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ELECTRICAL.INSPECTOR R ECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby aflinn undcr pcnolly of pcrjury that I m excmpl fmm thc Conlracton' Liccns Law for thc following rclmn (5@.7031.5 <br />Busincss ond Profcssion Codc): Any Cily or County which rcquircs a tsmit to conslruct, altcr, improve, dcmlish or rcpair my <br />structuc. prior to its issuancc, also rcquircs thc applicmt for such Fmit to Iilc a signcd statercnl lhBt hc or she is liensd pusuut <br />to lhc pmvisions of the Contractor's Liccned kw (Chsptcr 9. Comrcrcing with Scction 7m0 of Division 3 of lhc Busiress tnd <br />PmfcssionsCodc)orthathcorshcisexcmplthcrcfromandthcbasisforthcallcgcdcxcmption. Anyviolationofscction?0-ll.5byany <br />applicant for a pcrmit subjccts the applicant to I civil pculty of not morc than livc hundrcd dollss ($500). <br />-1. <br />as owncr of thc propcrty. or my cmployccs with wagcs as thcir solc compcnsation. will do thc work and thc structurc is not <br />intendcd or offercd for salc (Scr.7044. Business and hofcssions Codc: Thc Contractor's Liccnse Law does not apply to an owncr of <br />thc propcrty who builds or improvcs thcreon, and who docs such work himsclf or hcrsclf or through his or her own employecs. <br />providcd that such improvcnrnts arc not intcrdcd or offcrcd for salc. lf, howcvcr, thc building or inprovcnpnt is sold within onc )rcar <br />of complction. thc Owner Buildcr will have tlre burdcn of proving that hc or shc did not build or irnprove tlrc prcpcrty for thc purposc of <br />salc). <br />-1. <br />as owncr of thc propcrty, am cxclusivcly conlracting with liccnscd contractors lo conslruct the proict (Scc. 7W, Busincss <br />and h,ofessiorr Code: Thc Contractor's Liccnsc Law does not apply to an owncr of property who builds or improvcs thcreon. <br />and who conlracls for such projects with a Contractor(s) licenscd pursuant to thc Contractor's Liccnse Law). <br />-IamcxemptundcrScrtion-.B'&P.C.forthLsrcason.rl.. r ^. <br />TOBtrEEIIO!4EENSAIqN <br />DECI.ABAIIAN <br />I hercby affrmundcr Fmltyof pcrjuryonc of the followirg d$luations: <br />I <br />-thaveardwillmintsiosCertilrcateofconsenltoself-lnsurcforworkcrs'compcnetioo,as <br />prcvidcdforbySstion3TOOofthc <br />Lrbor Codc, for the pcrformce of the work for whhh thc pqmit is issuc{. <br />bktra"c ana *itt maintain workeB' comlrcnsalion insumrce, s rcquircd by Setion 37OO of the tibor Codc, for thc Frforlrec of <br />thc work lbr which this is issucd. My workers' comJrcnsatiorr insurance carrier and Jxrlicy nurnbcr arc: <br />t <br />-l <br />ccrtify that in thc performancc of the work for which this prmit is issucd. I shall not cmploy any lrcrson in any manner <br />so as lo bccome subjcct to the workers' comlrcnsation laws of California. and agrcc that if I should bccomc subject to thc <br />workcrs' compcnsation provisions of Section 3700 of thc l-abor Codc, I shall. forthwith cornply with thosc provisions.. <br />WARNING: Failure to secure workers' compcnsation coveragc is unlawlul. and shall subjcct an employcr to crinrinal pcnaltics and <br />civil fincs up to onc hundred thousand dollars ($100.0001. in addition cost of comlrcnsation. damagcs as providcd for the <br />Scction 3076 of the l;rbor Codc, intcrcst and altorncy's fccs. <br />q""",6f frf yr <br />LICENSED CON'I'RA CTOR <br />DECLARATION <br />I hcrcby affirrn undcr pcnalty of prjury thal I am liccnsed undcr provision of Chaptcr 9 (comrrrcncing with Scction 7000) of Division 3 <br />of thc Business and Profcssions Codc. and my liccnsc is in full force and cffcct. <br />/Licensc C Nurnbcr: <br />6 <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby affirm undcr Jrcnalty of lrcrjury that therc is a construction lcnding agercy for thc pcrformrcc of lhc work for which this lErmit is <br />issucd (Sc.3097, Civ. C.). <br />lrndcr's Namc: <br />hnder's Address: <br />APPLICANT DECI {RATION <br />I hcrcby alfrm undcr pnalty of perjury onc of thc following dcclarations: <br />Dcmolition Permits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6) <br />_Rcquired lrtter of Notification <br />-l <br />ccrtify that the t'cdcral rcgulations regarding asbcstos rcmovalarc not applicable to this projcct. <br />statc that thc abovc intbrmation is corrcct. I agrec to cornply with all City und County <br />and County to cntcr uJnn thchcrcby aulhorizc rcprcscntatives of this City <br />abovc nrcnli<lncd propcrly firr inspcclion <br />?Appticant or Agent <br />\Pemile name (prinl): <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltase <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Groundinq / UFER / <br />Transformers \ <br />Torqueinct <br />Sub-Panels \ <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh)d,tlz,,l-A20 <br />Ceilings (Hard & Soffit Rouqh qlAb,llAa \ <br />Ceilinqs [-Bar Rouqh)t I / <br />N/eter Release <br />Rouqh <br />Service N/eter / <br />FINAL Q/rh,JK% <br />Notes, Remarks, Etc.'l <br />) <br />El,-'.r nO n7 rrn{ q <br />Owner:_ <br />il/4t /?7JExpircs: <br />a <br />L', C. <br />) <br />*,", i/??f 7