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APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DIIR DT'I,CARATION <br />I hcrcby affrm undcr penahy of perjury that I iln cxcnpt from thc CbntracloB Liccns llw for (hc followinB rcasn (S1(.?oll.5 <br />Busincss afil Profcssion Codc): Any Cit], or County which rcquircs a pcrmil to construct, alter. improvc. demlish or rcpair ily <br />slruclurc, pdor to ils issuancc. aLso requiEs lh. applicol fo. such lEmrit to fih a sigrcd slat.mnt lhat lE o. shc is licc[rcd pusilt <br />to thc pmvisions o[thc Contractor's l-icenscd lrw (Chapter 9. Commcncing with Section 70fi) ol Division 3 ofthe Busincss ild <br />Professions Code) or that hc or she is exempt therefrotu and tlE balis for tlt alleged exenption. Ary violation ofsection 7031.5 hy any <br />applicant for a pennil subjecls llt rpplicant to a civil pcnalty of not more than five hundrcd dollars ($500). <br />_1. as o*ncr ol'the prol*(!,. or my employccs with wages as thcir slc comfEnsdion, willdo Orc work ard the stM@ is mt <br />intcrxlcd oroffcredforslc(Scc.7(X4,BusincssandPrcfessionsCodc:TheContEclor'sLfucnr[rwd@snolapplytomowrcrof <br />tlEpmFEdy wlnboildsorhproEstlMsqandwlrcdmsuchsorkhimselforlEr*lforttuoughhisorherownenrployees, <br />providcd that such impovemnts dc not intcodcd or ol'fercd lor slc. Il. howe v6, thc builditrS o! irpmvcrrcnl is sld wi0in one }t{ <br />ofconrpldinr, lhe owner Buildcr will hdve thc burdcn ofpmviilS llut lE or she did nd build or imprcve lh. pmpeny for lhc purposc of <br />sle). <br />_1. ss owncr of (hc prupclly, um cxclusively con(racting with liccnEd con(ractoB (o conslrucl lha prcjcct (Se. 7044, Busircrs <br />arxl Proltscbn Code: The Conlractor's License Law d@s not apply to an owrer of prolEny who builds or inrproves thereon. <br />and who contracls for such prejccts with a ConlEcto(s) liccnscd pursuet to thc Conkactor's Liccnse kw). <br />-lantcxemptundersecli(nl-,B.&P,C.li,rthisreas0l. <br />lYORK}:RS' C()NI PI'NSATION <br />DECI-ARATION <br />I hcrcby alfirnr undcr pcnalty of pcrjury one oflltc li)lh)wing dccldattr)ns: <br />_lluveMdwill nlaitrlairra(cnilicrteofCoilsentloSell:lnsurelirrworkers'conrpcosation,as providedforhySection3T00ofthe <br />lntnr Cdlc, for t hc pcrfornuncc o I I hc work lirr u'hich I hc pcrmit i\ L\sucd. <br />_l havc aild will mintain workc6' con{tflsalion insumnce, as Equircd by Sdlion 3?00 of thc t bor Codc, for lhc Frcrfomure. of <br />thc work li)r insurancc csicr dl lmlicy numbcr uc: <br />,L <br />"LPolicy <br />-l <br />ccrily Ihrl in thc lrrlirr nrancc' of tlrc wor k f()r which this pcrnrit is issucd, I shall not cn4rloy any lErson i[ any manncr <br />soastotrcoDrcsubjccttolhcworkcrs'cotrrpcnsillionlawsofCalilotrria.andagrccthaliflshouldbccortu'subjccttothc <br />workers' con)lrcDsrtioD provisiotrs of SectioD 1700 of the Labor Cbdc, I shall, fonhwilh coruply with thoc provisious.. <br />WARNING: Failurc to scuc workcrs' @mpcnsation @vcfr8c <br />civil fincs up to onc hundrcd thousnd dollds ($100.000), in <br />is unlawful, aM shall subjcct to qiminal p.mhies and <br />b the cost (,f s providcd for lhc <br />Section 1076 lhc and dk)rNy's lccs. <br />DECLARATION <br />I hcrcby affrm under peoahy of pcrjury tlut I anr liceo*d undcr pruvision ofchaptcr 9 lconnEncin8 with Scction 7000) of Dilision 3 <br />of thc llusincss and Prcfcssions Cod.. arxi my liccnrc is in full fore affl cffccl, <br />LiccDse <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby allirm undcr pcnally ol pcrjury thfl thcrc is a constructi(tn lcnding agency for thc pcrlormance of(hc work lor which this pcrmit is <br />issucd (Scc. 1097. Civ. C.). <br />IJnder's NonE. <br />[.ndcr's Addrcssl <br />APPI,ICANT DI]CI,ARATION <br />I luchy aflirnr undcr pcnalty of pcrjury onc of lhc lirllowing dcclualions: <br />Dcnx,lition Pcrnils-Asbcs(rs Notification Ftdcral RcSulatioos (l'illc 40, Pd6) <br />_Rcquircd Irttcr of Nolificati(,n <br />_l ccflily that lhc lcdcral rcgulations rtgudirS asbcstos removal ilc not applicablc to lhis projcct. <br />-l <br />c!'nily dul I lBvc read tlii applicalion ilxl stalc lhal lhc is corccl. I agrw to conply with all City and Counry <br />ordioeccs ild Statc hws rclaling lo building rcprcsnulives ofthis Cily and County to cots upon the <br />abovc nEntioncd prcpeny for inspcction <br />Applicatrl or Agcnt <br />h1l )KI,IL <br />\L <br />l'crn)ilcc nnnrc <br />md <br />** gl.|ql')ol0 <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq i UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Flouqh <br />Ceilinqs (T-Bar Rouqh) <br />lt/eter Release <br />Rough <br />Service Meter I <br />FINAL 1/t-z^./q^,t') -b h4/ / <br />Notes, Remarks, Elc. / (((-/ <br />ELECTRICAL.INSPECTOR RECORD -- <br />Rev.08-07-2015