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ELECTRICAL.I NSPECTOR RECORD ()^t no n7 ?^"t,t APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hoeby aflim undo poalty of perjury that I m cxcmpt from thc ('ontmclo6' Liccrc law for thc following remn (Src.7031.5 Busines and Profeion Code): Any City or County which rcquira a pcmh to coEtruct. alt6. improvq dcmolish or rcpair my strucluc, prior to its issuucc. also rcquira the applicant for such pcnnit to filc a signcd stamot thar hc or shc b licmscd pmgert to thc provisiore of thc Contractor's Licqscd taw (Chapts 9. Commencing with Sction 7000 of Division 3 of the Busins ild PrcfosionsCode)orthatheorsheiscxcmptthscfromildthcbasisfortheallcgcdcxoption. AnyviolationofSetionT03l.5byany applicant for a pemit subj(ts thc applicant to a civil pcnalty ofnot morethil fivc hundred dollus ($500). _1. as owner of the property. or my employec with \,r'ages as their sole compensation. $'il|do the work and the structure is not intended or offerd for sale (Sec.7M4. Business and hofessions Code: The Contractor's License Law does not apply to an orvner of the properly rvho builds or improves thereon. and who does such work himself or herself or through his or her own employees, provided that such irnprovonents are not intended or offerd for sale. lf. however. the building or irnprovement is sold within one year of cornpletion. the Orvner Builder will have the burden of proving tha he or she did not build or improve the propo'ty for the purposc of sale). _1, as owner of the property, am exclusively contracting rvith licensed contractors to construcl the project (Sec. 7M4, Business and Profession Code: 'l'he (-'ontractor's License Law does not apply to an owner of property rvho builds or improves thereon. and n'ho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contraclor's License Larv). -l arn exempt under Section--. B. & P.C. for this reason. Date' Owner:_ WORKERS' CONT PENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for workers' cornpensation, as p,rovided for by Section 3700 of the Labor Code. for the performance of the work for which the perrnit is issued. _l have and will rnaintain workers' compensation insurance. as required by Section 3700 of the labor Code. for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: .*-. r /tv'tc riqnrn ?1lt,i lt Policy Number: ? tdf- (lal G7Z Expires: tl (lZ O _l cerlify that in the perforrnance of the rvork for rvhich this perrnit is issued. I shall not ernploy any person in any manner so as to become subject to the rvorkers' cotnpensation larvs of California. and agree that if I should bccome subject to the rvorkers' cornpensation provisions of Seoion 3700 of the Labor Code. I shall. forths'ith cornply rvith those provisions.. WARNING: Failure to secure workers' cornpensation coverage is unlawful. and shall subject an onployer to crimina! penalties and civil fines up to one hundred thousand dollars ($100,000). in addition to the cost of compensation, damages as prfvided for the Section 3076 of the labor Code. interest and attorney's fees. a L t I hereby affinn under pcnalty of perjury that I arn 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 effect. Licensecl^"r,) {-1o I L-t4, -LicenseNumber: ' ICWZC Utor tr>>Dnte:r Lt['tlI'?-o(4 ('ontrnctor:rt W I hwby affm und6 pclalty of perjury tha th@ is 8 consruction lcnding ag6cy for thc pafomcc of thc wort for which this pqmil b issued (Sc. 3097. Civ. C.). lgd6's Nme: Lender's Atldress: APPLICANT DECLARATION I hoeby aflirm under penalty of perjury one of the following declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Pan6) _Required Later of Notification -l cgtify thar the H@l rcgulatioG rcgading 6b6los moval {c not applicablc to this prcjet. j-lcqtify tha I havc râ‚¬d this application ed statc rhd the abovc infomation is conql. I agre to comply with all City aod County ordinancB and Statc Las rclating to building construction. ad h6cby authorizc rcprffitativG of this City ud County to otq upon thc above mentioned property for ,^,"t h{ cr/t,tq A- Applicant or Agent t)ernrilee nflmc (print): }(W-h rrvt Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm I Dampers Communications Cable Buildinq Under Slab / Floor I I I /a ,l Bonding I Grounding / UFER 1,wo D tu1 6 t Transformers I I Torqueing Sub-Panels Air Conditioners I lt \t t I I Roof Top Eq uipmen tlffitat l,Obo I Factory Wired Unit l"r Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Roush) Meter Release Rough I \n T ,l Service Meter I L ''afu) \ffr,,w - FINAL 7-t 46u I 19C^ Notes, Remarks, Etc.It I Malr^a a I I