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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNIiR B I.'ILDER DEI,CARATION I hereby afhrnr under penalty of per.iury that I am exempt frorn the Contractors' License l.aw for the following reason (Sec.7031.5 Busincss and Prolbssion Codc): Any City or County which requircs a Srcrmit to construct, alter, irnprovc. demolish or repair any structure, prior to its issuance. also requires the applicant for such prerntt to file a signed staternenl lhat lrc or she is licerrscd pursuant to the provisions of thc Contractor's l.iccnsed l:w (Chaptcr 9, Commcncing with Section 7fi)0 of Division 3 of thc Busincss and Professions Corle) or tlut lrc or she is exempt therefrom and tlrc basis for tlre alleged exemption. fuiy violation of Section 7031.5 by any applicant for a pennit subjects the applicant to o civil penalty of not nrorc than five hundred dollars ($500). _1. as owncr ol'the propcrty, or my cmployees with wages as their sole compcnsalion, willdo thc work and the structure is not irrterrtlcd or o{fered for sale (Sec.704+. Business and Prcfessions Code: The Contractor's License l.aw does not apply to an owner of the proSlerty wlro builds or irngrroves theruon, arxl wlp docs such work himself or herself or through his or her own employees, provided that such impmvcrrcnts are not intendcd oroffered for sah. If. howevcr, the building or inprorrcnrcnt is sold within orc year of conpletioq thc Owncr Buil&r will have the burden of proving that hc or she did not build or improve thc propaty for the purposc of sale). _1. as owner of the propcrty, am exclusively contracting with liccnscd contractors to construct thc pnoject (Sec. 7044, Business arxl hrofesskrn Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereoru and who contracts for such projccts with a Contractor(s) liccnsed pursuant to thc Contractor's License Law). -lanrexemptunderSection-,B.&P.C.fortlrisreason. Date: WORKIiIiS' COMPIiNSATION DECLARATION I hereby aflirm under pcnalty of pcrjury one of thc tbllowing dcclarations: _l have arxl will nuinlain a Certilicate of Consent to Self-lnsure for workers' compensation, as pruvided for by Section 3700 of the labor Code, lor the pctforrnance of thc work for which the pcrrnit is issucd. _l have arrd will maintailr workers' corupensalion required hy Seclion 3700 of the Labor Code, for the performarrce of thc work for which this prnrit is issucd. My workcrs' Policy _l ccrrify llra( in thc ;^-rlirrnuncc of thc work whiclr this prmit is of Califonria. issucd, I shall not cmploy any pcrson in any manner .so as lo becolne subject to thc workers'compen.sation laws and agrec that if I should bccorne subjcct to the slrall, forthwith conrply with thosc provisioru..workers' conrlrnsation provisions of Section 37fi) of the labor Code, I WARNING: Failure to secure workers'compensation coverage is and shall subject an ernployer pcnalties and civil fines up to one hundred thousand dollars ill of as provided f<lr the I hereby affrnr under penalty of perjury that I ant licens,erl 9 (conmrncing with Section 7000) of Division 3 of the Business and Professions Code, and my liccnsc is in full forcc and cffect. License Nunrber: CONSTRUCTION LENDING AGENCY I hcreby allirm under pcnalty of perjury that therc is a construction lending agency for the performance of thc work for which this perrnit is issued (Sec. 3097. Civ. C.). l,cnder's Nanre: Lrnder's Address: APPI,TCA NT DECI,ARATION I hcrchy affrnr undc'r pcnalty of perjury onc of thc firlklwing dcclarations: Dcnxrlit ion Pcrnrits-Asbc'stos Notification Federal Rcgulat ions (Title 40, Part6) _Rcquircd l-cttcr of Notification _l certily that thc fcdcral regulations regarding &sbcstos rcrrrrval arc not applicable to this projcct. -l ccrtify tlrathavc rcad this application and statc that thc ahrve informalion is corrcct. I agrce to comply with all Ciry anrl County ordinanccs and Statc Laws rclating to building construction, and hcreby authorize reprcscntatives of this City and County lo cntcr upon lhc above rnentioned property for Applicant or Agent Pernritce nanle \.*,", /t//Z /Za 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 tl Al Bonding I Grounding I UFER tdt ll'd{)WM.tl 0efi Transformers , Torqueinq Sub-Panels Air Conditioners ln ,,rl .d Roof Top Equipment pAru f /d lllld<-trpa4 roy1)v Factory Wired Unit I Walls (Conduit) Walls (Rouoh) Ceilings (Hard & Soffit Rough Ceilinos [-Bar Rouoh)rz lVleter Release aruu viladf) I Rough I f I I .?, - Service [/eter trruua bad FINAL llUttt VS[,W Notes, Remarks, Etc. Flev. 08-07-2015 carricr and policy numbcr arc: Codc, o,r", h/t42 t l7/t'7/?1)