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