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ELECTRICAL-I NSPECTOR RECOR D APPROVALS DATE ID/SIG.COMMENTS OWNI'R BUII,I)F]R I)I,I,CARATION I lrcreby aflirnr untler penalty of pr.jury tlrat I anr exenryt frorn the Contractoru' License Law for the following reason (Sec.7031.5 Busincss and Prol'cssion Codc): Any Citl,or.Countv which rcquires a 1o-rrnit to construct, allcr. irnprovc. dcmolish or rcpair any structure. prior to its issuance. also requires the applicant lirr such pennit lo frle a sigrrcd slatenrnl that lr or she is licensed pursuanl to thc provisions ol' tlr. Contraclor's l,iccnscd Iaw (Chaptcr 9. Cornmcncing with Scction T(XD ol' l)ivision 3 ol'thc Busincss and Profe.ssions Ctxle) or tlrat lre or slre is exen4rt thereliorn and tlre ba.sis for the alleged exenrptiott. Any violation of Section T0S l .5 by arty applicant for :r lxnnit sutrjects the applicanl to a cil il penalty of not nnre thun five hundred dollars ($5m). _1. a.s owncr ol'thc propcrty. or nty ernpkryccs with wagcs as their solc' cornpcnsation, will do thc work and the structurc is not interxled or offeretl ftrr stle (Sec.7(I14. Business antl Pnrfessiorrs Crxle: The Contraclor's Licensc [-aw does not apply to an owncr of the 1xr;rr1y wlxr builds or in4rroves thererl\ ard wlxr does such work himself or lrcrself or througlt his or her own enrployees, provided that such irnprrvcrncll(s atc not intcndcd or ollbrcd lbr salc. ll. hrwcvcr, tr*h buikling or itnprovctncnt is sold within one ycar of conrpletiorl the Owtrcr Builder will have tlrc burden of pruving tlurt lre or she did rrut buikl or inpnrve the pruperty for thc purpose of sale). _1. as owner o[the propefly, am exclusively contructing with liccn.scd conlraclors to conslruct thc project (Sec. 7tXa. Business arxJ Pnrtession Code: The Contructor's License Law dtxs not apply to an owner of proSrrty who builds or intproves thereon. and who conlmcts lor such pr<rjccts with a Contractor(s) liccnscd pursuant to thc Contraclor's Liccnsc Law). _l am exenlpt under Section-, B. & P.C. tbr tlti.s reason. WORKER.S' COM PENSATION DECLARATION I hcreby allirm undcr pcnalty of perjury onc of the tolkrwing dcclarations: _l have and will nraintain a Certilicate of Consent to Self-lnsurc for workers' conrJrensation, as provided for by Section 3700 of the lahor Codc, for thc Jrcrformancc of the work lor which tlrc perrrrit is issued. _l have antl will nraintain workers' conrperrsation insurance, as rcquired by Section 3700 of the labor Code, for lhe grcrfornutrce of thc work lirr which is issuctl. M1' workcrs'insurancc carricr;uxl Jxllicy rtumbcr arc: {.1 wPolicy _l ccrrity that in thc grrtirrnuncc of thc work frrr whiclr this pcrrnit is issucd, I shall not cntploy any pcrson in any nlanncr so astobccorncsubjccttothcworkcrs'conrpcnsirtionlawsofCalifornia.andagrccthatif lshouldbccolrrsubjccttothc workers' conrlrnsation pu'isiorrs of Section 3700 of the Labor Code, I slurll, forthwith contply with thosc provisions..I WARNING: Failure lo secure workers' cornlrcnsation coverage is and shall subject an employer to crirninul penaltie.s and cornpensation. datnages as provided fttr lhecivil fines up to orrc hundred thrusand dollars (S100.Q01. in the cosl o[ .Sc'ction 307(r of thc Lalxrr Ctxlc. intr'rcst an(l l'ccs. I hcrcby affinu under Jrnalty of perjury that I arrr licerr:cd under provision of Chapter 9 (cotrmrncing with Section 7firu) of Division 3 of the Business and l)rofessiorrs Code. arxl nrv license is in full fitrrce and License I hcrcby al'lirrn undcr 1*-nalty of pcrjury that thcrc is a construction lending agcncy for thc pcrl'orrnance o[ the work lbr which this pcrmit Ls issued (Sec. 3097. Civ. C.). knder's Nanrc: lrttder's Adtlress: A PPI,ICANT DECI,A RATION I trrrhy aflirnr undcr lxnalty of pcrjury onc rtf thc ltrlkrwing dc'cku'ations: Dcnxrlition Pcrnilts-Asht'stos Ntxification Fcdcral Rcgulations (Tillc 40, Parr6) _Rcquircd Lcttcr of Notificatkrn _l ccrtily lhat thc l'cdcral rcgulations rcgiuding astrcslos rcmoval ruc nol applicablc to this projcct. tlrat thc ahrvc infrrrnralion is con'cct. I agrcc to conrply with all City antl Couttty arxl hcrcby auttxrrizc reprcscntativcs o[ this City and County to entcr upon thc atxrve nrcntioned properry for r\llplicant or Agrnt ttl Ltr(T Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under SIab / Floor Bondinq I Groundinq I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) N/eter Release Rough Service N/eter I -?/FINAL h'12'aa vvbdto p6\ Notes, Remarks, Etc. D*", {€)?T\ *n fQV(V