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ELECTRICAL-INSPECTOR RECOR D APPROVALS DATE !D/SIG.COMMENTS Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding lGrounding I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouoh) Ceilinss (Hard & Soffit Rouqh Ceilings (T-Bar Roush) N/eter Release Rouqh Service [/eter rA, FINAL 7-\J-7 T \ul,]N Notes Remarks Etc ) OWNIiR BUILDER DELCARATION I hereby affrnr under penalty of perjury that I anr excnrpt from the Contracton' Licensc [:w for the following neason (Sec.7031.5 Busincss and Protbssion Codc): Any City or County which rcquires a pcrmil to construct, alter, irnprove, dcmolish or repair any structure, prior to its issuance. also requires the applicanl for such prnrit to file a signed statellEnt that h or she b licenscd pursuanl to thc provisions of the Contractor's l,iccnsed l:w (Chapter 9. Commcncing with Section 7fi)O of Division 3 of the Business and Professions Code ) or that hc or slrc is exempt therefrom and tlre basis for the alleged exenrption. Any violation of Section 7031 .5 by any applicant for a pennit subjects thc applicant to a civil penalty of not morc than five hundred dollars ($500). _1. as owncr ol'the propcrty. or my crnployccs with wagcs as thcir sole compensation, will do thc work and thc stnrcturc i.s not intended or offered for salc (Ser.7M4. Business anrl Professions Codc: Thc Contractor's Licensc Law tloes not apply to an owner of tlre propeny wlro builds or inrpnrves therurn, and wlro does such work himself or herself or through his or her own enrployees, providcd that such ilnpmvenrcnts arc not intcndcd or olfcred for sale. Il, howcvcr, t]rc building or improvcrnent is sold within onc year of conpletion, the Owner Builder will have the burden of proving that he or she did not build or improve tlrc properry for the puryose of sale). _1. as owner of the propetly, am exclusively contracting with licenscd contractors to construct thc arxl Protbssiorr Code: The Contractor's License Law does not apply to an owner of property wh<t project (Sec. 7044, Business builds or improves thereon. and who contracts for such projccts with a Contractor(s) liccnscd pursuant to thc Conuactor's _l anr exempt under Section_, B. & P.C. ttrte,' laa ll-l ' 2O I hcrcby affirm undcr pcnalty of pcrjury onc of thc _l have and will nmintain a Certilicate of Consent to Self-lnsure for workers' conrpensation, as prcvided for by Section 3700 of the Labor Code, for the performance o[ thc work for which thc permit is issucd. _l have and will nraintain workers' conrpensation insurance, as required by Seclion 3700 of the Labor Code, for the perfonrutrce tlf thc work for which this pcrnrit is issucd. My workcrs' conrpcnsation insurancc carricr uxl policy nuntbcr arc: Policy Number: Iixpires: _l certify that in tlrc lxrftrrnuncc o[tlrc work firr which this grcrmit is issued, I shall not cmploy any pcrson in any manncr so as to beconre subject to thc workcrs' compcn.sation laws of California. and agrcc that if I stnuld become subjcct to the workers' conpensation pruvisions of Section 3700 of the labor Code, I shall, forthwilh conrply with thosc provisions.. WARNING: Failure to secure workers' compensation coverage civil fines up to oue hundred thousand dollars (S100.0001. in Scction 3076 of the l,abor Codc, intcrcst and attorncy's [ecs. is unlawful, and shall subject an employer to criminal penalties and addition to tlre cost for llrc\ -2^t I hereby affirnr under penalty of perjury that I 9 (conunencing with Section 7000) of Division 3 . of the Business and Professions Codc. and rny license is in full force and effect. Licerse Class: Licensc Numbcr: I CONSTRUCTION LENDING AGENCY I hereby allirm undcr pcnalty of perjury that thcrc is a construction lcnding agcncy for the perlbrmance of thc work lkrr which this permit is issued (Sec. 3097. Civ. C.). lrnder's Nanre: [rnder's Address: APPI,ICANT DECI,ARATTON I lrcrcby affrm undcr pcnalty of pcrjury onc of thc following drxlarations: Dcnxrlition Pcrnrits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40, Part6) -Rcquired lrtter of Notification _l ccrtity that thc fcdcral rcgulations rcgarding asbcstos rcnnval arc not applicablc to this projcct. with all City and County and County to cnter upn thc above nrentioned property for Applicant or Agent Pcrmitee nanlc statc lltat rl Rev. 08-07-201 5 and