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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEITARATION I hrcby allirm undr pcnalty of pajury thar I m cxempt fipm thc Conusctoo' Licoc Law for thc following rcon (Se.7031.5 Bsincs illd Profsion Codc): Any City or County which rcquirc a ponit to @Ntruc1 alta. improvq donolish or rcpair oy structu.q prior to its isumcc. also rcquirc thc applicat for such pcmit to filc a signcd stat@cnt that he or shc b licoscd pt$mt to thc provisiore of the Contractor's Licoscd taw (Chspts 9, Commcing with Sation 7000 of Division 3 of thc BBins md PrcfcsionsCodc)orthatheorshcisqanptthrefromedthcbssisforthcallegedcxmpion. AnyviolationofSetionT03l.5byany applicant for a pemit subjets thc applicut to a civil pcnalty of not morc thm livc hundred dollrs ($500). --1, as owner of the property, or my cmployecs with wages as their solc compensation, will do thc work and the structure is not intcnded or offered for sale (Sec.7044. Business and hofessions Code: The Contractor's License l-aw does not apply to an owncr of the propcrty who builds or improves thcron, md who does such wort hirnself or hcrself or through his or her own employees, provided that such improvanents are not intcnded or ofFood for sale. If. howerrer. the building or improvemcart is sold wilhin one )â‚¬zr of cornplaion, the Orvner Builder will have the burden of proving tha he or she did not build or improvc the propoty for the purposeof sale). -1. as owner of the propcrty. am exclusively contraciing with licersed contractors to con$ruc1 thc project (Sec. 7044, Busiricss and hoftssion Code: The Contractor's License Law does not apply to an owner of property who builds or irnproves thereon, and who contracts for such projects with a Contracto(s) licenscd pursuant to the Contractor's License t aw). -l am exempt under Sc<tion-, B. & P.C. for this reason. rloto. WORI(ERS' COMPEI\ SATION DECLARATION I hereby affrrm under penalty of perjury one of the following declarations: -l have and will maintain a Certifrcate of Consent to Self-kxurc for workers' compensalion, as provided for by Section 3700 of the I-abor Codc, for the pcrformance of the work for which the pcrmit is issued. -l have and will maintain worksrs' compcnsation insurancc, as requircd by Section 3700 of the Labor Codc, for the performance of the work fqg which this permit is issued My workers' compensation insurance carrier and policy number are: Policy ./l 3o -zr _l cerri$ that in the perforrnancc of the work for which this pcnnit is issued. I shall not employ any pcrson in any manne{ so .rs to becorne subject to the workers' compensation laws of California, and agree that if I should becorne subject to the workers' cornpensation provisions of Section 3700 of the labor Code, I shall. forthwith comply with thosc provisions.. WARNING: Failure to secure workers' compensation coveragc is unlawful, and shall subjcct an anployer to crirninal penalties and civil fincs up to one hundred thousand dollars ($100.000), in addition to thc cost of cornpensation, damages as provided for the Section 3076 of the Labor Code, interest and attorney's I)ECI,AITA'I'ION I hereby affurn under penalty of perjury that I am licensed under provision of Chapter 9 (comrnencing with Seqion 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License I hereby aflirm undcr penalty of perjury that thcre issued (Sec. 3097, Civ. C.). l,ender's Name: aSency performance of the work for which this po'rnit is Lender's Address: APPLICANT DECLARATION I hcreb}/affinn under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Lettcr of Notification _-l ccrtify that the federal regulations regarding asbcstos removal are not applicable to this project. -l certify that I have read this application and state that the above information is correct. I agree to comply with all City and County ordinancqs and State Laws rclating to construction, and hereby authorizc representatives of this City and County to entâ‚¬r upon the above mentioned property for Applicant or Agent Permitce nnme J*",3q-llzt Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Building Under SIab / Floor Bonding I Groundins / UFER l*'?-zl c>-4 4t Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Roush Ceilinqs (T-Bar Rouqh) Meter Release lo-2-? t D-P {.,1_ Rouqh t D -', -2t <l.l.-.gl ttl Service Meter lo- 7 -2 t \; FINAL lo -? -2- //{ r{z Notes, Remarks, Etc. Dr.rr na n7 nnltr, c*,io, 7M frXss I oerc: 7-? /-2-,/ ll-"{