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ELECTRICAL-INSPECTOR RECOR D APPROVALS DATE ID/SIG.COMMENTS OWNITR llt, I LDl,lR Dlll,CA RATION I lrreby afhrnr untler penalty of per.iury that I arn exenrpt fronr the Contraclon' License Law for the following, reason (Sec.7031.5 lfusincss and Prol'cssion Codc): Any City or Countv which rct;uircs a pcrrnit lo construct, altcr. irnprovc. de'molish or rcpair any structure, prior to its issuance. al.so requires tlre applicanl for such Jremtt to file a sigrted slatenrenl that ln or she ls licen.scd pursuanl to the provisions ol'tl*.^ Contractor's l,iccnscd Iarv (Chapter 9. Comrncncing with Scction 70U) ol' Division 3 of thc Busincss and Prol'essions Code) or that lrc or slre is exenrpt tlrerefronr and tlre basis lirr the alleged exenplion. Any violatiott of Section T03l .5 by any applicunt for a Jrennit subjccts the npplicunt to l civil pennlty of not rnore than llve hundred dollars ($500). _l. as owner ol'thc. propctly. ()r tny c.lnployccs with wagcs as thcir solc' cornp^-nsation, will do thc work and thc stnrcturc is rnt irrrerrded or oflered ftrr sale (Sec.7(]44. Business and Professiorrs Code: Tlte Contraclor's License [.aw does not apPly to an owncr of tlrc property wlxl builds or inproves thereorl aml wlxr dtles such work himself or lrerself or lhrough his or her owtt enployees, providc.d that such improvr'rrrcnts arc ff)t intcndcd or ollcrc.d for salc. ll. howcvc'r, t-k building or improvetncnt is sold within onc yL'ar of completion, tlre Owner Builder will have tlrc burden of proving that lre or she dirl not buikl or improve 0re prcpary for thc purposc of srle). _1. as owncr of thc pnrperly, um cxclusively contracting with licen:;ed contractors to construct thc pnoject (Sec. 70*t4. Business and Pnrlbssfult Code: 'l'he Contractor's [-iceuse Law does rrrt apply to an owner of proSrerty who huilds or inrproves tltereon. and who contracts for such proiccts with a C()ntractor(s) liccnsed pursuant to thc Contractor's Licensc law). -l anr exempt under Sectiorr-, B. & P.C. lbr tltis reasott. Date: }ryORKEITS' COM PT]NSATION DECLARATION I hcreby affirm undcr pcnalty of perjury one of thc hllowing declarations: _l have arxl will nuinlafur a Certilicate of Consent to Sclf-lnsure for workers' conqrcnsation, as provided for by Section 3700 of the Lahor Code, for thc l**rfonlrance o[ thc work lbr which the permit is issucd. _l have and will nuintain workers' corupensation insurarrce, as required by Section 3700 of the Labor Code, for tlre perfornunce of tlrc work frlr insuriurcc carricr arxl p,olicy nunrbcr :ue: .l a al'olicy _l ccrrily that in tlrc grcrlirrnuncc of tlrc work firr which this pcrnril is issucd, I shall not cntpkry atry lrcrson in auy manncr so as to hccornc suhjcct to thc workcrs' cornlrcrrsation laws of Califonria. and agrcc that if I should bccornc suhjcct to thc workers' cornpensation provisiolts of Section 3700 of the Labor Code, I slurll, forthwith conrply with tlpsc provisions.. WARNING: Failure to secure workers' cornpettsation and shall subject an to and to tlrc cosl of lhe Sr'clion 3076 intcrcst and atlorncy's l-ccs. a t.tcl,NSt.,l) ('( )NI'ItA( "1'( )R I )[.( :1.,\ lt,\'l'l( )N ) I hereby alfinn under penalty r.rf perjury that I anr licersed under provision of Chapter 9 (cortutrncing with Section 7000) of Divisign 3 of the Business and l)rofessiorrs Code. and rrrv license is in full fbrce and el'fect. il License o ID - O CONSTRUCTION LEND]NG AGENCY I hercby al'lirm undcr 1^-nalty ol'pcrjury that thcrc is a construction lcnding agcncy for thc pcrlbrmarrcc of thc work l'or which this prmit is issued (Sec. 3097. Civ. C.). [-cnder's Nanre: APPT,TCANT DECI,ARATION I hcrcby aflirnr undcr p^-nalty of pcrjury onc of the following dc'clarations: Dcnxrlition Pcrnrits-Asbcstos Notification Fctlcral Regulations (Titlc 40, Pan6) -Rcquircd l,ettcr of Ntlification I ,tffi"aify that thc fcdcral rcgulations regarding .tsbestos rcmoval arc not applicable to this projcct. \l ccrtiti tlrat I lurvc rcad this application and statc llral ltrc atxrve infornution is corrcct. I agrcrc to contply with all City and County ordinanccs and Statc Laws rclating to building arxl hcrcb], authorizc rcprcscntativcs of this City and County to entcr upon thc above lnentioned pnrprty ftrr .lAllplicant or Agcnl I'crnrilcc nanlc turirrrl: X, -2D Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildins Under Slab / Floor Bondinq I Groundinq I UFER Transf ormers Torqueino Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Wdls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouoh) Nleter Release Rough Service l/eter I FINAL tzl r€l?t ,D**1c ) Notes, Remarks, Etc., D Rev. 0B-07-201 5 civil lines up lo one hurrdred tlxrusand dollars / I -- 14 -'z