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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor Bondinq I Groundinq I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Wdls (Conduit) Walls (Rouqh) Ceilinss (Hard & Soffit Roush Ceilinqs (T-Bar Rouqh) Meter Release Rouqh /o'?zt .>st* Service N/eter a, FINAL /O-4-?l e*I fu Notes, Remarks, Etc. I hereby affrnr under penalty of prjury that I anr exenrpt from the Contraclors'License [:w for the following red\on (Sec.7031.5 Business and Prolbssion Codc): Any City or County which rcquircs a pcrmit to construct, alter. improve. dermlish or rcpair any structure, prior to its issuance. also requires the applicant for such Srernrit to file a signed slaternent that he or she b liccnscd pur$tdnt to the provisions ol'thc Contractor's l,iccnsed L-aw (Chapter 9, Commencing with Section 7000 of Division 3 of thc Busincss and hofessiorrs Code) or that he or she is exempt therefronr and the basis for the alhged exenrption. Any violation of Section 7031.5 by any applicant lor a perrnit subjects thc applicant to a civil penalty of not morc than llvc hundred dollars ($500). _1. as owner ol'thc propcrty. or my crnployees with wages as their sole compcnsation. will do the wcnk and the structure is not interxhl or oflered for sale (Scc'.7tX+, Business and Profcssions Code: Thc Contractor's Liccnsc l-aw docs not apPly to an owner of the property who builds or improves thereon, and wlto does such work himself or lrerself or througlt his or her own enrployees, provided that such improvcnrcnts are not intendcd or ollercd for sale. Il, howevcr, thc building or inprovenrcnt is sold within onc )car of completiorl thc Owncr Buik-ler will havc the burdcn of proving *ra hc or she dirJ not buikl or inprove thc propaty for thc purpose of sah). _1, as owner of the propcrty, um exclusively contracting with licenscd contractoni to construct thc project (Scc. 7044, Busirrcss arx! hohsskm Code: The Contractor's License Law does not apply to an owner of property who builds or intproves tltereon. and who contracts for such pnrjects with a Contractor(s) licensed pursuant to the Contraclor's Liccnse Law). -l :rnrexenlpt uuder Sectiott-, B. & P.C. for this reas<ltt. l)ate: TVORK I.:RS' CONT P},NSA'TION I)ECLARATION I hcrcby affirm undcr pcnalty of pcrjury onc of tltc ttrllowing dcclarations: _l have alxt will nnintafur a Certificate of Consent to Self-lnsure for workers' cnnrytensation, as provided for by Sectircn 3700 of the Labor Codc, for thc Jrcrforrnancc of the work lor which thc pcrmit is issued. arrd will nraintain workers'insurance, as by Saction 3700 of the labor Code, for thc perfornunce of lirr whiclr this is issucd.workcrs'can'ier arxl pllicy numbcr are: Policy zg-7 _l ccrtify that in tlrc 1.--rfornuncc of tlrc work f<rr which this Jrcrmit is issucd, I shall not cmploy any person in any manncr so as to bccome sutrject to thc workers' cornpensation laws of California. and agrcc that if I should become subject to the workers' conr;rcnsation provisions of Section 3700 of the Labor Code, I shall, forthwith conrply with those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employcr to criminal pcnalties and civil lines up to otrc lrundred thousand dollars ($100,0001. in addition to tlrc cost of compensation, danuges as provided for the Section 3076 of thc [:bor Cule. intercst and attorney's [ees. LICEI{SED CONTRACTOR DI}CLARATION I hcreby affrrrr under penalty of perjury that I anr licenscd under provision of Chapter 9 (conurrncing with Scction 7000) of Division 3 of the Business and Professions Code. and my license is in full force and cffect. License {Nunrber: CONSTRUCTION LENDING AGENCY I hcrcby allirm undc.r pcnalty of pcrjury that thcrc is a construction lcnding agency for the performancc of the work lbr which this pcrrnit is issued (Sec. 3097. Cir'. C.). [-cnder's Nanrc: A PPI,ICANT DECI,ARAI'ION I txrctry affrnt undcr pnalty of pcrjury onc of thc firllowing dc'clarations: OcnxrlitionJsql\Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6) -Rcquircd thc I'cdcral rcgulations rcgarding asbcstos rcmoval are not applicable to this projc'ct. _l ccrtity tlrat I havc rcad this application axl stalc tlrat the ahrvc intbrnution is correct. I agrce to conrply with all City and Couttty ordinanccs and Statc Laws relating to building construction, and hcrcby authcrrizc rcprescntatives of this City and County to entcr above rnentioncApplicant lfcrnritcc Rev. 08-07-201 5