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ELECTITICAL.I NSPECTOR RECORD f,} c"rl0. n'7 ')n-, fi APPROVALS DATE ID/SIG,COMMENTS OWNER BUILDER DEI,CARATION I h6cby amm undo pemlty of pctjury thst I m ercmpt ftom the ContmctoE' Licm Law forthc following rcmn (Sc.70-11.5 Buinqs ud Profession Code): Any City or County which rcquira a pcnnit lo coEtrucl. alta, improvc dmolish or npair uy structuc. prior to its isuance. also requirG the applicdt for such pennit to lilc a signcd statmcnt thal hc or shc b licoscd pNuilt to thc provisioB of the Contractor's Licenscd llw (Chapta 9. Commcing rvith Sation 7000 of Division 3 of thc Buins a{ Prof*sions Codc) or that hc or shc is cxcmpt thccfrom md thc b6is for thc alleged cxmption. Any violation of Scction ?031.5 by an! applicantforapmitsubjslsthe applicanttoacivilpcnaltyofnotmorcthmfivehundreddollm($500). _1. as owner of the property. or my employecs with wages as their sole compensation. will do the rvork and the structure is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the poperty rvho builds or itnproves thereon. and rvho does such wort himself or herself or through his or her own employees. provided that such improvanents are not intâ‚¬nded or offered for sale. lll hou'ever. the building or improvemcnt is sold within one )â‚¬ar of complaion, the Or,r,ner Builder will have the burden of proving that he or she did not build or imp,rove the propoty for the purposc of sale). _1. as owner of the propeny. am exclusively contracting rvith licensed contractors to construct the project (Sec. 7044, Business and hofcssion Code: 'l-he Contractor's License Law does not apply to an owner of property rvho builds or improves thereon. and u'ho contracts for such projects rvith a Contraclo(s) licensed pursuant to the Contractor's License Law). _l arn exempt under Section_B. & P.C. for this reason. o*e, l('V - I 1 DECLARATION I hereby alhrm under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workss' compensation. as provided for by Section 3700 of the Labor Code. for the performance of the work for which the perrnit is issued. _l have and will maintain workers' compensation insurance. as required by Section .3700 of the Labor Code, for the performance of the work for which this permit is issuecl. My workers' compensation insurance carrier and policy number are: Carrier:- Policy Number: Expires: _l certi& that in the performance of the work for which this perrnit is issued. I shall not anploy any person in any manner so as to become subject to the workers' compcnsation laws of California and agree that if I should become subject to thc u'orters' compersation provisions of Sertion 3700 of the labor Code. I shall. forthrvith comply with thosc provisions.. a WARNING: Failure to sccure workers' cornpensation coverage is unlau'ful. and shall subjecr an onployer to criminal penalties ar.? civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as providcd for the Section -1076 of the Labor Code, interest and attorney's fees. .2 I DECI.,ARATION I hereby affirm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and cffect. _License Number:License Class: Date:Contractor:_ (:0NS'l'RU("!'ION l,llNDIN(; A(;llN('Y I hreby affm undtr pcnalty of pcrjury that th6c is 8 construction lending agcncy for thc psfommce of lhe uork for u'hich this pqmit b issued (Sec. -1097. Civ. C.). Lender's Ad&ess: APPI ICANT DECLARATION I herelry affirm under penalty of perjury one of the following declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40, Pafl6) _Required Lrtter of Notification -l cqliry that the fedral regulatiou regoding sbestos moval re not applicable to this projat, -l cdiry that I have md this application ild state thst the abovc infomation is corccl. I agc to comply with all Cityand County ordhaocc trd State Laws rclating to building comtruction. and hscby authoriz reprcutativa of this City md County to 6t6 upon thc o*u, f l- Lf -l 7 above mentioned property for inspectign purposes. ::'*:,**#:-eg,?t'*oz4 Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire Alarm I Dampers Communications Cable Building Under Slab / Floor Bondins I Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Wails (Roush) Ceilinss (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release Rough t/// z/rQ D$ttoa-,*En Service Meter I ^-l ll I FINAL f/4v<1 /0v Nofes, Remarks, E{c ?- q *H- I ///)11 l7 lr