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