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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq // Under Slab / Floor v/4%7',U khtrb,tfit$ Bonding I Grounding I UFER I Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) N/eter Release Rouqh Service N/eter r/\r,.*) FINAL IUru}J atab)tY) Remarks Etc. Y1llU l'- \ tlt ILUjY f:ffun \fitrI v1 I\-..J t)0 OWNIiR B UII,DER DIiI,CARATION I hereby affinu under penalty of perjury that I arrr exempt fronr the Cbntractors' License l-aw for the following reason (Sec.7031.5 Busincss and Profession Codc): Any City or County which requircs a permit to construct, alter. improve. demolish or repair any structure, prior to its issuance. also requires tlre applicant for such yrernrit lo fih a signed slalernent that lr or she is licerrsed pursuant to thc provisions of the Contraclor's l,iccnscd l-aw (Chaptcr 9, Commcncing with Scction 7fi)0 of Division 3 of thc Business and Professions Code) or that he or she is exempt therefronr and the basis for tlrc alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects thc applicant to o civil penalty of not morc than five hundred dollars ($500). _1. a-s owncr of the propcrty. or my cmployecs with wagcs as their snlc compensation, willdo thc work and the structure is not interxlcd or offered for sale (Sec.7tX+. Business and Professions Codc: Thc Contractor's Licensc Law docs not apply to an owner of the proprly wlro builds or inrproves thereon, and wlto does such wort himself or herself or ttrough his or her own employees, provided that such improverncnts iuc ff)t intcndcd orollcrcd for sale. Il, however. thc building or improrrcment is sold within one year of completion, the Owrrr Buil&r will have the burden of proving ttrat hc or she tlid not buikl or inprove Orc propary for the purgrse of sale). _1. as owner of the propertyi am exclusivcly contracting with liccnscd contraclors to construcl the proict (Sec. 7044, Business anJ Professi<rn Code: The Contractor's License Law dtrcs not apply to an owner of property who builds or improves thereon. and who contracts for such projccts wilh a Contractor(s) licenscd pursuant to the Contractor's Liccnse Law). -Iantexenlptun<JerSectiort-'B.&P.C'tbrtltisreason. WORKERS' COM PIiNSATION DECLARATION I hcrcby affirrn undcr pcnalty of pcrjury onc of thc lirllowing dcclarations: _l have arx! will nraintain a Certiticate of Consent to Self-lnsure for workers' con4rcnsation, as provided for by Section 3700 of the Lahor Codc, for thc 5rcrlonnancc of the work lbr which the pcnnit is issued. _l have and will nuintain workers' conrpeusation insurance, as required by Sectittn 3700 of the L-abor Code, for the perfornrurce of thc work frlr which this pcrnrit is issucd. My w<lrkcrs' cornpcn.sation insurancc carricr and plicy numher are: SiV{ On,,---e o?-ouaoZ IPolicy _l ccrtify that in the pcrfornuncc of tlrc work for which this prmit is issucd, I shall not cnploy any pcrson in any manncr .so as lo bccornc subjcct to thc workers' corrrpcrrsation laws of California. and agrce that if I should becorne subjcct to the workers' conrpensation provisions of Section 3700 of the labor Code, I slrall, forthwith comply wilh thosc provisions.. WARNING: Failure to secure workers' compensation coveragc is unlawful, and shall subject an employer to criminal pnalties and civil lines up to orrc hurdred thousanrl dollars ($100.000). in .Scction 3076 of thc Latnr Codc, interest and attorncy's fees. danuges as provided for lhe DECLARATION I hereby affirnr under penalty of perjury that I anr licerrsed untler provisiorr of Chapter 9 (contmcncing with Section 7000) of Division 3 of the Business and Professions Code. and my liccnsc is in full force and effect. Liccnse BI ,rrr (b ' Z3'k) CONSTRUCTION LENDING AGENCY I hcrcby al'lirm undcr pcnalty of pcrjury that thcrc is a construction hnding agcrrcy for the perl'ormance of the work lbr which this permit is issued (Sec. 3097. Civ. C.). knder's Nanre: I-cnder's Addrcss: APPI,ICANT DECI,ARATION I hrcby affimr undcr Jrcnalty of pcrjury onc of the folklwing dcclarations: Dcnxrlition Pcrnits-Asbcstos Notification Fccleral Rcgulations (Tille 40. Part6) -Rcquircd Lcttcr of Notification _l ccrtify that thc fcdcral rcgulations rcgarding ashstos rcrnoval arc not applicablc to this projcct. _l ccrtily that I lravc rcad this applicatiort and statc tltat inltlnnation is corcct. I with all City antl County ordrnanccs and Statc Laws rclating to building and County to enter upn thc above rnentioned property for a c0st Applicant or Agent l'crntitce nanlc Rev 15 of