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ELEGTRICAL.I NSPECTOR RECORD f).r,, n(l n:)r1-t q APPROVALS DATE !D/S!G.COMMENTS OWNER BUILDER DEI,CARATION I hqeby affrm undo pcralty of perjury that I m cxmpt from thc Contracton' Licw t:w for thc following rcen (Ss,7031.5 Buines and Profasion Codc): Any City or County which requiro a pomit to @nstruct. altq, imprcve, dernolish or rl{Bir ey sruaue. prior to its issumcc. aho rcquire thc eplicat for such pcflnit to file a signcd statmmt that hâ‚¬ or shc b licsâ‚¬d pwuut to the provisioru of lhc Cotrtractor's Liccnscd law (Chapl6 9. Commcncing sith Sction 7000 of Division 3 ofthc Buine md PrcfsionsCode)orthathâ‚¬orshciscxmptthqefromildtheb6sisfortheallcgcdcxmptioo. AnyviolationofSatbnT03l.5byany applicant for a pqmil subjels lhc applicanl lo a civil pcnahy ofnot morc thil five hundrcd dollm ($500). _1. as owner of the property. or my employees with rvages as their sole cornpensation. willdo the wort and the structure is not intended or offered for sale (Sec.7044. Business and Professions Code: T'he Contractor's License Larv does not apply to an owner of the property rvho builds or improves thereon. and rvho does such work hirnself or herself or through his or her own employees. provided that such inrprovanents are not intendd or offered for sale. ll. horvever'. the building or improvement is sold within one year of cornplaion. the Owner [luilder rvill have the burden of proving that he or she did not build or improve the propory for the purpose of sale). _1. as owner of the properly. am exclusively contracting rvith licensed contractors to construct the project (Sec. 7044. Business and Ptofession Code: 'l'he Contractor's l-icense Larv does not apply to an owner of property rvho builds or improves thereon. and u,ho contracls for such projects rvith a Contracto(s) licensed pursuant to the Contraclor's License Law). -l am exempt under Section_. B. & P.C. for this reason. Date: Owner:_ WORKERS' COI}T PENSATION DECLARATION I hereby alTirm under penalty of perjury one of the following declarations: -l have and rvill maintain a Ccrtificate of Consent to Self-lnsure for rvorkers' cotnpensation. as provided for by Section 3700 of the Labor Code. for the perfonnance of the work for which the pennit is issued. y'have and will nraintain rvorkffi' compensation imurance. ro rcquired by Setion 37OO of the Labor Code. for thc pcrfomuce of 'ihe work for rvhich this psmit is isucd. My workcs' compmation insuruce cris md policy numbc rc: o@ ?/r:rpcs: ;/rfu _l certi& that in the pcrformance of the rvork for which this trrrnit is issued. I shall not anploy any person in any manner so :ls to become subject to the workers' compensation laws of California. and agree that if I should be-come subject to the rvorkers' compensation provisions of Seoion -1700 of the Labor Code. I shall. forrhu'ith cornply with those provisions.. WARNING: Failure lo sccure rvorkers' cornpensation coverage is unlarv[ul, and shall subjoct an anployer to criminal paraltics and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of cornpensation. darnages as provided for the I hereby affirm under penalty of perjury that I am licensed under provision of Chapto 9 (comrnencing with Section 7000) of Division -3 of the Business and Professions Code. and my license is in full force and effect. CONSTRUCTTON LENDING AGENCY I hreby alfinn undcr penahy of pqjury that thqc is a construc{ion lending agmcy for thc pqfommcc of thc rvork for which lhis Fnnil b issued (Sec. .3097. Civ. C.). Lender's Name: Lender's Address: _ APPLICANT DECLARATION I herdry afnrm under penalty of perjury one of the following declarat ions: Demolition Permits-Asbestos Notifrcation Federal Regulations (Title 40. Par16) -Required Lrtter of Notification -l certify that the federalregulations regarding asbestos renroval are not applicable to this project. _l certify that I have read this application and state that the atxrve infiorrnation is correct. I agree to cornply rvith all City and County ordinances and State Laws rclating to building construction. and above rnentioned propefly for Applicant or Agent Perntitee nrme (print): inspection ./ the Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm I Dampers Communications Cable Building Under SIab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Roush Ceilinss (T-Bar Rouqh) l/eter Release Rouqh Service Meter .//I F!NAL ///ct/a 4!)4- Notes, Remarks, Etc./ '(l\J /L/ Section -3076 interest and attorney's fees. A rrrrlinonl. License rr^*, License Nurnber: 7 7 7/ - t r.", // /27 't ? Conrracro',, E