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