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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUTLDER DELCARATION I haeby affm undo poalty of pcrjury that I m exmpt frem thc Coilraclon' Licw Law for thc following rcon (Se,7031.5 Busins ild Prof6sion Code): Any City or County which requirB a pennit to coNtruct. alto. improvc dcmolish or cpair my strucluc. Frior to its issuocc, also rcqutB lhc applicmt for such pcmit to filc I siBncd statmot thal hc or shc is lictred pEuet to thc provisioG of thc Contraclor's Licoscd Law (Chapt6 9, Commocing with S6tion 700O of Division 3 of the Bwins ud PrcfsionsCodc)orthathâ‚¬orshcbcxmptthqefromildthcbasisforthcallcgcdcxmption. AnyviolationofsctionT03l.5byany applicantforapmitsubj(tsthc applicanttoacivilpemltyofnotmorcthilhvchundrcddollas($500). - l. as owner of the property. or my employees with wages as their sole compensation. will do the rvorft and the structure is not intended or offered for sale (Sec.7M4. Business and hofessions Code: The Contractor's License Law does not apply to an ouncr of the prnffiy who builds or improves theron. and who does such w'ort hirnself or herself or through his or her own employees. provided that such improvonents are not intendod or offered for sale. lf. horvever. the building or im5novement is sold within one year of completion, the Orvner Builder will have the burden of proving that he or she did not build or improve the propoty for the purpose of sale). -_ I. as o\r'ner of the properly. am exclusively contracting rvith licensed contractors to construct the project (Sec. 7O44. Business and ttofâ‚¬ssion Code: The Contractor's License Larv does not apply to an owner of property'*'ho builds or improves thereon. and who contracts for such p,rojects with a Contracto(s) licensed pursuant to the Contractor's License Law). _l arn exempt under Section_B. & P,C. for this reason. 0*ner. WORKERS'COMPEN DECLARATION one ofthe following declarations:I hereby affirrn under penalty of perjury -l have md will mirtain a Ccatificate of Cotmt lo Self-lreurc for workm' compqsdiou u povidcd for by Selion 3700 of the labor Codc for thc pcfomilcc of thc wo* for which the psrnit is issued. fthave ana witt maintain workm' compcreation insurance. c rcquircd by setion 3700 of thc t bor codc. for thc pqfonnucc of thc work for which thb pemit is i$ued. My worko' ompcnsuion imurucc cuiq md policy numbo re: I'olicy I:xpires: _l cerrifu that in the perfonnance of the rvork for rvhich this permit is issued, I shall not employ any person in any manner so as to become subject to the $,orkers'compensation lau's of California. and agree that if I should become subject to the rvorketrs' cornpensation provisions of Section 3700 of the Labor Code. I strall. forthrvith comply rvith thosc provisions.. WARNING: Failure to secure workers' cornpersation coverage is unlawful. and shall subject an onployer to crirninal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section 3076 the Labor Code. interest and attorney's Jo l-l DECI.ARATION I hereby affrm under penalty of perjury that I am licensed under provision of Chapto 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my liccnse is in full force and effe<t. o o-*(Js+l,icense Licenser1 CONSTRUCTION LENDING AGENCY I hwby alfirm undo penalty of pqjury that th6c is a corutruclion lcnding agocy for the prformcc of the work for which this parnit is issucd (Sc. .1097. Civ. C.). kndd's Nmc: l.cnder's Address: APPLTCANT DECLARATION I hereb,y affinn under penalty of pcrjury one of thc following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) _Required Letter of Notification _l certi& that the fderal rcgulations regarding asbestos removal are not applicable to this project. _ I ceni& that I havc read this application and state that the above information is correct. I agree to comply rvith all City and County orclinances and State Larvs relating to City and County to enter upon the above rnentioned property for Applicant or Agent ab I'ernrilee and &c lol Site-Work Underground Pole Bases Light Standards Spas, Poo!, Fountains Signs (monument) Life Safety /Low Voltase Fire Alarm I Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER /-z ? -za KAD Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Rouqh Ceilings (T-Bar Roush) Meter Release / -27*Za /1 C-Z 7 Rough //?-â‚¬c 2< ?l I Service Meter /.2, -La /Zc2n F!NAL Z-51oe o Rcte,JQ (A> 1n Notes, Remarks, Etc. /r /r' r Contrector'&- w