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ELECTRICAL-I NSPECTOR R ECOR D COMMENTSAPPROVALSDATEID/SIG. Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondins I Groundins I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouoh) Ceilinos (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) N/eter Release Rough Service N/eter tl FINAL tTltflu DnWgt 7/ Notes, Remarks, Etc OWNE,R BUII,DER DEI,CARATION I hereby affinn under penalty of perjury that I anr exenlpt frcm the Contractoru' License l-aw for the following reason (Sec.7031.5 Busincss and Prol'cssion Codc): Any City or County which requires a permit to construct, allcr, itnprove, dcrnolish or rcpair any structure, prior to its issuance. als<l requbes tlrc applicant lbr such perndt to fih a sigrrcd staternenl that lre or she is licenscd pursuanl to the provisions of thc Contractor's l,iccnsed l-aw (Chaptcr 9. Cornmencing with Scction 7000 of Division 3 o[ the Busincss and Professiorrs Code) or that he or she is exenqrt therefrom and tlre basis for the alleged exempion. Any violation of Section 7031.5 by any applicant for a perrnit subjects the applicant to a civil penalty of not more than five hundred dollars ($stttt). _1. as owner ot'thc property, or my crnployccs with wagcs as thcir solc compcnsation, will do the work and the stlucture is not interx.lal or offered for suh (Scc.7U4. Business and Professions Cqle: The Contraclor's License Law does not apply to an owner of tlrc prcperty wlro builds or inrproves there<rn, and wlxr dots such work himself or lrerself or through his or her own entployees, providcd that such improvcmcnts are rmt intcndcd orolfercd for sale. Il. howcver, thc building or inprovenrcnt is sold within oIrc ),car of completictn, rhe Owner Builder will have the burden of pruving ttut hc or slrc did not buikl or inprove 0rc propoty for thc purposc of sale). _1. as owner of the property, am exclusively contracting with licenscd conlraclors to construct thc project (Sec. 7M4. Business arxJ hotbssion Code: The Contractor's License Law dtxs not apply to an owner of property who builds or improves thereon. and who cont"racts lor such projccts with a Contracto(s) liccnscd pursuant to thc Contractor's Licensc [aw). -l anr excmpt unrler Sectiorr-, B. & P.C. lbr tltis reason. WORKE,ITS' COMPENSATION DECLARATION I hercby affirnr untlcr pcnalty of pcrjury one of thc lirllowing dcclarations: _l have and will nuintailt a Certiticate of Consent to Self-lnsure for workers' contpettsation, as prcvided for by Scction 3700 of the L^abor Code, fior the Jrerfonnance of the work lbr which thc pcrmit is issucd. H have and will nraintain workers' corupernalion insurarrce, as required by Section 3700 of the Labor Code, for lhe Jrerfornunce of work which this prmit is issucd. My workcrs' con4rcnsation carricr uxl lxllicy nunrbcr iue: rYl u{q u9-- - t- ?-lPolicy1 _l ccrrify that in tlrc Jrcrfornnncc of thc work for which this pcrmit is issucd, I shall not cmploy any pcrson in any manncr so as to bccome subjcct to the workcrs' compensation laws of California. and agrce that if I should becomc subject to the workers' compensation provisions of Section 3700 of the labor Cqle, I shall, forthwith comply with thosc prcvisions.. WARNING: Failure to secure workers' compensalion coverdge is unlawful, and shall subject an employer to crirninal penalties and civil lines up to otrc hundrerl thousand dollars ($100.000t. in addition to lhe cost of comlrcnsation, danrages as provirled for the Section 3076 ot Codc, interest and attorncy's l'ccs. ILuLo I hcreby affrnr under penalty of perjury that I anr licensed under provision of Chapter 9 (conrnrncing with Section 7000) of Division 3 of the Business and Professions Code. and my licenrc is in full forcc urxl effcct. License C CONSTRUCTION LENDING AGENCY I hcrcby al'lirm under pcnalty of pcrjury that thcre is a construction lcnding agcncy for thc pcrformance of thc work for which this permit is issued (Sec. 3097. Civ. C.). lrnder's Name: [rnder's Address: APPT,ICANT DECI,ARATION I hcrctry affirm undcr pcnalty of pcrjury ttnc of the following dcclalations: Dcnplition Pcrmits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6) _Required l-cttcr of Notification _l certily that thc fcdcral rcgulations regarding asbcstos rcmoval iuc not applicablc to this prolxt. I agree to conrply with all City and Countystalc tlrat lhc ahlvc ittlot'lttaliott is cotrcct. above rrntioncd property for inspcction Applicant or Agent Pcrmitec nanre irnd authorize o[ this City and County to cnlcr upon thc Da'e: 1?hla) 08-07-201 5