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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE !D/SIG.COMMENTS OWNER BUILDER DELCARATION I hqeby affirm undcr penalty of pgjury that I m cxempt from the Contracto6" Licme Law'for the following rcmn (Sff.7031.5 Buincs md Profsion Codc): Any City or County which rcquirs a pcrmit to comtruct, ahc. improvc, donolish or rcpair my struclurq prior to its isumcc. slso rcquirs thâ‚¬ applicat for such pennit to file a signed stalmfft that he or shc b licq&d pmumt lo thc prcvisio$ of thc Contraclor's Liccnscd tarv (Ctapls 9. Commcncing \rith Sction 7000 of Division 3 of thc Busins md Prcfesions Code) or that hc or she is cxmpt threftom ad the basis for the alleged cxcmpion. Any violstion of Scction 7031 .5 by any applicant for a pcnnit subjcts thc applicant to a civil pflalty ofnot morc thm five hundred dollrs ($500). -1. as owner of the property. or my employees with wages as their sole compensation. willdo the rvork and the.structure is not intended or offered for sale (Sec.7M4. Business and Professions Code: l'he Contraclor's License Law does not apply to an owner of the proper-ty rvho builds or inrproves thereon. and u,ho does such w'ort hirnself or herself or through his or her own employees. provided that such irnprovanents are not intended or offered for sale. I[, hos'ever. the building or improvement is sold within one ]tzr of completion. the Orvner Builder will have the burden of proving tha he or she did not build or improve the propoty for the purposc of sale). -1. as owner of the propcrty. am exclusively contracting rvith licensed contractors to construct the projecl (Sec. 7044. Business and hoftssion Code: The Contractor's License Law does not apply to an owner of property rvho builds or irnproves thcreon. and u'ho contracts for such projects u'ith a Contracto(s) licersed pursuant to the Contractor's License Larv). _l am exempt under Section_. B. & P.C. for this reason. Date: Owner:_ WORKERS' COI\T PENSATION DECLARATION I hereby affirm under penalty of perjury one of the follorving declarations: -l have and will nraintain a Certilicate of Consent to Self-lnsure for rvorkers' compensation. as provided for by Section 3700 of the Labor Code. for the performance of the rvork for which the perrnit is issued. -l have and u,ill rnaintain rvorkers' cornpensation insurance. as required by Sc',ction .i700 of the l.abor Code. for the performance of the work for rvhich this permit is issued. My workers' compensation insurance can'ier and policy nurnber are: ( 'irt t it'r Policy Number:_[:xpires: _l certiS that in the performance of the rvork for rvhich this perrrrit is issued. I shall not employ any pemon in any nranner so as to beconre subject to the rvorkers'compensation larvs of California. and agree that if I should become subject to the u'orkers' compensation provisions of Section 3700 of the Labor Code. I shall. forthw'ith cornply rvith those provisions.. WARNING: Failure lo secure u'orkers' compensation coverage is unlarvful. and shall subject an anployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. darnages as provided for the Section 3076 of the Labor Code. interest and attorney's D,r", I t/ 2t / lq I DECI.ARATION I hereby affrrrn under penalty of perjury that I arn licensed under provision of Chapter 9 (comrnencing with Section 7000) of Division -3 of the Business and Professions Code. and rny license is in full force and effect.t0 License Cl^rr, C {6 License Number: 3s- vt? i Contractor:_, CONSTRUCTION LENI'ING ACENCY I hwby allirm undr penahy of pcrjury that thrc is a consruction lcnding 886cy for the pqformcc of thc work for which this pqrnil b issued (Se. 3097. Civ. C.). kndo's Namc: Lender's Address: APPLICANT DECLARATION I hereb'y aftinn under penalty of po'jury one of the following declarations: Demolition Permits-Asbestos Notilication Federal Regulations (Title 40. Part6) -Required Letter of Notification -_J cqtify lhal lhc fedqal rcgulalioB rcgading 6b6tos rqnoval tre not applicablc to thb prcjcr{. j- t cotifo that I havc rcad this application sd statethat the above infomation is corcct. I agre to comply with all City and County ordinancs md Statc Laws rclating to building coBtructiotr md hqeby authorirc reprentativG of this City od County to mt6 upon thc Permiree name (prinu: lIyL- -Iy!- I)ora.tl/z 1/q Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire AIarm I Dampers Communications Cable Building Under SIab / Floor Bonding I Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release Rough Service Meten ,l -aaFINAL lT lrl),lq rrJiLl {,1 Notes, Remdrks, Etc. nCI n7 ?n,l G