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APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Groundins I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factorv Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinss (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rouoh <br />l')Service Meter t bfldr 5YFINALtlv\4n <br />Notes, Remarks, Etc.ll <br />OWNT'R B UII,DER DEI,CARATION <br />I hcreby affirnr under penalty of perjury that I arn exenlpt frorn the Contractors' Licerse l-aw for the following rcason (Scc.7031.5 <br />Busincss and Profcssion Codc): Any City or County which rcquircs a permit to construct, alter. improvc, demolish or rcpair any <br />structure, prior to its issuance. also requires the applicant for such pernrit to file a signed slaternenl that h or strc is licenscd pursuanl <br />to thc pmvisions of the Contractor's l-icenscd I:w (Chapter 9. Commencing with Section 7000 of Division 3 of the Busincss and <br />Professions Code) or that lre or she is exempt therefronr and the basis for tlrc alleged exenption. Any violation of Section 7031 .5 by any <br />applicant for a pennit subjects thc applicant to a civil penalty of not more than five hundred dollars ($500). <br />_1. as owner ol'thc propcrty. or my ernployccs with wagcs as their solc compensation, willdo the work and thc structure is not <br />interxled or offered for sale (Scc.7(Xa. Business and Profcssions Cotle: Thc Contractor's Liccnsc Law tloes not apply to an owner of <br />thc pruperty who builds or improves thcreoru and wlro dtrcs such work hirnself or lrerself or through his or her own entployees, <br />providcd that such improverncnts arc not intendcd or ollered for sale. Il. however. thc building or irprovermnt is sold within onc ycar <br />of completior\ thc Owrrr Buiklcr will havc the burden of proving tlru he or she did not builtl or improve thc propcrty for thc purposc of <br />sale). <br />-1. <br />as owncr of the property, am exclusively contracting with licensed Business <br />and hufcsklrr Code: The Cotttractor's License Law dtrs not to lhereolr. <br />and who contracts for such projccts with a <br />-I \ <br />I hcreby affirm under grcnalty of perjury one of the <br />_l have and will nraintah a Certilicatc of Consent to Self-lrrsure f<rr workers' compensation, as provided for by Scction 3700 of the <br />l-abor Codc, for thc Jrcrforrrancc of thc work for which the pennit is issued. <br />_l have and will nraintain workers'conrpensalion insurarrce, as re<luired by Seclion 3700 of the l-abor Code, for the perfontunce of <br />the work for which this prmit is issucd. My workers' compensation insurance carrier and Sxllicy number are: <br />Policy Number: Expires: <br />_l ccrtify that in tlrc pcrfornurncc of thc work f<rr which this grcrmit is issued, I shall not cnploy any pcrson in any mannet <br />so as lo bcconrc subjcct to thc workcrs' compcnsation laws of California. and agree that if I should bccorne subject to the <br />workers' conrlrnsation provisions of Section 37fi) of the Labor Ctxle, I shall, forthwith conrply with thosc provisions.. <br />I <br />WARNING: Failure lo secure workers'shall subject an cmploycr to oirninal pcnalties and <br />civil fines up to hurdred thousand of compcnsalian, danrages as proviled for the <br />Scction intercst and <br />I hcreby affrnr under pnalty of perjury that I anr licensctl 9 (comnrcncing with Section 7000) of Division 3 <br />of the Busincss and Professions Code. and my license is in full forcc arxl effect. <br />License Class: Liccnsc Number: <br />CONSTRUCTION LENDTNG AGENCY <br />I hcrcby affirm undcr pcnalty of pcrjury that thcrc is a construction tcnding agency for the pc-rformance of thc work for which this permit is <br />issucd (Scc. 3097. Civ. C.). <br />[.cnder's Name: <br />APPI,ICANT DECLARATION <br />I hrchy zrffrm under Jrcnalty of pcrjury one of thc foll<lwing dc.clarations: <br />Dcnxrlition Pcrmits-Ashe'stos Notification Fedcral Rcgulations (Title 40, Part6) <br />-Rcquircd <br />l-ctter of Notification <br />-l <br />certily that thc fcdcral rcgulations arc not applicable to this proict. <br />( <br />I ccrrity that I havc rcad this County <br />above nrcnti<lned <br />Applicant or Agent <br />7 <br />I)crnrilcc <br />thc ahlvcrilfornrat ion all <br />upon thc <br />ELECTRICAL.INSPECTOR RECORD <br />\ <br />-20 <br />who <br />representatives of this