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ELECTRICAL.INS PECTOR RECORD na n"7 1r1-l q APPROVALS DATE ID/SIG.COMMENTS Site-Work U nd Pole Bases StandardsL Pool Fountains monumSi Life /Low Fire Alarm lDam rS Co mmunications Cable Buil Under Slab / Floor I Groundi IUFERBondi Transformers T Sub-Panels Air Conditioners Roof T Wired Unit Walls Walls h S Hard & Soffit Ceili S Bar h Meter Release h Service FINAL Notes hereby alTirrn under penalty of perjury that iull exempt firrnr the Contractors l.icense Larv for the following reason (Sec.70-3 .5 Business and Profession Code):Any City or County rvhich requires pcr:nit ttl construct.alter.improve.dernolish repair prior or any structure.to its issuance.also requires the applicant ftrr suclr permit to filc signed staternent that he ()r she is licensed pursuant to the provisions of the Contractor's [.icensed Law (Chapter 9.Cornmencing rvith Scction 7000 of Division l of the Business and Professions Code) or that he or she ts exernpt therefiorn and the basis for the allcged exernption.Any violation of Secticln 703 .5 by applicant for pennit subjects thc applicant a civil penalty of any to not more lhan five hundrcd dollars ($5oo). -1. as owner of the propcrty. or my employees rvith wages as rheir sole compensation. s'illdo the rvork and rhe strudure b notintended or offered for sale (Sec.7044. Business and hofessions Code: The Contractor's License Law does not apply to an orvner ofthc property who builds or improves theroon. and who does such work himself or herself or through his or her orvn employees.provided that such improvements are not intended or offered for sale. lf. however. the building or improvement is sotd within one )qrof cornplaion' the Owner Builder rvill have the hrden of proving rha he or she did nor build oi improve the propoty for the purpose ofsale). -1. aso\t'neroftheproperty. arnexctusivelycontracting rvith licensed contractorsto construct theproject (Sec. 7044. Businessand Pnofcssion Code: The Contractor's License Law does not apply to an o$,ner of property who buiids or improves thereon.and rvho contracts for such projects rvith a Contracto(s) licenied pursuant to the Contractor's Licerse Larv). _l am exempt under Section- Date: , B. & P.C. for this reason. _ Owner:_ I hereby alTirrn under penalty of perjury one of the fol lorving --l have and n'ill maintain a Cerrificate of Consent to Self-lnsure for s,orkers' compensation. irs provided for by Section 3700 of theLabor code. for the performance of the rvork for which the permit is issued. _l have and the rvork for o Carrier: rvill rnaintain rvorkers' cornpensation insurance. as required by Section .1700 of the Labor Co4e. for the performance ofwhich this permit is issued. My workers' compensation insuranie carrier and plicy number are: - Policy .tExpres: $\L' .lirv thar in the performance of the work for rvhich this permir is issued. I shall nor employ any person in any mannerso its to become subject to the workâ‚¬rs' compensation lau's of California. and agree thar if I should become subjcct to theworkers' compensation provisions of Section 3700 of the Latnr Code. I shall, forrhrvith comply rvith those prouirionr.. WARNING: Failure to secure u'orkers' compensation covcrage civil fines up to one hundred thousand dollars ($100.000). in is unlarvful. and shall subject an anployer to crirninal penalties and Section 3076 Code. interest and attorney's fees. addition to the cost of compensation. damages as provided for the ) I hcreby affirrn under penalty of perjury that I arn licensed of the Business and Professions Cocle. and my license is provision of chapter 9 (commencing rvith Secrion 7000) of Division 3 in full force and effect. License License Number: '6Z I)ate:('ontraclo..D . ELfurc,t(AL ) I hereby afTirm under penalty of perjury that of the work for which this perrnit isissued (Sec. -3097 Civ. C.). Lender's Name: Lender's Address: _ APPLICANT DECLARATION I hereby affinn under penalty of perjury one of the foilorving declarations: Dernolition Perrnits-Asbestos Notification Federal Regulations (Title 40. pan6) _Required Letter of Notification --l certify that the fbderalregulations rcgarding asbestos removalare not applicable ro rhis projed. corify that I have read this application and state that the atnve information is ordirranccs arrd State Larvs relating Itt building above nrentioned properly fitrr inspc.ction Applicnnt or Agent Signature:)A I)ernrilce nflnlt, (print): )( construction.antl hereby authorize correct. I agree to comply rvith all ('ity and County