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ELECTRICAL.I NSPECTOR REGORD <br />)n-t A <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Und round <br />Pole Bases <br />ht Standards <br />FountainsSPool <br />NS monume <br />Life /Low <br />Fire Alarm lDa <br />Com munications Cable <br />Buildi <br />Under Slab / Floor <br />I Ground IUFERBond <br />Transformers <br />Sub-Panels <br />Air Conditioners <br />Roof nt <br />Facto Wired Unit <br />Walls Conduit <br />Walls <br />Ceilin Hard & Soffit h <br />-Bar RoCeil <br />Meter Release <br />Service Meter <br />FINAL <br />Notes Remarks Etc. <br />tl Ctllcgu-Eb - <br />\:P <br />()\!'N l,lR 'r.toN <br />hereby affirrn under penalty of pcriury that cxcnlpl fronr thc Contractors'License Larv for the followirf!reason (Sec.70-3 t.5 <br />Business and Profession Code):Any City or ('ounty which requires a fiennit to c0nslruct.alter.improvq demolish or Faa .repatr <br />structure.prior to issuance.also requires the applicant frlr such pennit to hle a signed statenlent that he she is licensed <br />tnY <br />the <br />()r punlrant <br />to provElons of the Contractor's [.icensed [.as'(Chapter 9.Comnrencing u'ith Section 7000 of Division of the Business and <br />Professions Code)or that he or she is exempt lhcrcfrorn and the basis [or lhc alleged exemption.Any violation of Section 703 .5 by <br />applicant for a permit subjects the applicant civil penalty of not <br />any <br />to than fir,e hundred dollars ($so0). <br />-1. <br />as owner of the property. or my employees with rvages as rheir sole cornpensation. willdo the work and the structure is not 'intended or offered for salc (Sec.7044. Business and hofessions Code: The Contracror's License Law does not apply to an owner ofthe property who builds or improves thereon. and who does such work himself or herself or through his or her own employecs.provided that such improvonenls are not intendod or offerod for sale. I(, hou,ever. rhe buirding o, ilrprouement is sold u.ithin one )erof complaion' the ourner Builder will have thc hrden of proving tha he or she did not build oi improve the property for the purposc ofsale). <br />-1. <br />as owner of the propefly. am exclusively contracting with licensed conrractors ro construct the project (Sec. 7044. Businessand Profession Code: The Contraclor's License Law does nor apply to an owner of property who bui[ds or improves thereon.and who contracls for such projects with a Contracto(s) licensed pursuant to the Contractor's License taw). <br />_l arn exetnpt under <br />-. <br />B. & P.C. for this reason. <br />()n ner: <br />I hmby aflim unda pcnaltyof p{uryoncor,n,o,,o*,n*ffiq <br />-l <br />have md will maintain a Ccrtificatc of CoMt to Sclf-lmurc for workm'compcruation, a pmvidcd for bySetion 3700 ofthelabor Codc, for thc pqfomcc of thc wort for which thc pcrnit is bsued. <br />-l havc and will maintain workm' comp-mation iEurancc. I cquircd by sstion 3700 of thc tabor codc. for thc pqfomcc ofth€ wrk Ewhich this pmit is isucd. My worko' ompmalion insurmic miq and policy numbc mi ' <br />a*o, <br />^.,", *,?NL5172 ,^orn O31J3/_fu2.O <br />.E-r "oti& tt "t in jlE p6f:rmc: olthc worl for which this pcmir is issucd. I shail oor mproy any pamn ir aoy mma$ Btobeomc$ubjcttothcwortc'mmpcnsarionlawofcarifomia.udagrcthaifrshoutducorcsuqettJtrc <br />wort6' composation provisions of Sclion 3700 of thc hbor Codc. I stull. ionhwith comply with tfprc prcvisiore-. <br />WARNING: Failure to secure u'orkers' conrpensation coverage is unlarvfiul. and shall subject an employer to criminal penalties andcivil fines up ro one hundred thousand dollars ($l 00.000).in addition to the cost of compensation. damages as provided for theSection 3076 of the Labor Code. interest and attorney's fees. <br />I hereby affrnn under penalty of periury that I arn licenscd under provision oichapto 9 (commencing rvith Section ')rOl of Division -3of the Business and Professions Code. and my license is in full force and effeg. <br />License License - q?B1 3 <br />Date:It -o 3-('ontrgctor,*. <br />Ihrcby-affmudapcnaItyofpfijurythat*ffifomilccofthcworkforwhichthispqmitb <br />issucd (Se. 3097. Civ. C.). <br />kndq's Nmc: <br />Lender's Address: <br />APPLICANT DECLARA'IION <br />I hercby a{firm under penalty of perjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40. part6) <br />-Required <br />Letter of Notification <br />w'ith all City and Counry <br />and County to enter upon the <br />-l <br />ceni$, that the federal regulations regarding asbestos removal are not applicable ro this project. <br />-0 _lq <br />cr. <br />a <br />,,,", ll-O?- l{