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ELECTRICAL.I NSPECTOR RECORD I heeby affrm unda pcrulry of pojury that t m cxcmpt from thc ContractoE' Licffi law for the following rwn (Ss.7031.5 Buins and Profsion Codc): Any City or County which rcquira a pei'mit to conslruct. alta, improve dmolish or repair my srudwq prior to its isuucc. also rcquirB thc applicet for such pcrmit to filc a sig,ncd statmot that hc or shc b licoscd pmuut to thc povisioN of the Contraclor's Licmred law (Chapts 9. Commcnciag with Sction 7000 of Division 3 of thc Buin* od Prcfesions Code) or that he or shc is cxcmpt thqcfrom ed the basis for the allcgcd exmflion. Any violation of Seoion 7031.5 by uy applicatrt for a pemit subjets thc applicatrt to I civil pmalty ofoot morc the five hun&cd dollm ($500). _1. as owner ofthe propâ‚¬r1y, or my employees with wages as their sole compensation. willdo the work and the structure is not intended or offered for sale (Sec.7M4, Business and hofessions Code: The Contractor's Licensc Law docs not apply to an owner of the property who builds or improves theron. and who does such work hirnself or herself or through his or her own employees. provided that such imp,rovonents are not intenderJ or offerd for sale. lf, hower/er. the building or improveme-nt is sold within onc yâ‚¬xu of completion, the Or,vner Builder will have the burden of proving that he or she did not build or improve the propoty for the purposc of sale). _1. as o\lner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7U4, Business and Prrofession Code: The Contractor's License Larv does not apply to an owner of property rvho builds or improves thereon. and who contracts for such projects with a Contracto(s) licorsed pumuant to the License Law). _l am under I hereby ofperjury one ofthe _l have and rvill maintain a Certificate of Consent to Self-lnsure for compensalion, as provided for by Section -3700 of the Labor Code. for the performance of the work for which the pcrrnil is issued. _l have and will maintain workers' compcnsation insurance. as required by Section 3700 of the Labor Code, for thc pcrformance of the work for which this permit is issued. My workers' compensation insurance carier and policy numbcr are: this r _t certi& that in the perforrnance of the work for which this perrnit is issued. I shall not employ any person in any manner so ns to become subject to the work6s'compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the l-abor Code. I shall. forthwith comply with thosc provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost the Section interest and attorney's fees. I hereby aflinn under penalty of perjury that I arn liccnsed under 9 (comrnencing with Scction 7000) of Division 3 of the Business and Professions Codc, and my liccnse is in full forcc and effcct. License Class: License Number: W I hercby alfim unda penalty of pâ‚¬rjury that th6c is 8 coBtruction lcndiog agflcy for thâ‚¬ psfomucc of thc work for which this pgrnit is isucd (Se. 3097. Civ. C.). Lender's Narne: Policy Number: Expires: l.endcr's Address: APPLICANT DECLAITATION I ho,*y affinn under penalty of perjury one of the following declarations: Demolition Permits-Asbestos NotiFrcation Fcderal Regulations (Title 40. Part6) -Required Letter of Notification _l certi& that the federal regulations regarding asbestos retnoval are not applicablc to this project. _l certi0 that I have read this application and state that the above ordinances and State Laws relating to and above mentioned property for inspeaion Applicant or Agent Permitee'nRnle is correct. I agree to cornply with all City and County representatives of this City and County entc"r upon APPROVALS DATE ID/SIG COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire Alarm lDampers Communications Cable Building Under Slab / Floor Bonding I Groundins / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Roush Ceilinqs (T-Bar Rouqh) Meter Release Rough Service Meter rl ,- FINAL tb /, h.T'u c( r3-, Notes, Remarks, Etc.\../lt Rev. 08-07-2015 -. B. to Contractor:_