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APPROVALS DATE ID/SIG.COMMENTS OWNT'R BUII,I)I'R I)h:I,CARATION . <br />I hereby affirnr under penalty of prjury that I aru exenlpt frorn the Contracloru'License l-aw for the following rearcn (Scc'.703'1.5 <br />lfusincss and Prol'cssion Codc): Any City or County which rcquircs a pcnnit to construct, altcr. irnprovc. dcmolish or rcpair any <br />slructure, prior to its issuance. also requires the applicaurt for such Jrcnrrit to fih a sigrcd slatemetrl that lr or she is licensed pursuanl <br />to thr. pmvisions ol' tlr Contractor's l,iccnscd Iaw (Chaptcr 9. Cornmcncing with Scction 7000 of Division 3 ot'thc Bu.sincss and <br />Professiorrs Code) ()r that lrc or slrc is exenpl therefronr and tlre ba.si.s ttrr tlre alleged exen4rtiott. Any violation of Section 703 I.5 by arty <br />applicant for a perrnit subjects the applicunt to il civil penalty of not more than five hundred dollars ($sfir). <br />lAas owncr ol'thc'propcrty. or rny ernployecs wirh wagcs as thcir sotc cornpcnsation, willdo thc work and thc structure is rnt <br />intendetl or offered ftrr sale (Sec'.7M4, Business and Professions Ctxle: The Contractor's License Law does not apply to an owner of <br />the ptopeny wlxr huilds or inqrroves lhererru, and wlxr dtrs such wrlrk lrinself or herself or lluouglr his or lter own entployees, <br />providcd that such irnprovcrncnts arc not intcndccl or olTcrcd for sah. ll. howcvc'r, thc building or irqrrovermnt is sold within one ycar <br />of completion" thc Owner Buikler will lurve tlrc burden of proving that he or she did not buikJ or inrpnrve hc propary for the purprsc of <br />sale). <br />_1. as owner of the propcrty, am exclusively contracting with licenscrl conlractors to conslruct tlre project (Sec. 7O14. Business <br />arxl Prulbssiou Code: Tlre Contractor's Licerrse l-aw drrcs not apllly to an owner of prolxrty wlro builds or intproves tltereott. <br />and who contracts frrr such profe'cts with a C()ntractor{s) liccnscd pursuant to thc Contraclor's Liccnsc L:w). <br />-IantexenrptutxlerSectiott-,B.&P.C.lbrtltisreason.o*n.r' 6 e .2/',1\ c \( s: z-- ( a' O <br />WORKIiR}CUMPENSATTON <br />DECLARATION <br />onc of tlrc lbllowing dcclarations:I hcrcby aflirnr under pcnalty ofpcrjury <br />_l have and will nnintain a Certiticate of Con.sent to Self-lrrsure for workers' conqrctxation, as pruvidetl for by Section 3700 of tlre <br />[:hor Codc, for thc Jrcrforrnancc of thc work lor which thc pcrntit is issucd. <br />_l have aml will nuinlain workers'conrpensation insurance, as required hy Section 3700 of the Latxrr Grde, ftrr lhe perf<rrnurtrce of <br />thc work lbr which this prnilt is issucd. My workcrs' conrycnsation imurancc can'icr ard plicy nunrhcr arc: <br />Policy Numbcr: lixpires: <br />$\ccrtity rhat in tttc g^-rfornuncc of tlrc work for wtrictr this pcrmit is issucd, I shall not cnrploy iury lrcrson in any nlanncr <br />so as to bccornc subjcct to thc workcrs' conrpcnsation laws of Califonria. and agree that if I slnuld bccotnc subjcct to thc <br />workers' con4rensati<lrr provisions of Section 3700 of the Labor Code, I shall, frlrthwith conrply with those provisions.. <br />WARNING: Failure to secure workers' compensation coverdge is unlawful, and shall subict an employer to crirninal pcnalties und <br />civil fines up to orre lrurrdred thousand dollars ($100.000). in addition to tlrc c<lst of comgrcmation, danuges as provided for the <br />Section 3076 of the latror Codc, intcrest and attorncy's l'ces. <br />LICENSED COTTRACTOR <br />DI'CI.ARATION <br />I hercby affrm under ;rcnalty of pcrjury tlrat I arrr licens,ed under provision of Chapter 9 (contmencing with Section 7000) of Division 3 <br />of the Business and Professions Code. arxl rny license is in full forcc arxl el'[ect. <br />License Nunrbcr: <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby al'lirrn undc.r pcnalty ol'pcrjury that thcrc is a construction hnding agr'ncy for thc pcrl'ormarrce of thc work l'or which this pcrrnit is <br />issued (Sec. 1097. Civ. C.). <br />l-cnder's Nanrc: <br />A PPI,ICANT DECI,ARATION <br />I trrchy afitnr undcr pnalty of pcrjury onc of thc firlkrwing dcclarations: <br />Dcnxrlitktn Pcrnits-Ashc'stos Notification Fctlcral Regulations (Titlc 40, Pur6) <br />-Rcquircd <br />lrttcr of Notification <br />_l ccAily that thc l'cdcralrcgulations rcgarding asbcstos rcrnval arc not applicablc to this proltct. <br />&"nily tlrar I travc rcad tlus application auxl state tlrat tlrc atxrvc infornulion is corcct. I agrce to conply with all City and County <br />ordinances and Statc laws rclating to building construction, and hcrcby authorize rcprcscntativqs of this City and County to cntcr upon thc <br />ubol'e rnentioned propefly for inspection purposes. <br />Allplit'artt or rlgenl o l\ or-{- ev <br />l'crrnilt'c q-qf <br />nete t-'(? 'a I <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Poo!, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq I Groundinq I UFER fl-Ll-Zl ,I)r.W ;g) <br />Transformers <br />Torqueinct <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouoh) <br />Ceilings (Hard & Soffit Rough / <br />Ceilings (T-Bar Roush)I \n <br />lVleter Release 6--/l-A ))w1 1,vLl -\- <br />Rouqh T-U'V( s I '?J) <br />Service N/eter u- 7\ -7) <br />FINAL -)-'16-2 I <br />Notes Remarks Etc. <br />ELECTRICAL.INSPECTOR RECORD A <br />D <br />Bev. 08-07-201 5 <br />(lrlrrtrer:lor: