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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 I 'LOBondinq I Groundinq I UFER I 0 t)A,I+-tt Transformers I Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouoh) Ceilings (Hard & Soffit Rouqh Ceilings (T-Bar Roush)I Zt)Meter Release I I pwV'g I I Rouqh Service N/eter ,|,A FINAL 0 -?/:D f,-{r{'b 7 Notes, Remarks, Etc I I hereby affirm under penalty of prjury that I anr exenrpt frorn the Contractos' License [:w for the following reason (Sec.7031.5 Business and Prol'cssion Codc): Any City or County which rcquircs a pcrmit to construct, altcr. irnprovc. dcmolish or rcpair any structure, prior to its issuance. also requires the applicant for such Srernut to file a signed slatement that lre or she ls licenscd pursuant to the pmvisions of thc Contractor's l,iccnscd Law (Chapter 9. Commcncing with Scction 7fiX) of Division 3 of the Business and Pr<lfessions Code) or that lrc or she is exempt therefrom and tlre basis f<lr tlre alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicunt to a civil penalty of not rmre than five hundred dollars ($5tltt). _1, a.s owncr ol'llre propcrty. or my ernployccs with wages as lhcir sole compcnsation, witl do thc work and the stnrcture is not interxlerl or offered for sale (Scc'.7tX+. Business and hofcssions Cotle: The Contractor's License Law does not apply to an owncr of the property wlro builds or inqprorcs thenxrrL arxl who does such work himself or herself or ttuough his or her own entployees, providcd that such improvernents arc ff)t intcndcd or offcrcd for sah. If. howcver. Orc building or inprovcment is sold within onc )car of conpletion, thc Owrcr Buil&r will have the burden of pnrving tlurt hc or she did mt buikl or inrprove thc prupcrty for thc purpose of sahl. _I. as owner of the property, tm exclusively contracting with licenscd contracto$ to construct thc pruject (Sec. 7044, Business and Pnltbssion Code: The Contractor's License Law dtrcs not apply to an owner of property who builds or improves thereon. and who contracts for such prcricts with a Contractor(s) licenscd pursuant to thc Contractor's Liccnsc Law). -I:rnrexenptutxlerSectiott-,B.&P'C.lbrtlilsreason. Date: WORKER.S' COM PT]IISATTON DECLARATION I hereby affirm under pcnalty of perjury onc of the following declarations: _l have and will nmintain a Certilicate of Consent to Self-lnsurc for workers' compensation, as provided for by Section 3700 of the I"abor Code, for the perforrrurrcc of the work lbr which the perrnit b issucd. Ll*"rand will nuintain workers' conqrcmation insurance, as required by Section 3700 of rhe L:bor Code, for the grerfornnnce of thc work for which this g^-rnrit is issuctl. My workcrs' compcnsation insurance carricr arxl nunrbcr uc: o,r" lr>l 6 I lJaT k rk Policy )1l _l ccrtify lhat in thc ;rcrfirrnuncc ol'thc work for which this 1rcrmit is i.ssucd, I shall not employ any pcrson in any rnanncr so as to bccomc subjcct to the workcrs' corrrpcnsation laws of California, and agrec that if I should becornc subjcct to thc workers' cornpensation provisions of Secti<ln 3700 of the Labor Code, I shall, forthwith comply with those provisioru.. WARNING: Failurc to secure workers'compensation coverage is unlaw[ul, and shall subject an employer to criminal penalties and civil lirres up lo one hundrerl thousand dollars (S100.m0). in addition to tlrc cost of compensation, daurages as provided for lhe attorney's DI'CLARATION I hercby affirm under pcnalty of perjury that I anr licensed under provisi<ln of Chapter 9 (conurrcncing with Sectbn 70m) of Division 3 of the Business and Pmfessions Code. and rny license is in full forcc and effect. + LL/ (€QoLicenseNunrber: tio CONSTRUCTTON LENDING AGENCY I hcreby allirm under pcnalty of perjury that therc is a construction hnding agency for thc pcrformance of thc work for which this permit is issued (Sec. 3097, Cir,. C.). Lrnder's Name: [rntler's Address: APPI,ICANT DECI.ARATION I hrcty aftum untlcr pnalty of pcrjury onc of thc following dcclarations: Dcnxrlition Pcrnilts-Asbe'stos Nuification Federal Regulations (Titlc 40, Part6) Rcquircd lrttcr of Notification _l ccrtily that thc fcdcral rcgulations regarding asbestos rcmoval arc not applicablc to this projcct. _l ceaity tlrat I havc rcad this applicalion ad stalc tlral thc ahrvc inlbrmation is corrcct. I agrc.c to conrply with all City antl County ordinanccs and Statc Laws rclating to building construction, arxl hereby authorizc rcprescntativcs of this City and County lo cntcr upon thc akrvc nrcntioned pnrperry for purposes. Applicant or /2o IDcrnrilec nanrc e ELECTRICAL-I NSPECTOR RECOR D t 08-0 -201 l} I n t, Scction 3076