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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNT]R BI'II,DER DI'I,CARATION I hereby affrnr under penalty of perjury that I am excmpt from the Contractoru' License l-aw for the following reason (Sec'.7031.5 Business and Prol'cssion Codc): Any City or County which requircs a pcrmit to construct, altcr, irnprove, demolish or rcpair any structure, prior to its issuance. also requires the applicant lbr such Jrcrnrit to frh a signed statenrent that lr or she is licenscd pursuanl - to lhe provisions of thc Contractor's l-icensed l:w (Chaptcr 9. Commencing with Scction 7fi)0 of Division 3 of the Business and Professions Code) or that hc or slrc is exenrpt therefronr and tlre basis for tlre alleged exenrption. Any violation of Section 7031.5 by any- applicant fior a pennit subjects the applicant to a civil pennlty of not more than five hundred dollars ($5Otl1. _1. as owncr ol'thc property. or my etnployccs with wagcs as their sole compensation, will do thc work and the structure is not intenlcd or offeretl for salc (Sec.7H+. Busincss and Professions Code: Thc Contractor's Licensc Law rloes not apply lo an owncr of thc property wlxl builds or improves thermnr and who does such work himself or lrcrself or through his or her own enrployees, provided that such improvemcnts arc not intcndcd or ollered for sale. Il. however, tlrc building or furprovctnent is sold within onc year of conpletkrru thc Owner Buikler will have thc burtlen of provirrg that he or shc dirl not buikl or inprove tlre propaty for thc purposc of sale). _1, as owner of thc ptopefly, am exclusively contracting with licensed conlractors to consttuct thc project (Sec. 7044. Business arrd hotession Co<le: The Contractor's License Law does not apply to an owner of proSrerty who builds or improves thereon. and who contracts for such projccts with a Contractor(s) licenscd pursuant to thc Contractor's License hw). -l anr exempt under Section-, B. & P.C. lbr tltis reason. Date: WORKT' ILS' COM P}:NSATION DECLAR,ATION I hereby affirm undcr pcnalty of pcrjury one of the following declarations: _l have ard will nuintain a Certifrcate of Consent to Self-lnsure for workers'cornpensation, as providcd for by Scction 3700 of the Labor Code, for the performance of the work for which the pcrmit is issued. $ n"r. and will maintain workers' compcnsation insurarrce, as required by Section 3700 of thc L:bor Code, for the perfornrurce of ttre work for which this pcrmit is iszued. My workers' cornpensation insurance carier and policy number are: c*,x,, S'hr{rnf Pr 5 ' 6,-LlPolicylluffrbell l\fvvrvv rrt J/I lixpires:. ?Pu/c" |flT>f _l ccrtify that in thc pcrfornuncc o[thc work for which this Jrermit is issucd, I shall not cnploy any lrcrson in any manncr so as to become subjcct to thc workcrs' conrpensation laws of California. and agree that if I should becorre subjcct to the workers' compensation provisiolu of Section 3700 of the Labor CorJe, I slull, forthwith comply with those provisions.. WARNING: Failure to secure workers'compensation coverage is unlawful,and civil fines up to one hundred thousand dollars ($100,000). in addition t<r lhe Section 3076 of thc l-atnr Code, intcrcst and attorncy's -7) LICENSED CONTRACTOR DI'CLARATION I anr licensctl untler provision of Chapter 9 (comnrncing with Scction 7000) of Division 3 my license is in full forcc und effect. I hereby affrnr under pnalty of prjury that of the Business and I'rofessions Code. and c J lo o16o -License Date:iL-7-7) CONSTRUCTION LENDING AGENCY I hercby allirm undc.r pcnalty of Srcrjury that thcre is a construction hnding agercy for the pcrformancc of the work for which this pcrmil is issuetl (Sec. 3097. Civ. C.). lrnder's Name: [rnder's Address: APPI,ICANT DECI,ARATION I trrdry allirnr undcr p-nahy of pcrjury onc of thc firlklrving dcclauations: Dcnxrlition Pcrnrits-Ashcstos Notification Fcdcral Rcgulations (Titlc 40, Part6) -Rcquired l-cttcr of N<xification _l ccaily that thc fcdcral rcgulations rcgarding asbc.stos rcrnoval arc not applicablc to this projc'ct. _l ccrtily that I havc rcad this upplication iuxl statc that thc ahrvc infix'rnation is corrcct. I agrec to contply with ull City antl Couttty ordinanccs and Statc [,aws relating to building arxl hereby authorizc reprcscntatives o[ this City and County to enter upon thc above rrEntioned property for Applicant or Agent Pcrnrilec I)ale:/2-?Zt Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab lJ)oor L- Bo nd i nq rerou ndinslDJ F E R //-z/'A (L1 -rl Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinos [-Bar Rouoh) [Vleter Release Rough Service N/eter \ln rt r>f,')At -? ,1.< i^?fr1 S F!NAL /,o vf -vv lc wt 7lv6 tu-/ 6 / Notes, Remarks, Etc. Rev. 08-07-201 5 I Arrrrlicnnt: