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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/S!G.COMMENTS OWNI'R BUII,DI'R DI),CARATION <br />I hercby aflrn) under penalty of Frjury thrt I dI excmpt from lhc Cbntractoa' Licensc Law for thc following rcasn (Se.7031.5 <br />Business and Prolbssion Codc): Any Ci(y or Counly which rcquircs a [Ermit to construct, alter. ihprovc, demlish or rcpair any <br />structurc, prior lo its issuance. aLso rcquircs llE applicel foa such pcnr)it to filc a siSned stalctrEnt lhst IE or she is licered pur$ail <br />to thc pmvisions of thc Contractor's l-iccnscd I:w (Chaptcr 9, Commencing wilh Section 7000 of Division J of the Business and <br />ProfessionsCode)orthatheorsheiserempttherefiomardtltbasisfortlrcallcgedexenrption. Aryviolatioilofs*tion703l.5byaDy <br />applicantfordpcnnitsubjectsthc ilpplicanttoncivilpchal(yofnotmrcthanlivchundrcddollars($5LU). <br />_1, as owncr o!-lhc prol*try. or rny cmployees with wagcs as thct mlc compensation, willdo thc wotk ard (he stMm ir mt <br />inteilal or o[Iered for sle (Sec.70l4. Busincss and Prcfcssions Codc: Thc Contractor's Liccnsc I:w rl@s nol apply lo an owDcr of <br />the prcftny wlD ttrlilds or irnproves theron, and wlD doei such w)rk himself or lErself or lhrcugh his or her owu enployes, <br />providcd that such improvcrrcnts dc not inerxicd or ollcrcd for salc. Il howcvq, OE boiHing or irTrovcmnt is $ld within orc ycr <br />of conrphtbn, thc Owtrer Buildcr will have the burdcn of prcving lhd lr or shc did mt boi.hl or imprcvc tE pmpdy for llE purpos of <br />sdc). <br />_1. as owner ofthe prcp€ny, om exclusively contractinS with liccnsed contraclors to conslrud lha pmjcct (Scc. 7O14, Business <br />arxl PnrllssinCode:Th€Contrac(,r'sLicenseLawdoesnotapplytoanowncrofpropenywhobuildsorinrprovesthereon. <br />and who conlracts for such projccts wilh a Contractor(s) liccnscd pursuml to thc Contractor's Liccosc [lw). <br />-l <br />m cxempt under Section-, B. & P.C. tbr this rcasoil. <br />E9ESEBS.:EAMIENSAII9N <br />DECI.AEAIIgN <br />I hercby affirm undcr penaltyofpcrjury onc ofthe followinS dccltratiom: <br />_l have srd will nEintaiD a Cenificate of Conscnt to Sclf-lnsurc for workds'Nmpcnsdion, as prcvidcd for bySdtion 3700 of thc <br />lrbor Code, for thc tErfonl@c of thc work for qhich the psmit is issued. <br />_l have and will tlaintain workers c()nrpensation insurance, as rcquired by Scclion 3700 of thc tibor Codc, for lhc [Erfoffie of <br />(hc work for wlich tlis l*rmit is issucd. My workcrs' comlEnsation itrurmcc cdier iuxl plicy numbct ile: <br />Policy Nunrber: tixpircs: <br />_l ccnily lhat ir thc lf,rlinnuncc of tlr work for which this pcrnit is issucd, I shall not cnrploy any Jrcrson in any manncr <br />s &\ to bccom subjccl lo lhc workcrs' cornpcnsntion laws of Califomia. and agrec thal if I should bccorrc subjcct lo the <br />workcrs' conrpensation provisions of Section 3700 of the Labor Code, I slull, fonhwith conrply wilh lho* prcvisions.. <br />WARNING: Failurc to *curc workcrs'compcnsation covcfr8. is unlawful, and shall slbjcct e cmploycr lo Giminul pemlics ud <br />civil fincs up to ole hundrcil thousand dollils ($100.000). in addition to llE cost of compcr&tiol dotsBcs s providcd for lhe <br />Section :1076 otthc Labor Codc, in(ercsl ild atrorrcy's [ccs. <br />Datei- <br />LICENSED CONTRACMR <br />UIiE&AEAIION <br />I hcrcby sfltrnr under pcndlty of pcrjury that I am liccn*d undd prcvision ofChaptcr 9 (coilrmncint wilh Section 7000) of Division 3 <br />of the Busincss and Profcssions Codc. anl mv liccnsc is in full for@ and cftcct. <br />Liccnsc Clus:-Liccnsc Numbcr: <br />W <br />I hercby al-ljrm undcr [rcnally ofpcrjury that thcrc is a construction lcnding agcrcy for the perlbrmarce ofthc work lbr which this permit is <br />issucd (Scc. 3(R7, Civ. C.). <br />knder's Natrrc <br />t hdcr's Addres\: <br />APPI,ICANT DECI,ARATION <br />I lurtry allimrundcr pnalty of pcrjury onc of thc following d@ldations: <br />Dcmolilion Pcrmits-Ash{sk)s Notification Fcdcral Regulati()0s (Tillc 40, Pm6) <br />_Rcquircd btlcr of Notificati(ro <br />_l cenily that lhc tcdcralrcgulatioflr rcgeding asbcslos rcrmval ec nol applicablc to this pmirt. <br />_l ccnify that I luvc rcad this application url slalc tlal lhc abovc inlbmulion is corccl. I agrrc to @nply with all City and County <br />ordinsnccs and Statc kws rcldioE b building consmc(ion, ard hercby autlFrize reprcsntativg ofthis Cily ud County to cnter upon thc <br />abovc rrcntioncd prcpcny for inspcction purpo*s. <br />Appllcsnt or Ag6l SlSnstur: D.te:- <br />Pcmile namc lDrlnll: <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 <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Jr/eter Release <br />Rouqh <br />Service [\Ieter <br />FINAL <br />Notes, Remarks, Etc.