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ELECTRICAL.I NSPECTOR RECOR D APPROVALS DATE ID/SIG COMMENTS Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding I Groundins I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) Meter Release Rouqh Service Nleter t-,l/t FINAL s "t I ,\r}ffi7 v/ Notes, Remarks, Etc. OWNIi,R BUIT,DI'R DI'I,CARATION I hcrcby affirm under penalty of perjury that I am exempt from the Contractors' License l-aw for thc following reason (Sec.7031.5 Business and Prolbssion Codc): Any City or County which requires a permit to construct, alter, irnprove, dcmolish or rcpair any structure. prior to its issuance. also requires the applicant for such pernrit to file a signed slaterEnt that hc or she is licensed pursuant to the prnvisions ol'thc Contractor's Liccnscd l^aw (Chaptcr 9. Commcncing with Section 7fiX) ol'Division 3 ol'the Busincss and Professions Code) or that lrc or she i.s exempl therefronr and tlre basis for tlrc alleged exenrption. Any violation of Section 7031.5 by any applicant for a pennit subjects the applicant to a civil penalty of not more than five hundred dollars ($5tttt1. _1. as owner ol'thc propcrty. or my employccs with wages as their solc compcnsation, will do the work and thc strwture is not inten&d or oflerctl for salc (Sec.7M4. Business and Prolessions Code: Thc Contractor's Licensc l-aw rlocs not apply to an owrrcr o[ tlre pnrprty wlro builds or inproves thereon, ud wlro does such work himself or lrerself or through his or her own employees, providcd that such improvcnrcnts arc not intendcd orollered for salc. [l. hcrwever, thc building or inprovenrcnt is sold within orc ]tar of completioq thc Owrrcr Builder will have the burtlen of proving that lrc or she did not buikl or improve 0rc propaty for thc purposc of sah). _1. as owner of the pnrpcrty, am exclusively contracting with licenscd contractors to construct tlr project (Sec. 7Og. Busirrcss urd Profession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projccts with a Contractor(s) licenscd pursuant to thc Conuaclor's Licensc l-aw). -IantexenptunderSectiott-,B'&P.C.forthisreason. WO RK F]R^S' COM PT]IISATION DECLARATION I hercby affirm undcr Jrcnalty of perjury onc of thc tbllowing declarations: _l have and will nuintain a Certilicate of Consent to Self-Insure for workers' con4rcnsation, as provided for by Section 3700 of the [:bor Code, for thc perfornuncc of thc work for which the pcrmit is issucd. _l have and will nraintain workers' comJrcnsation insurance, as required by Section 3700 of thc l-abor Code, for llrc performance of the work for which this Jrcrmit is issucd. My workcrs' compensation insurance carrier and policy number are: carrier: 1Ufi f Policy 9 'l - Ll _l ccrtify lhat in the ;rrfornuncc of thc work f<rr which this grcrmit is issucd, I shall not cmploy any pcrson in any Inanncr so as to becorrc subject to the workcrs' corrrpensation laws of California. and agrce that if I should becotnc subjcct to the workers' conrpcnsation provisions of Section 3700 of the Labor Ctxle, I shall, forthwilh conrply with thosc provisions.. WARNING: Failure to secure workers' civil fines up t() one hundred thousand Scction 3076 of thc Lakrr Codc, intcrcst compensution coverage is unlaw[ul, and shall ernploycr to criminul penahics and dollars ($100.000). in addition to lhe cost danuges as provided for lhc and attorrrcy's l'ecs. 9 - lz,D I hereby affirnr under ;rcnalty of perjury tlut I anr licensed under provision 9 (conrnrcncing with Sectbn 7firu) of Division 3 of the Bu.siness and Professions Code. arxl my license is in full force and effect. License c-xt a o ot3 Dare: g' lL- aO I hereby al'lirm under pcnalty of perjury that therc issued (Sec. 3097. Civ. C.). Lender's Nanre: a Jrcrlbrmance of the work lirr which this pcrrnit is [rnder's Address: A PPI,ICA NT DECI,ARATION I tucby affimr undcr Jrcnalty of pcrjury onc o[ thc following dcclarations: Dcnxrlition Pernrits-Asbcstos Notification Fedcral Rcgulations (Tillc 40, Part6) -Rcquircd [.cttcr of Ntxification _l ccrtily that thc fcdcral rcgulations rcgarding asbcstos rcmoval iue not applicablc to this projcct. _l ccrtify that I luvc rcad this application aud statc tlrat lhe above information is corrcct. I agrec to conrply with all City and County ordinanccs and Statc Laws rclating to building construction, and hereby authorize reprcscntatives of this Cily and County to enter upon thc above rnentioned property for inspection purposcs. *r",9-lL-4Applicant or Agent l'crnritec nanlc Bev. 08-07-2015