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ELECTRICAL.INSPECTOR R ECORD APPROVALS DATE ID/SIG.COMMENTS OWNI',R II IJILDIiR DIiI,CA RATION I lrercby afl-rnr under penalty of perjury tlrat I anr exenrpt fronr the Cbntraclom' License l-aw for the following reason (Scc.7031.5 Busincss and Profc.s.sion Codc): Any City or County which rcquircs a pcrmit to construct, alter. improve. dcmoli.sh or rcpair any structure. prior to its issuance. also requires the applicatrt lbr such Jrernrit to file a signed statement that lr or she is licensed pursuanl to the provisions of thc Contractor's Liccnscd law (Chaptcr 9. Commcncing with Section 70fi) of Division 3 ol'the lJusines.s and Professions Code) or that lrc or she is exenrpl tlrcrefronr arxl tlp basis for tlr alleged exenrptiort. Any violation of Section 7031.5 by any applicant for u lrrrnit sulljects the applicant to a civil pentlty of not more lhan five huntlred dollars ($500). _1. as owncr ol'th profrcrty. or Iny cmpkrvecs with wages as thcir solc comJrcnsation, will do the wcnk and thc stnrclure is rnt interxletl or oflbretl frrr sale (Sec.7044. Business antl Professions Ctxle: The Contractor's Licensc l-aw does not apply to an owner of the pmpefly wlxr builtls or inqnoves tlrre<rn, auxl wlxr does such work himself or lrerself or lhrough his or lur own entployees, providcd that such irnprovcrncnts arc fi)t intcndcd or ollbrcd frrr salc. ll. howevcr. thc building or inprovcrncnt is sold wilhin onc ycar of c<lnrpletioq tlrc Owner Buikler will luve the burtlen of pmving tlut hc or she did not build or impruve tlre pnrpoly for tlr purposc of sale). _1. a.s owner of the propeny, anr exclu.sively contructing with licensed conlractoni to construcl thc project (Sec. 7O14. Busines.s arrd Pnrlbssion Code: The Contractor's License Law dtrcs not apply to an owner of property who builds or intproves thereon. and who c()ntracls lcrr such pro.iccts with a C()ntractor(s) liccnscd pursuant to thc Contractor's Liccnsc [aw). _l anr exenrpt urrder Section-. B. & P.C. tbr this reasotr. Dale: Owner: WORKERS' COTII PENSATION DECLARATION I hereby affirm untlcr pcnalty of pcrjury onc of tltc folkrwing dcclarations: _l have arxt will nninlain a Certilrcate of Consent to Self-lnsure frrr workers' conqreruation, as pnrvided for by Section 3T00 of tlre Latxrr Codc, for thc 5rcrfonnancc of thc work lirr which tlrc Jrcrrrrit is Lssucd. Hxr and will nraintuilr workers'cornpersation ilsurunce, as requirrd by Section lbr which tlis ;rrrnit is issucrl. My workcrs' conrlrcrt.sation insurartcc can'icr " ,t/orG u, t.l tte, 3700 of the Latxrr Grde, for lhe perfontunce of axl Jnlicy nunrhcr arc: 3l'olicy i t _l ccrrily that in thc lrrlornuncc of tlrc work for which this prnrit is issucd. I shall not cnrploy any pcrson in any manncr so as to bcconr subjcct to thc rvorkers'conrpcn.saliorr laws of California. and agrce that if I stnuld bccotnc subjcct to thc workers' corrrpensatiorr pmvisions of Section 3700 of the Labor Cotle, I slrall. forthwith conrply with WARNTNG: I;ailure to secure workers' compensution coverage is slrall to criminal lrnaltie.s irntl civil fines up t(, oue hurrdred tlrousattd dollars ($1ffi.([]O1. itt cost of tirr lhe Scction 3076 ottho [atxrrEodc. rle,e: q lolral^r intcrcst and atlornc'y's l'ccs. a t( I hercby affrnr untler penalty of perjury that of thc Business and Pmfessions Cotle. and DI'CI,ARA'I'ION I anr licensed under provisiort of Chapter rnv license is in lull lirrce atrd efifect. 9 (conrnrncing with Section 7000) of Division 3 \ aa t.ILicense ,. Date: CONSTRUCTION LENDING AGENCY I hcrcby al'lirrn undcr p*nalty ol'pcrjurv that thcrc is a construction lcnding agcncy for thc pcrl'ormancc of the work lirr which this permit is issued (Sec. 3097. Cir'. C.). I-elrder's Nirnrc: l-erxler's Addrcss: APPI,ICANT DECI,ARATION I htcby allimr untlc'r lxnalty of pcrjury onc of thc firllowing dcclarations: Dcnxrlition Pcrnrits-Ashc'stos Nr[ification Fctlcral Rcgulations ('titlc 40. Part6) -Rcquirctl Lcttcr o[ Ntxification _l ccrtily that thc l'cdcral rcgulations rcgarding a.shcstos rcrnol'al arc not applicablc to lhis projcct. fficcrtity tlrat I luvc rcart this applicati.n axl state atxrvc witlr all City and Counly ordinanccs and Statc Laws rclating to building th: ahlve rrrcntioned propcrlv lrrr irrspection Aplllicant or Agent Pcrnritce nonle and ol'this and County entcr D 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 Bondinq I Groundinq I UFER Transformers Torqueincl Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Wdls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rough) ltleter Release Rough Service N/eter t I FINAL lt q\u DA.TV/ Notes, Remarks, Etc.\ --Il