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ELECTRICAL-I NSPECTOR RECORD n9 n'2 1n.t G APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hocby aflirm unda pemlty of pcrjury thar I m cxcmpt from thc Conlracto6' Licq* taw for thc following rwn (Sa.703E5 Businm and Profcssion Code): Any City or County which rcquire a pomit to coctruct. aho. improvc demolish or rqnir uy structure. prior to its isuece. also requirs the applicilt for such pcmit to file a signcd statmot thar hc or shc is liceNrd pEuant to the prcvisioN of thc Contractor's Licenscd Law (Chapt6 9. Commocing with Sation 7000 of Division 3 of the Businos md PrcfcsionsCodc)orthathe orshciscrmptthacfromudthe b6sisforthcallegcdexmption. AnyviolationofScctionT03l.5byan, applicant for a pcmit subjcts thc applicant to a civil pcnalty of not morc thil livc hun&cd dollds ($500). -1. as owner of the property. or my employeâ‚¬s with rvages as their sole cornpensation. rvill do the work and the struclure is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Larv does not apply to an orvner of the properly rvho builds or improves thcreon. and rvho does such work himself or herself or through his or her own employees. provided that such improvonents are not intended or offered for sale. l(. horvever. the building or improvement is sold $'ithin one )â‚¬ar of complaion. the Owner Builder will havc the burden of p,roving that he or she did not build or impnove the propo'ty for the purpsc of sale). -1. as owner of the property. am cxclusively contracting with licensed contractors lo construcl the project (Ser. 7044. Business and Pnofession Code: The Contractor's License Law does not apply to an owner of proper'ly who builds or improves thereon. and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License taw). -l an exempt under Section-. B. & P.C. for this reason. Date: Owner:_ WORKERS' CONTPENSA'I'ION DECLARATION I hcreby afTirm undcr penalty of perjury one of the follo*'ing declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the I-ahrr Code. for the performance of the work for rvhich the pcrrnit is issued. for the performance of ___l certi$ that in the perforrnance of the w'ork for u'hich this perrnit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation larvs of California. and agree that if I should becorne subject to the workets' compensation pmvisions of Section 3700 of the Labor Code. I shall. forrhwith cornply u,ith those provisions.. WARNING: Failure to secure workers' cornpensation co!'erag,e is unlau,ful. and shall subject an anployer to crirninal gmalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of conrpensation. darnages as provided for the Section 3076 of the interest and attorney's fees. a I hereby aflirm under penalty of perjury l of the Business and Professions Code. and my license is in full force and eflect. License Class:_o t (o _License Nurnber:ffi ,,r",' llf 1f l4 conrre*o,.rr- Vtvl-nJ-S'tqr W I hrcby affim undo Fnaltyof pcrjury that th@ is a coNtructbn lording agocy for thc pahmcc of thc wtrk for which this pqmil is issucd (Se. 3097, Civ. C.). [tnd6's Nms lrnder's Address: APPLTCANT DEC LARA'IION I herety affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notification -_l certifu that the federalregulations regarding asbestos removalare not applicable to this project. permiree name tprt^.t, * D C4 r1i C I Vq f n Q, S the Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire Alarm I Dampers Communications Cable Building Under Slab / Floor Bonding I Groundins / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Wails (Roush) Ceilings (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release / Rough / L/h 4/1 r/-A,Uat/ Service Meter / , FINAL //t ,D-? .l'/LL 4Jr) Notes, Remarks, Etc. // --D ((C I