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ELECTR!CAL.INSPECTOR RECORD <br />Bev.08-07-2015 <br />APPROVALS DATE ID/SIG.COMMENTS OWNI]R BUII,DI]R DI]I,CARATION <br />I hcrcby affirnr uilcr penalry of pcrjury thal I dn excmpl frcm thc Contractos' Licensc l:w for thc following rca$n (5(.7031.5 <br />Business and Profcssion Codc): Any City or County which requires a pcrmil to construct, altcr, improve. demlish or rcpair my <br />structurc. prior to its issuanac, also rcquires thc applicail for sucl Fmit to filc a sigftd slatemnt that ha or stE b liccred pursatrl <br />lo rhc pmvisions of thc Contractor's l-kenscd Irw (Chaptcr 9. Commencing wilh Section 7UJ0 ot Division 3 of thc Busincss and <br />PmfessionsCode)orthatlEorsheisexempttherefromandtlebatisfortlpalle8edcremp(ion. AnyviolalionofsElionT03l.5byany <br />opplicatrt tor u pcnnit subjccts the npplicant to a civil penaliy of not mr. than fivc hundrcd dollars ($500). <br />_1. as osncr ol lhe prclt(y. or nry crnployccs with wages as lhcir solc compcnsation, will do thc work and thc stretw is mt <br />ilxcndql or offcred for salc (Se.7(X4. Business and Prcfcssions Codc: Thc Contractot s Liccnrc l:w des not apply to m ownc, o[ <br />thepofEny wlDhilildsorimprovesthcrd)Gudwlpde3suchworkhimselforlErselforthroughhisorherownenlployees, <br />providcd rhal such improvcmnts dc ml intcndcd or olfcrcd for slc. ll. howcve!, OE building or itrprovemnt is sld withio onc ycd <br />ofcorphio[ rhe Owner Builder will havc the burdcn ofpmvinS lhd he or shc did mt bsill or imprcvc 0r prcpary fo. thc purpos of <br />sxld). <br />_1, as owner of the prcpcny, am cxclusivcly contracting with liccnpd contracloN to construcl llE pojact (Scc. 7014. Busirc$ <br />arxl Pfi)t!.rsionCode:TheContracrrr'sLicenseLawdcsnotapplytomowrcrofpropenywhobuildsoriDrprovesthereon. <br />and who conlncls for such pr(,jccts with a Conlracbr(s) liccNd pursuet to thc Contretor's Licensc Law). <br />-lanrexenrptundcrSectio[-,B.&P.c,lbrtbisreasoil.l)atc:_ <br />WORKI],RS' COMPENSA'I'ION <br />DECLARATION <br />I hcrcby allirD undcr pcnalty of pcrjury onc ol'lhc folhu in8 dccltrationsi <br />_t havc alxl will nEintain a Ce(ificatc of Conscnt to S.lf-lnsurc for workcrs'mmlrcnsdion, o povidcd for bySdtion 3?00 of thc <br />tabor Code, for the lErfonlr4e of thc work for which thc pcrmil is issued. <br />_l have aDd will nuintain workcrs' conpcNalion insurancc, as rcqutcd by Scction 3700 of thc trbor Codc, for lhe [ErfoI1mc of <br />thc work for wltch rhis Frnit is issucd. My worlss'comlENation iNuuce coicr dd polhy numbcr se: <br />Policy <br />_l ccnify that in thc prlor nrancc of thc work for which this pcrmit is issucd, I shall not cnpk)y any lErson in dy mdncr <br />s as to bccolm subjccl lo thc workcrs' coilrpen$tion laws o[ California. and agrcc that if I should bccorc subjcct to thc <br />Norkers' co,rpensatioil prori!ion$ of Seclion 3?00 of the kbor Code, I shall, fonhwith conply wilh tho* provisions.. <br />WARNING: Failur. to *curc workcrs'compcnsltion covcdSc is unlawful. and shall subjcct dn cmploycr to diminal pcmltics and <br />civil I'ines up ro otre hundrcd thousand dollars ($100.000). in addition to lhc cost of compcNalion, danEges ro providcd for thc <br />Scclion 3076 of thc titbr Codc. intcrcst and iltorrcy s fees. <br />Dste:- <br />USENSIB-CONI8dCIOB <br />DI'CI-ARATION <br />I hcrcby affrm undcr pcDahy of pcrjury tlral I anr licensd undcr prcvision ofChaptcr I (comnEncing with Scction 7000) of Divi$ion 3 <br />of lhe Bu$iness and Prcfcssions Codc, and my licensc is in full fore md effect. <br />Liccnre Nun)ber: <br />Dste <br />- <br />Contlactor' <br />W <br />I hercby afllrm undcr pcnalty ot pcrjury thd thffe is a construclion lending agcrcy for the pcrlbrmrce ofthc qork lor which this permit is <br />is$ucd (scc. 3097. civ. C.). <br />lindcr's Namc: <br />Irnd.r's Addrcs\: <br />@LPE!,ARA'I.!AN <br />I h6cby affrnrundcr pcnalty of pcrju.y onc ofthe following delarationsl <br />Dennlition Pcrmits-Ashcsk)s Notification Fcdcral Rc8ulations (Titlc 40, Pd6) <br />_Rcquircd l.ttcr of Notifi cation <br />_l ccnili that thc fcdcralrcgulalions reSdding a\bcshs rcrmvaltrc nol applicablc to this projcct. <br />_I cc(iti that I luvc rcarl this applicali(D and stalc that lhc atx)ve infornulion is corect. I agre to conply with all City and County <br />ordinances and Statc liws rclaling to building conshctio[ and hcrcby authorizc rcprcscntalivcs oflhis City ud County to cntfi upon thc <br />rbovc nrcnlioncd prcpeny k)r inspection purposs. <br />Applicanl or Agcnt D[lc- <br />Pcmrilec nanlc lprinl): <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 />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Grounding / UFER <br />Transtormers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouoh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />[\tleter Release <br />Rouqh <br />Service lVleter <br />FINAL l^-10 -7:t "lulllNotes, Remarks, Etc. <br />/\il\ <br />t <br />I