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ELECTRICAL.INSPECTOR RECORD ,APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm I Dampers Communications Cable Buildinq Under Slab / Floor Bondinq I Groundinq / UFER Transformers Torqueino Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouoh) N/eter Release Rouqh Service N/eter FINAL Notes, Remarks, Etc. OWNI'R BI'II,I)ItrR I)IiI,CARATION I hereby affirnt under penalty of periury tlmt I anr exenrpt frorn the Cbntractors' License Law for the following reason (Sec.7031.5 Busincs.s and Prol'cssion Codc): Any City or County which rcquircs a pcrrnit to construct, alter, itnprove, dcrnolish or rcpair any structure, prior to its issuance. also requires the applicant lor such penuit to ftle a .sigrted slatemenl that he or she is licersed pursuant to the provisions ol'thc Contractor's l,iccnscd law (Chapter 9. Commencing with Scction 7000 of Division 3 ol'thc Busincss and Profe.ssions Code) or that lrc or she is exen4rt therefronr and tlrc basis ftrr tlre alleged exenrption. Any violatiott of Section 7031 .5 by arty applicant for a pennit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). _1. as owncr ol'tlrc. propcnv. or llry crnployces with wages as thcir solc cornpcnsalion, willdo thc work and the structure is not irrtendetl or offeretl for sale (Sec.7B4. Business antl Professions Code: The Conlractor's License Law does not apply to an owner of the property wlro builds or inrproves thereorr, arul wlrc tloes such work hintself or herself or through his or her owtt entployees, providcd that such irnproverncnts are not intcndcd or olTcrcd for salc. Il. howcver. tlrc building or irnprovctncnt is sold within onc yL'ar of conrpletion, tlre Owrrcr Builder rvill have the burden of proving that he or she did not build or improve the prcrperty ftrr tlre purpose of sale). _1, as owner of the propelly, am exclusively contracting with licensed conlraclors to construct the project (Sec. 7tX+. Business and holbssion Code: The Contractor's License Law does not apply to an owner of property wlro builds or impr<lve.s thereon. and who contracts lor such projccts with a Contractor(s) licenscd pursuanl to thc Contractor's Liccnsc Law). -IantexetnptunderSectitltt-,B.&P.C.tbrtlrisreasott.Date: WORKERS' COM PT]NSATION DECLARATION I hcreby aflirm undcr pcnalty of perjury one of the tbllowing declarations: _I have and will nuintain a Certiticate of Consent to Selt'-lnsure for workers' compensation, as provided for by Section 3700 of tlre labor Code, for the Jrcrfounarrcc of thc work lbr which the perrnit is issued. _l have and will nraintain worker.s' corrpensation insurarrce, as required by Section 3700 of tlte Labor Code, for the Jrcrfonrrance of the work for which this pcrnrit is issucd. My w<lrkcrs' compcnsation insurance carrier and policy number are: Carrier: Policy Number: Iixpires: _l ccrrity that in thc lrcrlornrancc of thc work for whiclr this pcrnrit is issucd, I shall not cntploy any l)crson in any manncr so as to bccontc subjcct to thc workcrs'conlpcnsation laws of California. and agrce that iil should becolne subjcct to thc workers' conrpensation provisions of Section 3700 of the Labor Code, I shall, forthwith cornply with tlpse provisious.. WARNING: Failure lo secure workers' cornpensation coverage is unlawful, and shall subject an employer to criminal penalties arrd civil fines up to olle lrurrtlred tlrcusalrd dollars ($100.000). in addition to tlrc cost of cotnpetsatiolt, danuges as provided hr the Section 3076 of the Latxrr Ctxlc, intcrcst and attorncy's [ces. LICENSED CONTRACTOR DIICI,ARAI'ION ? I hereby affirnr under ;rcnalty of perjury that I aru licerrsed under provision of Chapter 9 (cottunencing with Section 7000) of Division 3 of the Business and Prolbssiorrs Code. ard rny licertse is in full force and effect. License Class: Licetxe Nurnber: Date: Contractor: CONSTRUCTION LENDING AGENCY I hcrcby al'linn undcr penalty ol'pcrjury that thcrc is a construction lcnding agency for the pcrlbrrnancc of the work l'or which this pcnnit is issued (Sec. 3097, Civ. C.). Lender's Narne: [*nder's Address: APPI,ICANT DECI,ARA'I'ION I lrcrchy ullirnr untlcr pcnalty of pcrjury onc ol'thc lirlkrwing dcclarations: Dcnxrlition Pcrnrils-Astrcstos Notification Fcrlcral Rcgulations (Titlc 40, Parr6) _Rcquircd Lcttcr ol' Nolillcation _l ccrtily that tlrc l'cdcral rcgulations rcgiu'cling astrcstos rcrnoval arc nol applicablc to this projcct. ordinanccs and Statc Laws rclating to lruilcling construction. irnd hcrcby authorizc rcprc'scntativcs ol this City and County to cntcr upon thc above rrrcntioned properly for inspection purlnses. Applicant or Agent Signature: Date:- I'crnrilcc a-,7