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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNTiR BIIILDIiR DI'I,CA RATION <br />I hereby affirnr under penulty of perjury that I anr exenrpt fronr tlte Contractors' License Law for the following reason (Sec.7031.5 <br />llusincss and Prol'cssion Codc): Any City or County which rcquircs a pcnnit to construct, alter. itnprovc, dcmolish or rcpair any <br />structure. prior to its issuance. also retluires tlre applicant li)r such Jremrit to file a signed slaterlrnl that lre or she is licen.sed pursuanl <br />to thc provisions of tlr Contraclor's l.iccnsed law (Chaptcr 9. Comrncncing with Scction 7(D0 ol'l)ivision 3 of the Busincss and <br />ProfessionsCode)orthatlrcorsheisexen4rttherefronrandtlrcbasisfortheallegedexenptioll. AnyviolationofSectionT03l.5byany <br />applicantforapnnitsubjectstlre applicanltoocivilpenirltyofnotmorethanfivehundreddollars($5tXt1. <br />_1. a.s owncr ol'tht prol^*rtv. or lny crnplovccs with wagcs as thcir sole comJrcnsation, will do thc work and thc structure is not <br />intentled or offered for sale (Sec.7044. Business antl Professions Code: The Cottlraclor's License Law does not apply to an owner of <br />the pnrperty wlxr txrilds or inrproves tlureon, atxl wlxr dtrs such work lrinrself or lprself or through his or her own entployees, <br />providccl that such irnprovr.rncnts arc il)t furtcndcd or olTcrcd for salc. ll. lrrwevcr, tlrc building or funprovctncnt is sokl within one year <br />of comphtiorr, the Owrrcr Builder will have the burden of proving tlrat he or she did not build or improve the property [or the purpose of <br />salet. <br />_1. as owner of the propetly, am exclusively contracting with licensetl contractors to conslruct the project (Sec. 7044, Business <br />arxl Protession Cotle: The Contractor's License Law dcrs not apply to an owner of property who builds or impr<lves thereon. <br />and who contracts lor such pr<rject.s with a Contractrlr(s) licenscd pursuant to the Contractor's License kw). <br />-l <br />anr exenpt urrder Section-, B. & P.C. lbr tltis reason. <br />Date: Owner: <br />lVO RKF]ITS' COM PI]NSATION <br />DECLARATION <br />I hcrcby aflirm under penalty of pcrjury onc of the tbllowing declarations: <br />_l have and will nmintain a Certilicate of Consent to Self-lnsure for workers'conrJreruation, as pruvided for by Section 3700 of tlre <br />Latxrr Code, for thc Jrcrfornmnce of thc work ftrr which the pcrmit is issued. <br />m,Irave and will nraintain workers'courpen.sation insurance. as required by Section 3700 of tlte Labor Code, lbr lhe perforttutrce of <br />work lbr which this llcrnrit is issucd. My,workcrs' conrJrcusatiun insurancc can'icr aurd grlicy nuntbcr iue: <br />tibqh+Y \r\5ttf(A^t-!Carier: <br />Policy <br />_l ccrrity that in thc lrcrtirrnuncc ol'thc work frrr which tlris pcrmit is is.sucd, I shall not cnpkry any lrcrs()n in any manncr <br />so as to bccornc subjcct to thc workers' corrrperrsation laws of Califonria. and agree that if I should bccolne subjcct to thc <br />workers' conrlrnsation provisions of Section 3700 of the labor Code, I slull, firrthwith conrply with tlrosc provisions.. <br />WARNING: Failure to secure workers' cornperrsation coverage is urrlaw[ul, and shall subject an cmployer to critninal Jrcnalties arrd <br />civil fines up to one hurdred tlxrusand dollars ($100.0001. in addition to lhe cost of conrpetrsatiott, tlanuges as provided for tlrc <br />attorney's <br />I hereby affirrrr under lrcnalty of perjury that I anr licensctl 9 (corrrrrnrcing with Section 70m) <lf Divisi<ln 3 <br />of the flusiness and Professions Code. amJ rnv license is in l'ull force and effect. <br />License Nunrber:+q b )\G <br />CONSTRUCTTON LENDING AGENCY <br />I hcreby al'lirm undc.r pcnalty ol'pcrjury that thcrc is a construction lending agcncy for thc pcrlbrmance ol'thc work lbr which this pcrrnit is <br />issued (Sec. 3097. Civ. C.). <br />Lrnder's Name: <br />APPI,ICANT DECLARATION <br />I tuu*ry affirnr untlcr pcnalty of perjury one of thc following declarations: <br />Dennrlition Pernrits-Asbcstos Notification Fedcral Regulations (Title 40, Part6) <br />-Rcquired <br />l-ctter of l.{otification <br />_l certily that the fcderal regulations regarding asbestos rcmoval arc not applicable to this prnject. <br />tllccrtily tlrat I luvc rcatl this apptication and state tlrat the ahovc informalion is correct. I agree to conrply with all City and County <br />r dldirlanccs and Statc l,aws rclating to building construction. and hcreby authorize reprcsentativcs o[ this City and County to enter upon thc <br />above rnentioned propcrty for <br />Applicant or Agent <br />l'crnrilee nanrc <br />\ <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under SIab / Floor <br />Bondinq I Groundino I UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factorv Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilinqs (Hard & Soffit Roush <br />Ceilinqs (T-Bar Rouqh) <br />N/eter Release <br />Rouqh <br />Service [/eter ,l l -.st <br />FINAL LII'I W ,PWYI <br />Notes, Remarks, Etc <br />lrnder's Address: <br />,^,",t9 l)o!lo