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APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor btWk:Bondinq I Groundina I UFER ?tur ) Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) N/eter Release 711 u)Drrtr-fr t Rouqh Service Meter It I ./ FINAL 7'Dtrw o'7 Notes, Remarks, Etc I I / OWNIi,R BUII,DER DTiLCARATION I hereby affrnr unrler penatty of perjury that I anr erempt frunr the Contractons' License l-aw for the following reason (Sec.7031.5 ; Busincss and Prol'ession Codc): Any City or County which requircs a permit to construct, alter. improvc, demolish or repair any structure, prior to its issuance. also requires the applicant ftrr such pernrit to file a signed staterEnt that lr or she is licenscd pursuant to the provisions of thc Contractor's l.iccnscd law (Chapter 9. Commencing with Section 7000 of Division 3 of the Busincss and ' Professions Code) or that he or she is exenrpt therefrom and tlre basis for tlre alleged exenption. Any violation of Section 7031.5 by any applicant for a pennit subjects the applicant to a civil penalty of not nrore than five hundred dollars ($500). _1. as owncr ol'thc propcrty. or tny crnployees with wagcs as thcir sole compcnsation, willdo the work and the stnrcture is not interxlcd or offered frrr sale (Sec.7Ua. Business and Profe.ssions Code: The Contractor's Licensc l-aw docs not apply to an owncr of the property who builds or improves thereorr, and wlro does such work himself or hrself or through his or her own entployees, provided that such irnprovcrrcnts arc not intendcd or offercd tor sah. Il. howcvcr, Orc building or irprovcment is soH within onc ycar of completion, the Owrcr Builtler will hnve the burden of proving that hc or she did not build or improve tlrc prcperty for thc puqposc of sale). _1. as owner of thc property, um exclusively contracting with licenscd contractoni to construct thc project (Sec. 7044. Business arxl Protbssion CorJe: The Contractor's License Law does not apply to an owner of property wh<l builds or improves thereon, and who conuacts for such projccts wilh a Contractor(s) liccnsed pursuant to thc Conuactor's License l-aw). -IantexemptunderSectiott-,B'&P.C.fbrtlrisreason. WORKI,RS' COTIT PE,NSATION DECLARATION I hercby affirm undcr pcnalty of pcrjury onc of tltc lbllowing dcclarations: _l have and will nuintafur a Certilicate of Consent to Self-lnsure for workers' conrpensation, as provided for by Scction 3700 of the Labor Code, for thc pcrforrnarrcc of the work for which thc pcrmit is issucd. /.' I have and will nraintain workers'cotupemation insuratrce. as by Section 3700 of the labor Code, for lhe Jrcrfornutrce of thc work tbr which this prnrit is issucd. My workcrs'carricr ruxl plicy nunrbcr arc: a7/za/z LPolicy _l ccrrify that in thc;rcrfornuncc of thc work fcrr which this prmit is issued, I shall not cnrploy any pcrson in any manncr .so as lo bccorne subject to thc workcrs' cotnpensation laws of California. and agrec that if I should becorre subject to lhc workers' conrpensation provisions of Section 3700 of the Labor Cotle, I shall, forthwith comply wilh those provisions.. WARNTNG: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal pcnalties and civil firrcs up Io one hulrdred thousand dollars ($100.000). in additiorr to tlrc cost of comgrcnsation, danrages as provided for the Section 3076 of the labor Code, interest and attorncy's [ces. I hereby affirm under penalty of perjury that of the Busincss and Professions Code. alxl LICENSED CONTRACTOR I)ECI,ARATION I anr licensed under prcvision of Chapter 9 (conmrcncing with Secti<rn 7000) of Division 3 my license is in full forcc arxl effect. License Nunrber: l/ CONSTRUCTTON LENDING AGENCY I hcrcby aftirm undcr penalty of pcrjury that therc is a construction lcnding agency for thc perl'ormance of thc work lbr which this pcrmit is issucd (Sec. 3097. Civ. C.). Lender's Nanre: APPT,ICANT DECI,ARATION I hreby affirnr undc'r pcnalty of pcrjury onc of thc following doclarations: Dcnxrlition Pcrnilts-Ashcstos Notification Fcderal Rcgulations (Titlc 40, Part6) -Rcquircd l-cttcr of Notifrcation _l ccrtily that thc fcdcral rcgulalions rcgarding asbcstos rcmoval arc not applicablc to this projc.cl. IZ/l "otyrhat I havc rcad this application utd statc tlut with all City and County and County to cnter upon thc abovc rncntioned property for inspcction Applicant or Agent ll IIlcrmilee nanre ^n ir f ,L/zc ELECTRICAL-INSPECTOR RECORD 'e'I1,1-l v A rrrrlir':rnl:\A), ordinanccs and Statc [,aws rclating to building