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ELECTRIGAL.! NSPECTOR RECORD APPROVALS DATE !D/SIG COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire AIarm lDampers Communications Cable Building Under SIab / Floor Bonding I Groundins / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinss (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release Rough Service Meter FINAL /l-2?-t g Br?ta> Notes, Remarks, Etc. I h6eby affm unda pcnalty of perjury that I on cxmpt from the ContracloB' Licmc Law for the following râ‚¬en (Se.7031.5 Busincs ard Profcssion Codc): Any City or County which rcquirs a pmit lo construct. alt6. improvc. &molish or npair uy structue. pdor to its isumcc. drc requirs the applicilt for such pcmit to filc a signcd statmot thd he or $c b licsed prmet to the provisiore of the Contractor's Liccnscd [aw (Chapt6 9. Commencing with Sslion 7000 of Division ] of the Buinas md ProfcssionsCode)orthathcorshcisexemptthcefromudthebasisfortheallcgedcxqnption. AnyviolationofsstionT0Sl.5byany applicantforapmitsubjelsthe applicanttoacivilpcnsllyofnotmorethefivehundreddollus($500). --1. as owner of the properiy. or my ernployees with wages as their sole compensation. will do the rvork and the structure is not intended or offered for sale (Sec.7044. Business and hofessions Code: The Contraclor's License larv does not apply to an owner of the property rvho builds or improves thereon, and who does such r.r'ork himself or herself or through his or her own employees. provided that such improvernents are not intended or offcred for sale. If. horvever. the building or improvement is sold within one )â‚¬ar of cornplaion. the Orvner Builder will have the burden of proving tha he or she did not build or improve the propory for the purposc of sale). _1. as owner of the propeny. am exclusively contracting with licensed contraclors to construct the project (Sec. 7044. Business and Profession Code: 'l'he Contractor's License Larv does not apply to an orvner of property who builds or improves thereon, and who contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License Law). _l am exempt under Section_. B. & P.C. for this reason. Dnte:_ Owner:_ WO RKER,S' COI}I PENSATION DECLARATION I hereby affirrn under penalty of perjury one of the follorving declarations: _l have and rvill maintain a Certificate of Consent to Self-lnsure for rvorkers' compensation. as provided for by Section 3700 of the Labor Code. for the perfonnance of the rvork for which the permit is issued. and s'iII nraintain workers'700 of the Labor Code.[or the performance of for s'hich this is and policy number l'olicy 8a+-- _ -l cerrify that in the performance of the rvork for r.r'hich this perrnit is issued. I shall not onploy any person in any tnanner so astobecomesubjecttothervorkers'compensationlarvsofCalifornia.andagrecthatiflshouldbecomesubjecttothe workers' compensation provisions of Secrion 3700 of the l-abor Code. I shall. forthrvith comply rvith thosc provisions.. WARNINC: Failure to secure rvorkers' cornpensation coverage is unlarvful. and subject an onployer to crirninal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition the of damages as provided for thel Section -j076 of the Code. interest and attorney's fees. I hc'reby affrnn under penalty of perjury that I arn licensed of Chapto 9 (cornmencing u'ith Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. [.icense o^,u,4/0//9 I hereby aflirm under pcnalty of perjury that there is a issued (Sec. 3097. Civ. C.). [rndcr's Name: agency for the pcrfonnance of the u'ork for s'hich this p,ornit is Lender's Address: APPLICANT DECLARATION I hetby affrnn under penalty of perjury one of the follorving declarations: Dernolition Permits-Asbestos Notihcation Federal Regulations (Title 40. Part6) _Required Letter of Notification _l certi$ that the federal regulations regarding astrestos removal are nol applicable to this project. _ I cerrifu that I have read this application and state lhat is correct. I agree to rvith all City and County and County to enter upon theordinances and State Larvs above mentioned property for ,tpplicalrl or Agent Pernritee name (print): ,*",qy'//? l]l ... afe:,'n * 6