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ELECTRICAL.I NSPECTOR RECORD Hl"r', nA ^7 1/'t,tG, APPROVALS DATE ID/SIG,COMMENTS OWNER BUILDER DELCARATION I hoeby affirm undr pmalty of pojury that I on excmpt from thc Contraclorc' Licme Law for the following rcmn (Se.7031.5 Busines md Profeion Codc): Any City or County which rcquirc a pornit to comlruct. alta. improva danolish or rcpair uj structurq prior to its isuocc. also rcquiro the applicant for such pemit to filc a signed statmat thal hc or shc is licdscd p$uml to thc provisions of the Contractor's Liccnsed law (Chaptr 9. Comnencing rvith Setion 7000 of Division 3 of thc Business ud Prcfesions Codc) or that he or she is exempt thcefrom od thc bsis for lhe allcgcd exmplion. Any violation of Selion 7031.5 by any applicantforapnnitsubjetsthc applicmttoacivilpcnaltyofnotmorcthofivchundreddollus($500). _1. as owner of the property. or my employees with wages as their sole compensation. willdo the work and the structure is not intended or ofFered for sale (Sec.7044. Business and hofessions Code: The Contractor's License Law does not apply to an owner of the property who builds or improves thercon. and who does such work hirnself or herself or through his or her own employees. provided that such improvcrnents are not intended or ofFered for sale. lf. howo'er. the building or improvement is sold rvhhin one )â‚¬ar of completion, the Orvner Buildcr rvill have the huden of proving tha he or she did not build or improve the pmpcrty for the purposâ‚¬ of sale). 1$t,as owner of rhe property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Pnoftssion Code: The Contractor's License Law does not apply to an owner of property rvho builds or improves thereon. and who contracts for such projects with a Contracto(s) licenscd pursuant to the Contractor's l,icense Law). -l arn exempt under Section-. B. & P.C. for this reason. Drt",' U- OS'lq o*n"r, ts a'urUl WORKERS' COMPENSATION DECLARATTON I hereby alTinn under penalty of perjury one of the following declarations: -_l have and will maintain a Certifrcate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code, for the perfonnance of the work for which the permit is issued. -l have and will maintain u'orkers' compensation insurance. as required by Section -1700 of the labor Code. for the performance of the work for which this permil is issued. My workers' compcnsation insurance carrier and policy number are: Carrier:_ Policy Number:_Expires: T-Lrcefiiry that in the perforrnance of the work for which this perrnit is issued, I shall not ernploy any person in any manner so as to become subject to the workers'compensation larvs of California. and agree that if I should bccome subject to the s'orkers' compensation provisions of Seoion 3700 of the Labor Code. I shall. forthrvith comply rvith those provisions.. WARNING: Failure to secure rvorkers' compensation coverage is unlarvful. and shall subject an onployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition lo the cost of cornpcnsation. darnages as provided for the .1 of the Business and Professions Code. and rny license is in flull force and effect. License -License Number: Date:_Contractor:_ CONSTRUCTION LENDING AGENCY I hcby a(fim undo parahy of ptrjury that thqe b a comtruclion lâ‚¬nding ag@cy for lhâ‚¬ pcfomuce of thc work for which thb pâ‚¬rmit is issucd (56. -1097. Civ. C.). Lender's Name: Lender's Adct'ess: APPLICANT I'ECI-ARATION I hctby affim undq pcnalty of po'jury onc of thc following delmtiom: Dcmolilion PmitgAsbetos Notification Fcdml Rcgulations (Titlc 40. Pan6) _R{uitrd ldtq of Notification -t csti& that thc fcdoal rcXulatiom rcguding cbctos rmoval rc not qplicsblc to this prcjcct. 191 cqti& ttra t tuvc rad thfu spplicstion od statc thst thc abovc infonnrtion is corcct. I agr to comply with all Cily ed Couty ordimca od Stac [:rw rclaing to building coostruclion. and hocby authoriu rcpr$tdive of this City md Comty to ots upoo thc abovc m@rioncd prcpcdy for iropoction purpos. ApptlcrntorAsmts,r-r*X --L0uUl 4 o"t", . ll-O5-ti permlree nnme tprintl: K Th , Y Bt- tl' Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm lDaffioers Communications Cable Buildins Under Slab / Floor Bondinq I Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Roush) Meter Release Rough t2.4-lg nr7$ la Service Meter FINAL L'65/rP DJ\s? l6z, Notes, Remarks, Etc -+