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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hreby affrm unda penalty of pcrjury that I m cxcmpt from the (t ntracloE' Licemc law for th€ following tl&n (56.703I.5 Busines md hofcsion Codc): Any City or County which require a po-mh lo construct. altq. improvc, dctnolish or rcpair ay structuc. prior to its issuocc. also requirc thc applicilt for such pemit to file a signcd ststmot that h€ or she is licmsd pmuilt to the prcvisions of thc Contrsctor's Licenscd kw (Chapto 9. Commmcing rvith Sction 7000 of Division 3 of thc Busitrs md Prof6sionsCode)orthatheorshcisexemptth6efromildthcbasisfortheallegedcxmptiotr. AnyviolationofSstiotrT03l.5byuy applicantforapcmitsubjGtsthc applicaniioacivilpenallyofnotmorethilfivehun&cddolltrs($500). _1. as owner of the property. or my employecs with rvages as their rcle compensation. will do the work and the structure is not intended or offered for sale (Soc.7M4. Business and hofessions Code: l'he Contractor's l,icense Law does not apply to an owner of the property who builds or imptoves thereon. and who does such work himself or herself or through his or her own employees. provided that such irnprovanents are not intended or off€red for sale. lf. horve!/er. the building or improvement is sold rvithin one ),Ear of conrpletion. the Orvner Builder will have the burden of proving thd he or she did not build or impnove the propoty for the purpose of sale). _1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Proftssion Code: The Contractor's License Larv does not apply to an owner of property who builds or improves thereon. and n'ho contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License l-aw). _ __ I arn exenrpt under Section_B. & P.C. for this reason. I)ale:Orr rtcr: DECLARAI'ION I hcrcby alTirm undcr penalty of pojury one of the follorving derlarations: -,_l have and rvill rnaintain a Certificate of Consent to Self-lnsure for rvorkers' compensation. as provided for by Section 3700 of the Labor Code. for the performance of the rvork for rvhich thc permit is issuerJ. _ _l have and rvill rnaintain workers' compensation insurance. as required hy Section 3700 of the Labor Code, for the perfonnance of the work for which this pennit is issued. My rvorkers' compensation insurance c.urier and plicy number are: r/l+(+ I'olicy -Expir€s: )l'rll 7D _l ccrri$r that in the perfonnance of the n'ork for u'hich this permit is issued. I shall not onploy any person in any manner so as to becomc subjcrt to the workers'compensation larvs of ('alifornia. and agree that if I should bccome subject to thc workers' compensation provisions of Section -j700 of the Labor Code. I shall. forthwith comply with those provisions.. WARNING: Failure to secure rvorkers' civil fines up to one hundred thousand Section -3076 of the Labor Code. interest conrpensation and dollars ($l the and ("I e I hereby allirm under penalty of perjury that I zun licensed under provision of Chapter 9 (cornrnancing with Section 7000) of Division -l of the Business and Professions Code. and rny license is in full force and effc<t. ) \b7 loLiccnseNumbcr: ,L rq t CONSTRUCTION LENDTNC AGENCY I hwby affrm undo perulty of pqjury that th6c is a construction lqding agocy for thc pofomilcc of the work for which this p6mit is issued (Sc. 3097. Civ. C.). Lender's Name: Lenclcr's Addless: APPLICANT DECLARATION I herdry affinn under penalty of perjury one of the follorving declarations: Dernolition Permits-Asbestos Notihcation Federal Regulations (Title 40. Part6) -Required Lettcr of Notification _l certify that the federal regulations regarding asbestos removalare nol applicable to this project. that with all City and County and County to ent€r u;xln the above mentioned propeity for Applicant or Agcnl Pernrilec nRme qttf (*_. 'ur[<fl*- Site-Work Underground 2 l9 4 U[, buohq 0 ?oan-&u/. Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm I Dampers Communications Cable Building rl lra,/ Under .Slab / Floor fr Bonding l)Groundins / UFER lultY tq "l - Wr^rotffu ha, t>ffiers r'f l-l Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Rouqh Ceilings (T-Bar Rough) l\4eter Release Rough Service Meter t t FINAL l-\\'l'5','lr0 DM V ,xYl Notes, Remarks, Etc.I I -c C)^'. nQ fl? 1n'ttr .t rY I and State l,arvs relating to building Drte: \ 1'/ <tl