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ELECTRICAL.! NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNERBUILDERDELCARATION e t I hwby affrm unds poally of pcrjury thal I m excmpt ftom the CortractoB' LiceN Law for thc following rcen (Sd.7031.5 Bwines ad Profeion Codc): Any City or Couty which rcquire a pamit to corutruci, 81i6, improvq danolish or rcpair oy structue, pdor to its isswca also rcquirc thc applicot for such pconit to filc 8 signcd statmot thar hc or shc is licoscd pmuot to thc provisiom of thc Conractor's Licoscd Law (Chapts 9, Commocing wilh Setion 7000 of Division 3 of thâ‚¬ Buin* od PrcfcsioroCodc)orthathcorshciscxqnptthqcfromildthe bssisfortheallcgedqmption. AnyviolationofsetionT03l.5byay applicant for a pemit subjets the applicmt to a civil pcnalty of not morc thm five hundrcd dollus ($500). _1. as o\vner of the property, or my ernployees with wages as their sole cornpensation. willdo the work and the struclure is not intended or offered for sale (Sec.7M4. Business and hofessions Code: Thc Contraclor's License [^aw does not apply to an owner of the property who builds or improvâ‚¬s theron" and who docs such work himself or herself or through his or her own employecs. provided that such hnprovanents arc not intended or offered for sale. If. however. the building or improvement is sold within one year of complaion. the Orvner Builder will have the burden of proving that he or she did not build or irnprove the propoty for the purpose of sale). -1, as owner of the p,ropâ‚¬rty, am exclusively contracling with licensed contractors to construcl the projcct (Scc. 7044, Bsiness and Pr,ofâ‚¬ssion Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves ther@n. and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Law). -l am exempt under Section-, B. & P.C. for this reason. flo t a. WORKER.S' COMPEN SATIO N DECT,ARATION I hereby affrrm under penalty of perjury one of the following dcclarations: _l have and will maintain a Certificate of Conscnt to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code, for the performance of the work for which the pcnnit is issued. _l have and will rnaintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the perfonnance of the work for rvhich this permit is issued. My workers' compeflsation insurance carrier and policy number .re: Policv Numbcr: Exoires: _l certify that in the pcrforrnance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'compensation laws of California. and agree that if I should become subject to the workers' cornpensation provisions of Section 3700 of the Labor Code, I shall. forthwith cornply with those provisions.. WARNING: Failure to sccure workers' compcnsation covcragc is unlawful, and shall subject an cnrployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000), in addition to thc cost of compcnsation, damages as provided for the Section 3076 of the tabor Code, interest and attorney's fees. Dofo. Annllnont. LICENSED CONTRACTOR DECI.ARATION I hereby affrrm under penalty of perjury that I am licensed under provision of Chapter 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and cffect. Liccnse Date: Contractor:_ CONSTRUCTION LENDTNG AGENCY I hereby affrm under penalty of perjury that thoe is a construction lending agency for the performance of thc rvork for which thls issued (Sec. 3097, Civ. C.). r{ennit is \I-crndcr's Namc: Lender's Address:) APPLICANT DECLARATION I hercby aflirm under penalty of perjury one of the following declarations: Demolition Permits-Asbcstos Notification Federal Regulations (Title 40, Part6) -Required Letter of Notification _l certi& that the federal regulations regarding asbestos removal are not applicable to this project. -l ccriry rhat I havc rod this application md statc that the abovc infomtion is corccl. I agrc to comply with all City ud Couty ordimncG ud Statc lrws rclaring to building constructioq ad hoeby authoria rcprmtstivB of this City 4d County to mtq upoo thc abovc mmtioned prcpqty for impcrion purpose. Applicant or Agent Pcrmitce nRme I)qlo' Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire AIarm I Dampers Communications Cable Building Under Slab / Floor tl Bondinq I Groundinq / UFER o ,7t tLl CItr&(K 7 Transformers ,t Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Roush Ceilinqs (T-Bar Rouqh)I Meter Release I (/-Dft*t'/ / Rouqh I -l A ll .a Service Meter (/v\Qtfra / FINAL t5 lE Dd-{lt'';a Notes, Remarks, Etc. D6q2 nA n7 nn4R a q