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APPROVALS DATE ID/SIG.COMMENTS OWNE,R BI.JIT,DER DEI,CARATION <br />I hcrcby affrm undcr penalty of pciury that I mr cxcmpl frcm lhc Contractos' Licens hw for thc following rca$n (Sd.7031.5 <br />Business atd Profcssion Codc): Any City or County which rcquires a pcrmit to construct, alts. improve. dcmlish or rcpair dy <br />structurc, Jrior h irs Lssuance. also rcquires the applicmt for such p€mtt to fih a sigred slatcmnt lhat lE or stE ii lic.Nd pu$ml <br />to the pmvisions of thc Contractor's l,iccnsed [2w (Chaptcr 9, Commcncing wilh Scction 7fiD of Division 3 of thc Busincss md <br />ProfessiotrsCode)orthathcorsheiscxenrpttherefiomandtlEbasisfortlEallesedexenrption. A[yviolationofsectionT03l.5byany <br />applicant for o pcnnit subjects thc .pplicnnt to a civil pcnalty oI not mre than fivc hundrcd dollars ($500). <br />_1. s owner ol thc profEny. or my (anphyccs wilh wagcs as thcir Flc @mpcnsation. will do 0r wtrk ard thc tum is mt <br />intcnhl o. ofTcrcd for slc (Se.7014. Busincss md Profcssions Codc: Thc Coiltaclor's Liccn* law rlrcs not apply to m owrcr of <br />thcprofEny wlrcbuildsorinprovestheN)[iudwlDd6srchworkhimelforlrrselforthrcughhisoaherownenploy*3, <br />providcd rhat such imprcvcmnts dc rel inlerded or ollcrcd for sk. Il, howcver, Or building or in{'rorcmil is eld within onc )ed <br />ofcotrpletion, thc Owrcr Buillcr will havc thc burdcn ofprcving tht he or shc did not boild or impmvc thc prcpay for thc purgrse of <br />sak). <br />_1, s own r of (hc propeny, am cxclusively conuacting with lic.Md contr.ctoB to conshct th. prcjcct (Scc. 7044. Busincs <br />and ProfesinCodc: TheContractor'sLicetrseLawdesnotapplyto4owrerofprolEdywhobuildsorimprovesth.r@n. <br />and who contracrs for such proFcts with a Coiltuto(s) liccred pus@( to thc Cotuador's Liccnsc llw). <br />-I <br />amexenril uildcr Section-, B. & P.C. tbr this reason. <br />EABtrEESTAMPJNSAIII}N <br />DECLARATION <br />I hcreby ailirm under pcnaltyofperjury ore ofthe foUowitrg dcclea(ioN: <br />_lhaveatdwillnEinlainaCenificateofConscnttoS.lf-lmurcforvorkds'conrpcNation,as providedforbyScction3?00ofthe <br />tabor Code, for thc pcrforlMce of lhc work lbr which (he J,ermit i! issued. <br />_l havc and will mintain workcs' con{rcEalion insurarrcc, as Gquircd by Stclion 3700 of lhc bbor Codc, for lhc pafomlmc of <br />thc work for wlich this pcrmit is issuc{- My workss' @r{ENdion itrumc wicr aod policy oumber uc: <br />f ^*r-. <br />Policy Numbc.: l;xpires: <br />.a <br />1-] ccnify that rn tlrc [rrfornunc('r,f rhc work for whrch this fcrmit is issucd. I shall not cmploy my fErson in my milncr <br />s 6 to becorE subject to lhc workcrs' compcnsation laws of Califomia. aM agrcc thrt if I slnuld becorE subjecl to thc <br />workers'comlrnsationprcvisioroofSctrionlT00ofthckborCod.,lslull,fonhwithcomplywiththosprcvisbns., <br />WARNING: Failurc lo securc wo'kers'conpensation coveftlge is unlawful, xDd shall $ubjcct nn employer to girninal pcnalti€s flnd <br />civil firresupk)onelruildredth(Nsanddollnrs($100.UJ0).iDadditiorbllEcostofcompensaliur,danugesasprovidedfbrtlre <br />Scction 3076 oflhc hhor Codc, iolcrcsl and atlorrcy's ltcs. <br />-\9-/oac <br />DI]CI,ARATION <br />I hereby affirDr undcr lrenaltyofperjury thal I am licensed undcr pruvision ofChaplcr 9 (coomEncins with Secrion 7000) ofDivision 3 <br />of the Busincss and l'rofessions Codc. and rny license is in full force md cffect. <br />Li""*" ct"*,fuLiccmc Numbcr:I D-ZO r+oo <br />-l 'L0 (l <br />CONSTRUCTION LENDING AGENCY <br />I hcreby allirm undcr pcnally ofpcrjury thar thcrc is a construction bnding agcrcy for the pqlormarcc of thc work lbr which this pefrit is <br />issued (Sec. 3097. civ. C.). <br />Lenilcr's Nanrc: <br />- <br />lrnder's Ad,.lres\: <br />APPI,ICANT DECI,ARATION <br />I hurby afiimrundcr Jxnalty ofpcrjury orc of thc folbwiog d(ldations: <br />Dcnnlition Pernits-Asbcslos Notification Fcderal Rcgulatt)ns (Title ,+0, Pfi6) <br />_Rcquircd l*tlcr ()f Notilicati()n <br />I cdily that rhc fcdcral rcgulalioos .cgdding asbcstos rclreval {c no( applicablc to (his prcj@t. <br />| )ll mrfy rlur I luvc rcad tlus application dxl stalc llBl thc atDvc infornBlion is colm. I agre to conlply with all Cily and County <br />ordinmccs ud Starc [jw$ rclating to building consmction, arxl hcrcby autlprizc rcprc*Mtives of lhis City and Couoty (o cnlq upon thc <br />abovc rrcntioncd prupcny for inspection <br />Applicant or Agent <br />I'cmlilec tranra {r^ crJ <br />1",Lo <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Gommunications Cable <br />Buildinq <br />Under Slab / Floor /n\ <br />Bondinq / Grounding / UFER 3*t (-fu x.vlll{"n <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 Rouqh -A <br />Ceilinqs (T-Bar Rouqh)1/\ <br />ltleter Release 3"l-Zl k"u-)il <br />Rouqh ,1\ <br />Service lVleter ?24 <br />FINAL E-G20 '4"16 <br />Notes, Remarks, Etc. <br />ELECTRICAL.INSPECTOR RECORD <br />Bev.08-07-2015 <br />Dr.lrjMll