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ELECTRICAL.I NSPECTOR RECORD nQ (\7 ?n1q, APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION I hsctry affrm und6 pcnalty of perjury that I m ctcmpt fiom thc Contraclos' Licosc [rw for thc following ren (54,7031.5 Busines and Prcfsion Codc): Any City or County which require a pcmit to conslruct. alto, improvg dmolish or rcpair my structue. prior to its isumce, also rcquirc thc applicut for such pcmit lo file a siSncd sldmqt tha hc or shc is licoscd pmuanl to the provisions of tlE Contmctor's Licmsed Law (Chapt6 9. Commencing wilh Sction 7000 of Division 3 of lhc Businm md PrcfsionsCodc)orthathcorsheisqwptthqcfromandthcbssisforthcallegcdcxemption. AnyviolationofscctionT03l.5byay applicantforapomitsubjststhe applicanttoacivilpcnaltyofnotmorclhfffivchundrcddollm($500). -1, as ou/ner of the property. or my employees with wages as their sole cornpensation. willdo the rvork and the structure is not intended or offered for sale (Sec.7044. Business and hofessions Code: The Contractor's l,icense Law does not apply to an owner of the property rvho builds or improves thereon. and rvho does such $'ork himself or herself or through his or her own employees. provided that such improvonents are not intended or offered for sale. If. horvever. the building or imp,rovement is sold within one )â‚¬ar of cornplaion. the Orvner Builder will have the hrden of proving tha he or she did not build or improve the property for ttrc purposc of sale). _1, as owner of the properly. am exclusively contracting with licensed conlractom lo construct the project (Sec. 7M4. Business and hoftssion Code: 'fhe Contractor's License Larv does not apply to an owner of property rvho builds or improves thcrc'on. and who conlracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License Larv). -l am exernpt under Section-. B. & P.C. for this reason. Date:_Owner:_ -w()RKERS' DECLARATION I hereby affrrm under poralty of po'jury one of the following declarations: _l have and rvill maintain a Certificate of Consent to Self-lnsure for workers' compensation. &s provided for by Section 3700 of the Labor Code. for the performance of the work for which the permit is issued. _l have and will maintain rvorkers' compensation insurance. as required by Section 3700 of the Labor Code, for the performance of the work for which this pcrmit is issued. My rvorkers' compensation insurance carrier and policy number are: o **,- . ,tf ,f rca Policy Number:_t^ rC. (D4 L'7r7 tq _l certi$ that in the perforrnance of the rvork for rvhich this perrnit is issued. I shall not etnploy any person in any manner so as to become subject to the workers' compensation larvs of California. and agree that if I should become subject to the workers' compensation provisions of Sertion 3700 of the Labor Code. I shall. forrhrvith comply with those provisions.. WARNING: Failure to secure workers' cornpensation coverage is unlawful. and shall subject an onployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided;[br the Section 3076 of the Labor Code. interest and attorney's fees. Dere: " I /s1n K CWIt DECLARATION r I hereby affrnn under penalty of perjury that I am licenscd under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profcssions Code. and my license is in full florce and effect. D Y6 License Number: o License Class:_a 8(753) a conrracro''K (rrid A/fentrafi vgj W I hercby allim undc pcnalty of pcrjury that th6e b I coslruction lcnding agmcy for the pcfol]mcc of thc work for u'hich this pcmh b issued (Se. 3(x)7, Civ. C.). Lender's Name: _ Lender's Address: APPLI(:ANT DECLARATION I hseby afiim undcr p6alty ofperjury onc ofthe following dalaations: Detnolition Pqmits-Asbâ‚¬tos Notification Fedsal Regulations (-l ille 40. Paa6) Required l-ctter of Notifi cation -_-t cenify that thc federal rcgulatiore regr<Iing asbcstos removal ae not applicable to this preject. X ccniry rtar I havc rcad this application ild state that the akrve infomalion is coftsl. I agrs to comply with all Cily and County ordinancG and State larvs relating to building construction. ild hseby authoriz.e refreglativ6 of this City ild County to mte upon the above mentioned property for inspection Applicant or Agent x l'ernritee name (print): K b((tn5 _ Date ,- t t/gf H Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm lDampers Communications Cable Building Under Slab / Floor I I .) Bondinq I Groundinq / UFER I bt rq{)WVVl '4Xd Transformers I Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Re]ease tl r)ffirN .01*10_! tul 3t r00 (#N Rough I Service Meter II \Or FINAL 1t 'Jcilt1 DY lZ.{lE' Notes, Remarks, Etc. \XUD<A