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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hcrcby offirm undcr penalty of lsjury that I m excmpt ftom thc Contr.clos' Liccns kw for lhe followiog Easn (5â‚¬.7031.5 Busincss and Profcssion Codc): Any City or County which rcquircs a Jf,rmit to snstrud, alts, itrprcvc, demlish or rcpir uy structurc, prior to its issumc, also rcquircs the applicsnt for such lErmit to filc a signcd statcmnt that lrc or shc is licenEd pusuaili to the pDvisions of lhc Contmctor's Liccnsd lav (Chaplcr 9, Comrcing with Setioo 7000 of Division 3 of the Busircss ed PrcfcssionsCodc)orthathcorshciscxcnrptthcrcftomandthcbsisfortheallcgedcxcmption. AnyviolationofsctionT03l.5byany applicant for a pcrmit subj$is thc spplicant to a civil pcnslty of not mrc thq fivc hundred dolles ($500). -1. as owner of thc propcrty, or my employees with wagcs as thcir solc compcnsation, will do thc work and the stnrcturc is not intcndcd or offcred for salc (Scc.704+. Busincss and Profcssions Codc: The Contractor's Liccnsc [-aw does not apply to an owner of thc propcrty who builds or improvcs thereon, and who does such work himself or hersclf or through his <lr her own employees, provided that such improvcrncnts are not intendcd or offcrcd for sah. If, howcvcr. the building or improvcnrnt is sold within one )rcar of complction. thc Owncr Buildcr will havc the burdcn of proving lhat hc or she did not build or inryrrove thc proprty for thc purynse of salc). -1. as owner of the propcrty, am exclusivcly contracting with liccnsed contractors to construct the projcct (Scc. 7W, Busincss and holbssion Codc: Thc Contractor's License Law does not apply to an owner of property who builds or improves thercon, and who contracts for such projccts with a Contracto(s) liccnsed pursuant to thc Contractor's Liccnse Law). _l am cxcmpt undcr B. & P.C. for this rcason. Owner: w(r ru< r' ns t'oM Pr.r\I.s A Tlox DT'CLARATION I hcrcly affirm undcr pcnalty of perjury one of the following dcclarations: V , nou"and will maintain a Ccrtificate of Conscnt to Sclf-Insurc for workers' compensarion, as provided for by Section 3700 of the I-uUor Codc. for thc performance of the work for which the pcrmit Ls issued. -l havc and will maintain workers' compensation insurance, as rcquircd by Scction 3700 of thc l-abor Code, for the performancc of the work for which this permit is iszued. My workers' compensation insurancc carrier and policy numbcr are: .rD(lrrter: t -Policy -l ccrtify that in the;rrformance of thc work for which this grcrmit is issucd, I shall not cmploy any [rcrson in any manncr so as to bccome subject to thc workcrs' compcnsation laws of California. and agrcc thal if I should becomc subjcct lo thc workcrs' comfrcnsation provisions of Section 3700 of thc l-abor Codc, I comply with those provisions.. WARNING: Failurc to sccurc workcrs' comlrcnsalion coverag,c shall subjrrt an cmploycr lo criminal pcnaltics and civil fincs up to onc hundrcd thousand dollars ($100,000;, Scction 3076 of the [:bor Code, interest and attorrrcy's f'ccs. cost damagcs as providcd for thc t 1'7A-1. Ir\^. ^. I hcrcby alfirm undcr pcnalty of pcrjury that I anr liccnscd provision of Chaptcr 9 (comnrcncing with Scction 70m) ot'Division 3 of the Business and Profcssions Code, and my license is in full force Liccnse \o .1 I hcrcby affirm undcr penalty of pcrjury that therc is a issued (Sec. 3097, Civ. C.). [.cnder's Namc: lending agcncy for thc performancc of thc work for which this pcrrnit ls lrndcr's Address: APPLICANT DECI AITATION I hcrcby affrm undcr pcnalty of perjury onc of thc following dcclarations: Dcnrolition Permits-Asbcstos Notification Federal Regulations (Title 40, Part6) _Rcquircd l*ttcr of Notification -l ccrtity that the fcdcralregulations asbcstos not applicable to this projcct. inforrnation is corrcct. I agrcc to comply rcpresentatives of this City with all City and Crrunty and County to entcr u1xrn thc abovc mentioncd propcrty for Applicant or Agenl Pernritee nanre Itt that and hcreby authorize orr".- ?^L$-)l Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq I Groundinq I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rough) lVleter Release Rough Service N/eter FINAL 8"lg-Ll w(frq" Notes, Remarks, Etc. f,J,^,no n7 onl tr (r^^rl^- Applicant:_ 7