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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hseby allim unde pcnalty of pcdury tha I m cxmpt from thc CoilracloB' Licw kw for thc following @n (Se.7031.5 Bwincs and Profeion Codc): Any City or County which requirB a pqtnit to construct. altc, improvc, <bnolish or npair gry structurq prior to its isswcc, also rcquirc thc applicmt for such pcmit to file a signcd stdmat thst hâ‚¬ or shc b lic@scd pw@t to the prcvisioro of thc Contnctor's Licenscd Law (Chapttr 9, Commcncing with Setiotr 7000 of Divhion 3 of the Busincs ud Prcfe$ioru Codc) or that he or shc is cxcmpt thqcfrom ud the bcis for thc sllcgql qmption. Any violation of Scrion 7031.5 by any applicmtforapermitsubjetsthe applicanlloscivilpcnaltyofnotmorethillivehundreddollus($500). -1. as owner of the property. or my employees with wages as their sole compensation. will do thc work and the structure is not intended or offered for sale (Sc.7044. Business and Professions Code: The Contraclor's License Law does not apply to an owner of the property who builds or improves thereon. and rvho does such work hirnsclf or herself or through his or her own employees. provided that such improvements are not intended or offered for salc. lf. howerver. the building or improvement is sold within one )Ear of completion, the Or,vner Buildcr will have the burdcn of proving that he or shc did not build or improvc the propoty for the purpose of sale). -1, as owner of the property. am exclusively contracting with licensed contractors to construct the p,roject (Sec. 7U4, Business ard Profession Code: The Contractor's License Larv does not apply to an orvner of property rvho builds or improves thereon. and who contracts for such projccts with a Contracto(s) licensed pursuant to the Contractor's License [aw). _l am exempt under Section-. B. & P.C. for this reason. I.lo i n. WORKERS' COMPENSATION DECLARATION I hereby affirrn under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compcnsation. a.!i provided for by Section 3700 of the Labor Codc, for the po'formance of the work for which the permit is issued. k:have and will rnaintain workers' compcnsation insurance. as requircd by Section 3700 of the labor Code, for the perflonnance of work for which this pcrmit is issued. My compensalion carrier and policy nurnber are: (o I I /zzPolicyT--t -l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any mannâ‚¬r so .rs to become subjert to lhe rvorkers' compensation laws of California. and ag,ree that if I should bccome subject to the rvorkers' compâ‚¬nsation provisions of Section 3700 of the Labor Code, I shall. forthwilh comply with thosc provisions.. WARNING: Failure to secure workers' compensation coverag,e is unlawful. and shall subjert an employer to criminal ponlties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of cornpensation. damages as provided for the Section 3076 of the Labor Code, interest and attorney's fees. 2L I ha'eby affrm under penalty of perjury that I arn licensed 9 (corrunencing rvith Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effcct. License 2 C-- Dere: lo 1o b /'?.1 e_ //W I hcby aflm udo pcnalty of pqjury thar thqc is a construction knding agocy for the pafomcc of thc wort 6r which this p6nit b issued (Se. 3097, Civ. C.). I-ender's Name: Lender's Address: APPLICANT DECLARATION I ha*y affirm undcr penalty of perjury one of the follou,ing declarations: Demolition Permits-Asbestos Notification Federal Regulations (Titlc 40, Part6) -Required Letter of Notifrcation _l certify that thc fcderal regulations regarding asbestos removal are not applicable to this project. with all City and County and County to enter upon'thc above mentiond properry for Applicant or Agcnt l'crnritee name (print): state that Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Building Under Slab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Roush) Meter Release ls4 4A T Q,4A Rough Service N/eter F!NAL lD-?- zt p1 fr Notes, Remarks, Etc. E)r.rr na n7 nn{ q Owner: Expires: o*r, l0W