanrc: <br />lrnder's Address: <br />A PPI,ICANT DECI,A RATION <br />I lrcrchy affirnr untlcr Jrcnalty of pcrjury onc of the lirlkrwing dcclarations: <br />Dcnxrlition Pcrnrits-Ashcstos Ntxification Fctlcral Rcgulations ('Iitlc 40, Part6) <br />-Rcquircd <br />lrttcr of Notification <br />_l ccrtily that thc fcdcralrcgulations rcgarding asbcstos rcrnoval arc nol applicablc to this projcct. <br />_l ccrtily tlrat I luvc rcatt this applicatiorr auxl state tlul lhc atxlvc infornulion is corrcct. I agrc'c to contply witlr all City and County <br />ordinanccs and Statc laws rclating to construction. and of this City and County to enter upon thc <br />above rnentioned propcrty for <br />tr- 11-zo <br />l. <br />A;lpliciurl ()r /\gtnt f)irlc: <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor <br />Bonding I Groundi ng I UFER <br />Transf ormers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinss (Hard & Soffit Roush <br />Ceilinss (T-Bar Rouqh) <br />N/eter Release /2./f-D 2*7 <br />Rouqh <br />Service N/eter --\ <br />FINAL 2-/?-b k/.,/trz2t -Zr7 <br />Notes, Remarks, Etc.