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ELECTRICAL-I NSPECTOR RECORD <br />n nQ n-7 ?n{ s, <br />APPROVALS DATE !D/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hoeby aflim unds peralty of pqjury that I m cxcmpt from thc ContractoE' Licosc taw for the following rcn (Se.7031.5 <br />Busins ild hofsion Code): Any City or County which rcquirs a pomh to @Etruct. altq. improvg dcmolish or rcpeir uy <br />slructue, prior to its issumcc. also requirG the applicant for such pcnnit to filc a sigocd stat@@t that hc or shc is licmcd plltrml <br />to the previsions of tlrc Contractor's Licenred Law (Chapts 9. Commmcing rvith S6tion 7000 of Division 3 of thc Buins ud <br />Prcfcssions Codc) or that h€ or shc is exmpt thqefrom ild thc b6sis for the allcgcd cxoption. Any violstior of Selion 7031.5 by 8ny <br />applicant for a pmit subjats the applicant to a civil pcnahy of not more thil fivc hundrcd dollus ($500). <br />-_ l. as owner of the p,roperty. or my employees with rvages as their sole compensation. s,illdo the rvork and the structure is not <br />intended or offered for sale (Sec.7M4. Business and hofessions Code: The Contraclor's Liccnse law does not apply to an onner of <br />the property who builds or improves thereon. and rvho does such rvork hirnself or herself or through his or her orvn employees. <br />provided that such intprovanents are not intendod or ofFerqJ for sale. !f,, horvever. the building or improvernent is sold within one year <br />of completion. the Owncr Builder rvill have the burden of proving that he or she did not build or improve the propoty for the purpose of <br />sale). <br />---_1. as owner of the propefly. am exclusively contracting rvith licensed contractors to construct the project (Sec. 7044. Business <br />and [tofcssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. <br />and u'ho contracls for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License Larv). <br />_l am exetnpt under Section_. B. & P.C. for this reason. <br />I l.r r.'.0n'ner: <br />I hereby alfirm under penalty of perjury one of the following declarations: <br />-l <br />have and will maintain a Certilicate of Consent to Self-lnsure for rvorkers' cornpensation. as provided for by Section 3700 of the <br />Labor Code. for the perfonnance of the work for rvhich the pennit is issued. <br />'0m*Code. for the pei'formance of <br />are: <br />&Expires: <br />-l <br />certify that in the Srcrforrnance of the work for rvhich this perrnit is issucd. I shall not employ any pcrson in any manner <br />so as to be<ome subject to the rvorkers' compensation larvs of California. and agree that if I should become subject to the <br />workers' compensation provisions of Section .3700 of the Labor Code. I shall. forrhwith comply with thosc provisions.. <br />WARNING: Failure to secure rvorkers' compensation coverage is unlan'ful. and shall subject an onployer to crirninal penalties and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of cornpensation. damages as provided for the <br />Section of the Code. interest and attorney's fees. <br />S <br />DECI,ARATION <br />I hereby allinn under pcnalty of pcrjury that I arn licensed under provision of Chapter 9 (commencing rvith Section 7000) of Division 3 <br />of the Business and Prolessions Code. and my license is in full force and effect. <br />License o _License <br />t <br />CONSTRUCTION LENDING AGENCY <br />I heeby aflinn unda pcnalty of pcrjury thtt th6c is a comtruction loding agocy for thc pofotmcc of thc work for which this pcrmit b <br />issued (Se. 3097. Civ. C.). <br />kndc's Name: <br />l,ender's Address: <br />APPLICANT DECLARATION <br />I h:reby affirm under penalty of perjury one of the follorving declarations: <br />Dernolition Pcrmits-Asbestos Notification Federal Regulations (Title 40. Part6) <br />_Required Letter of Notification <br />_l cfiiry thal thc fcdcral regulatioro rcgarding obctos rmoval re not applicable to this prcjcr. <br />--l <br />cqtiry that I havc rcad this application md statcthat thc above infomtion is conEct. I agrc to comply with all City md County <br />ordinancG ild Statc [iws rclating to building co$tructioil ild h€rcby authorirc reprffitalivG of this City ud County to mtq upon thc <br />above mentioned property for <br />Applicnnt or Agent <br />Perlnilee nR me (print): <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltase <br />Fire Alarm lDampers <br />Communications Cable <br />Building <br />Under SIab / Floor <br />Bonding I Groundins / UFER / q-q -zd fLc At-7 <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilings (Hard & Soffit Roush <br />Ceilings (T-Bar Rough) <br />Meter Release /-21- zd Z. zrl <br />Rough <br />Service Meter /-21 -za Bc-z\ <br />FINAL Z-f-Ztta 2e/et teru> I t7 <br />Notes, Remarks, Etc. <br />\$+ <br />_ ** rt/o.o/t 1