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ELECTRICAL.INSPECTOR RECORD ()^'nQ n'7 ?^,r rr APPROVALS DATE ID/SIG.COMMENTS OWNERBUILDERDELCARATION , ,I hoeby aflim undo poalty of perjury thar I m cxcmpt from thc ConlmctoB' Licce hw for the following r6n (Se.7031.5 Busines md Profsion Code): Any City or County which require a po'rnit to construcl. altc, improva dcrnolbh or rfinn my structue. prior to ils issumce. also require the applicst for such peqnit to file a signcd statqnot that hc or she b licosâ‚¬d pwuut to the provisions of thc Contractor's Licoscd taw (Chapt6 9, Commcncing rvith Sâ‚¬tion 7000 of Division 3 of the BNin6 ild hofsions Code) q that he or she is cxempt thsefrom ild thc bssis for thc allcgcd cxmFion. Any violation of Srtion 7031.5 by any applicantforapâ‚¬nnitsubjGtsthc applicattoacivilpenaltyofnotmorcthilfivehundrcddollus(S500). -1. as owner of the property. or my employees $'ith wages as their sole compensation. willdo the rvork and the structure is not intended or offered for sale (Sec.7044. Business and hofessions Code: The Contraclor's License law does not apply to an ou,ner of the property rvho builds or improves thereon and who does such wort hirnself or herself or through his or her own employees, provided that such improvonents are not intended or offered for sale. lf. hou'ever. the building or improvemsrt is sold within one ]rtr of cornplcion. the Orvner Builder will have the hrden of proving tha he or she did not build or improve the propo'ty for the purpose of sale). -1. as o\r'ner of the property. am exclusively contracting rvith licensed contractors to conslruct the projea (Sec. 7044. Business and ttofession Code: The Contractor's License Larv does not apply lo an owner of propoly rvho builds or improves thereon, and rvho contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Larv). I aln exempt under Section_. B. & P.C. for this reason. l):rle:Orvner:___ _ _ DE(]LARA'I'ION one of the follorving dcclarations:I hereby affinn under penalty of perjury --t have and will maintain a Certificate of Consent to Self-lnsure for rvorkers' compensation. as providcd for by Section 3700 of tlfr Labor Code. for the performance of the work for which the permit is issuerJ. --l have and rvill maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the performance of the s'ork for u'hich this issued.rvorkers' compensation insurance carrier and policy number are: Carricr: Policy ___l certify that in the performance of the rvork for which this permit is issue<I. I shall not employ any person in any manner so astobecomesubjecttothervorkers'compensationlawsofCalifornia.andaglrerthatiflshouldbecomesubjecttothe rvorkers' cornpensation provisions of Section 3700 of the Labor Code. I shall. forthrvith comply rvith those provisions.. WARNTNG: Failure to secure rvorkers' cornpensation coverag,e is unlau'ful. and shall civil fines up to one hundred thousand dollars (S100.000). in addition to the cost of subject an onployer to and the Section .1076 the interest and attorney's fees. I hereby affirrn under penalty of perjury that I arn licensed under provision of Chapter 9 (comrnencing with Section 7000) of Division 3 of the llusiness and Professions Code. and rny license is in full force and effect. License Class:_Nurntrcr://,4?4 l)ate:Contrrcto\( CONSTRUCTION LENDING AGENCY I heby alfrm undr pqElty of pcrjury thal th@ is a co$truclion lmding agacy for thc psfommcc of thâ‚¬ work for which this pannit b isued (Se. 3097, Civ. C.). [.nd6's Nmc: Lendcr's Address: APPLICANT DECLARATION I hereby aflinn under penalty of perjury one of the following declarations: Derno lit io n Perrnits-Asbestos Notil'rcat ion Federal Reg u lat io ns (T it le 40. Parl 6 ) - Required Letter of Notification I ccrtify that the federalregulations regarding asbestos rqnoval are not applicable to this project. --l cerrify that I have read this application and state that the above infionnation is correct. I agree to comply with all City and County ordinances and State [-aws relating to building construction, and hereby authorize above mentioned property for Applicarrt or Agerrl Ittrlrtilt'e nir!nt purposes. City and to enter upon 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) Walls (Roush) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Rough) [\Ieter Release I Rough t75 n DtY{n6L r[n Service Meter I FINAL I 25 2D Vklfle Lvkq Notes, Remarks, Etc.I I I-/ - r.rrr-; 14#/t tl