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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNIi,R BUTI,DER DTiLCARATION I hereby affirnr under penalty of perjury that I arn exenrpt from the Contractors' License [:w for the following reason (Sec.7031.5 Busincss and Profcssion Codc): Any City or County which requircs a pcrmil to construct, altcr. itnprove. dcmolish or rcpair any structure, prior to its issuance. also requires the applicant for such Srenrrit to file a signed statemenl that lre or she is licensed pursuant to thc provisions of thc Contractor's l,iccnsed law (Chaptcr 9, Commencing with Scction 70fi) of Division 3 of the Business and Professions Code) or that he or she is exenrpt therefronr and tlrc basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for u lxrrnit subjects the applicunt to a civil pennlty of not more than live hundred dollars ($5tttt1. L _1. as owncr ol'the propcrty. or my crnployccs with wages as their srle compensation, willdo thc work and thc structure is not intendcd or offered for sale (Sec'.7044. Business antl Professions Cotlc: The Contraclor's License Law does not apply to an owner of the pmperty wlxr builds or inproves there<rn, and wlxr does suclr work himself or lrerself or lhrough his or her own entployees, provided that such impmvcrncnts are ff)t intcndcd or ollcrc'd for sah. Il. hcrwcvcr, the building or inprovenrcnt is sold within onc )aiu of conrpletion, tlre Owner Builder will havc the burden of proving that he or she did not buikl or improve the prcperly for the purpose of sale). _1. as owner of tlrc propefly, am exclusively contracting with licensetl conlractors to construcl thc project (Sec. 7(X4, Business and hotessbn Code: The Contractor's License Law does not apply to an owner of proJrrty who builds or improves thereon. and who contracts [<rr such projccts with a Contractor(s) licenscd pursuant to the Contractor's License [aw). -l anr exempt under Section-, B. & P.C. lbr this reason. Date: WORKI'ILS' COM I'EIISA'I'ION DECLARATION I hercby affirrn undcr pcnalty of pcrjury onc of thc following dcclarations: _l have arxt will nuintain a Certilicate of Consent to Self-lnsure for workers'conqrensation, as pruvided for by Scction 3700 of the Latxrr Code, for thc perlrrrrnancc o[the work lbr which thc pcrrnit is issucd. _I have and will nurintain workers' conrgrcmatiorr insurance, as required by Seclion 3700 of the L-abor Code, for lhe perfonruurce of thc work for which this pcrmit is issued. My workcrs' compcnsation insurancc carrier arxl plicy number arc: Carier: Policy Number: Expires: )g..!ccrtify that in thc lrcrfornuncc of thc work frrr which this pcrmit is issucd, I shall not cnrploy any lrcrson in any manncr -so al to becornc subject to the workers' cornpcnsation laws of California. and agrce that if I should becomc subject to the workers' corrrpensation provisions of Section 3700 of the Labor Code, I slull, forrhwith comply with those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to crirninal penalties and civil fines up lo one hurdred tlmusand dollars ($100.0001. in additiort to tlte cost of comgrctsation, danuges as provided for lhc Section 3076 of thc Labor Codc, intercst and attorncy's fees. I hercby affrnr under penalty of perjury that I anr licensed under provision of Chapter 9 (cottrnrcncing with Section 7000) of Division 3 of the Busincss and Professions Code. and rny license is in full force and effect. Nunrber:1e715 o License 2 2o CONSTRUCTION LENDING AGENCY I hcrcby affirrn under pcnalty of pcrjury that there is a construction hnding agency for thc pcrforrnance of thc work ltrr which this permit is issued (Sec. 3097. Civ. C.). Lender's Nante: APPI,ICA NT DECT,ARATION I hcrcby aftirnr undcr pcnalty of pcrjury onc of thc firllowing dcclauations: Denxrlition Pcrnrits-Asbc'stos N<lification Fctleral Rcgulations (Tillc 40, Pafl6) _Rcquircd l.cttcr of Notification _l ccrtily that the fcdcral rcgulations rcgarding a.sbcstos rcmoval are not applicable to this projcct. _l ccrtify tlul I havc rcad tlus applicalkrn axl statc that tltc ahtvc infornution tl**ordinanccs and Statc laws rclating to building above rnentioned propeny lor inspection Applicant or Agent I'crnrilec 12 20? o Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor Bondinq I Groundinq I UFER Transf ormers Torqueincr Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinos (Hard & Soffit Rouoh Ceilinqs [-Bar Rouqh) lVleter Release I Rough tt lt -rlService N/eter r lqlDt /l,tvt,'Ma)fl FINAL t'l7-/n-tQ\-r t svy Y J Notes Remarks Etc. I Rev. 08-07-201 5 f)ate:71 l/, /te?Dll City and County and entcr u[X)nto