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ELECTRICAL.I NSPECTOR REGORD f),..,fio rl-, fln { r:, APPROVALS DATE ID/SIG,COMMENTS O1VNER BUTLDER DEI,CARATION I hreby aflim unda pdalty of pdjury that I m cxmpt from thc ('ontncto.!' Liccnsc hw for thc followilg wn (Sa:.fr31.5 Busincs and Profesion Codc): Any City or County which rcquirc a psrnit to comtruct. alro, improvc, danoliJh or rcpair an'y. sruduq prior to its issumcc. also rcquirc thc eplicilt for such pcmit to filc a signcd statmot thd hc or $c b licqEcd puslatn to thc provisios of thc Contractor's Licenscd Law (Chaptd 9, Commencing with Sction ?000 of Division 3 of thc Busins ud Profsions Codc) or that hâ‚¬ or she is cxmp thqcfrom md the basis for thâ‚¬ allcgcd exmption. Any violation of Sction 7031.5 by my applicmt for a pcnnit subjets thc applicmr to a civil pcnally oftrol morc thm five hundrcd dollm ($500). -1. as owner of the propâ‚¬rty. or my employees with wages as their sole compemation. will do the work and the structure is not intended or offerd for sale (Sec.7044, Business and hofcssions Code: The Contractor's License Larv does not apply to an orvner of the property who builds or improves thereon and who does such wort himself or herself or through his or her own employees. provided that such imp,rovonents are not intendcd or offcred for sale. If. howwer. the building or improvemslt is sold within one year of complaion. the Orvner Buildcr will have thc hrden of proving thd he or she did not build or improve the property for the purpose of sale). -1, 8s owner ofthe property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Busincss and hoftssion Codc: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contractor(s) liccnsed pursumt to the Contractor's License l-aw). -l am exempt under Section-. B. & P.C. for this reason. l)rtlc: Orr rtcl': WO RKE ITS' CONT PEN SATION DECLARA'[ION I hereby affrrm under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for rvorkers' conlpensalion, as provided for by Section 3700 of the Labor Code. for the performance of the work for which the pennit is issued. -l have and rvill maintain workers' compensation insurance. as required by Scction 3700 of the l.abor Code. for the per-formance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Policy Number: Expires: _l certify that in the perfonnance of the work for which this permit is issued. I shall not employ any person in any manner so as to becomc subjcct to the workcrs' compcnsation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall, forthwith comply with thosc provisiotls.. WARNING: Failure to secure rvorkers' compensation coverage is unlawful. and an anployer criminal penahies and civil fines up to one hundred thousand dollars ($100.000). in addition to the as provided fcrr the Section 3076 of the Labor Code. interest and attorney's Ior,..t-, -ZS -2c) ,) I hereby afl'irm under penalty of perjury that I am licensed under Chapter 9 (cornrnencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License S'D)c W I hcby allim unda Fnalty of psjury that thqc is a @nsructbn lcnding agacy for thc psfomcc of thc mrk for which this pqmit is issued (Se. -1097, Civ. C.). Lender's Name: Lender's Address: APPI ICANT NECLAIL{TION I hoeby affurn under penalty of perjury one of thc following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Lettcr of Notification -l certify that the federal regulations regarding asbestos removal are not applicable to this project. -l certi& that I have read this application and state that the is I agree to comply rvith all City and County ordinances and State Laws relating to building construction.of this City and County to enter upon the above mentioned property for inspecrion Applicant or Agent Pernritee nttnrc D authorize l\^r ^. t-l - 75-7o)1 Site-Work Underground 65'e)lcc v r) Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Building Under SIab / Fjqar Bondins I C#undlnq / UFER '"-l ? ,? rs tuv 7 TransformeiH Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinss (T-Bar Rouqh) Meter Release b-{1 4D tucz7 >/D J9=22 /-i z2 Rough Service Meter 61f,3 14z / F!NAL t-Z.Otl rLQ')re@)-)rl Notes, Remarks, Etc.