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ELECTRICAL.INSPECTOR RECORD no n7 on.t tr APPROVALS DATE ID/SIG.COMMENTS +. D !OWNER BUILDER DELCARATION I hcrcby aflirm undcr lrcnalty of pcrjury thal I m erempt frcm thc Contrrcto6' Licensc ljw for tlE following rcmn (Sc.7031.5 Busincss aid Profcssion Code): Any City or Counly which rcquircs a lumit to construcl, alts, improvc. dcmlish or rclEir ey structurc. ,rk r to ils issuance, .L$ rcquircs lhc rpplicant for such pcrmit to filc a sigrcd statcmnt that hc or dE is liccnrcd pusuant to lhc pDvisions of thc Contraclor's Licensd hw (Chaptcr 9. Commncing wilh SBtion 70OO of Division 3 of thc Busircss od Prcfcssions Codc) or that hc or shc is crcmpt thcrcfrom ed the basis for thc lllcgcd cxcmption. Any violation of Sstkrn 703 1.5 by any applicant for a lEmit subjecls ]hc applicant to a civil pcnalty of not mrc than fivc hundrcd dollus ($500). -1. as owncr of thc propcrty. or my employccs with wagcs as thcir solc cornlrcnsution. will do thc work arxl thc stnrcturc is not intcndcd or offcrcd for salc (Scc.7044. Busincss and Professions Code: Thc Contractor's Liccnsc Lrw docs not apply to an owner o[ thc propcrty who builds or improves thcrcon. and who drrcs such work himself or herself or through his or hcr own cmployccs, providcd thut such irnprovcmcnts arc not intcrrdcd or oflbrcd for sah. lf. howclcr, the building or irnprovcrncnt is sold within onc )rcar of comphtion, the Owncr Buildcr will have the burden of proving thal he or she did not build or improve the propcrty fbr thc purpsc of salc). -1, a.s owncr of thc propcrty, am exclusivcly c<lntracting with liccnsed contractors to construct thc projcct (Scc. 7W. Busincss and Profcssion Codc: Thc Contractor's License Law docs not apply to an owncr of proJrerty who builds or improves lhcrcon, and who conlracts for such projccts with a Contracto(s) liccnscd pursuant to thc Contractor's Liccnsc Lrw). _l anr cxcnlpl undcr B. & P.C. for this reason. Il.,r ^.(1.-^--. WORKF' RS' COM PENSATION DECT ARATION I hcrcby affirrn undcr pnalty of pcrjury onc of the following dcclarations: -l havc and will maintain a Certifrcate of Conscnt to Sclf-lnsurc for workers' compensation, as providcd for by Scction 3700 of the Labor Codc. for thc lrcrfornuncc of thc work for which thc ;rcrmit is issucd. -l havc and will maintain workers' comFrcnsation insurancc, as required by Section 3700 of the labor Codc, for thc lrcrfornunce of thc work for which this permit is issued. My workcrs' comJrcnsation insurancc carrier and plicy number are: i)n Policy t ,c6 lz I lzc;zz -l ccrtily that in thc pcrformancc of the work for which this Jrcrmit is issued. I shall not cmploy any lrcrson in any nr&nncr so as to bcconrc subject to thc workcrs' compensalion laws of California. and agrec that if I should bccorrc subjcct to thc workcrs' compcnsation provisions of Section 3700 of thc [-atxrr Code. I shall. tbrthwith comply with thosc provisions.. WARNING: Failurc to sccurc workcrs' compcnsation coveragc is unlawful, and shall subjcct an crnploycr to criminal pcnaltics and civil fincs up to one hundred thousand dollars ($100.000). in to lhc of compensation. damagcs as providcd for thc I Scction 3076 of thc intcrcst and attorncy's fccs. L I hcrcby affirm undcr penalty of perjury that I am licensed undcr provision of Chapter 9 (cornmencing with Scction 7m0) of Division 3 of the Busirtcss and Profcssions Codc, and rny liccnse is in lull force and cffbct. 'U Liccnsc 'C--\O Nunrbcr: o a W I hcrcby offrm undcr lEnalty of perjury that tlm is a construdirn lcnding 8gercy for the perfome of thc eort for which this tEmit is issucd (Sc. 3097. Civ. C.). bndcr's Nom: lrndcr's Addrcss: APPLICANT DFCL ^ RTITION I hcrrty affirm undcr pnalty of pcrjury one of the following declarations: Dcmolition Permits-Asbcstos Notification Fedcral Rcgulations (Titlc 40. Part6) -Rcquircd lrttcr of Notification -l ccrtify that thc fcderal regulations regarding asbeslos rcmoval arc not applicablc to this project. D, ccrtify that I havc read this application and state rhat rhe abovc information is correct. I agrere to comply wirh atl Ciry and County ordinanccs and Statc Laws rclating to building authorizc reprcscntativcs of this City and County to entcr ulnn thc abovc mcntioncd propcrty for inspection Applicant or Agent Pernritee ion. and i Site-Work Underground Pole Bases Light Standards Spas, Poo!, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor l).-\ Bondinq I Groundins I UFER blq /zt Z-Ly i\t Transformers I V Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walts (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh)//.,.<- lVleter Release lo/a ht ) I Rough I Service N/eter tbl 4 / z-t LrJ -71 FINAL tt>/i ht Notes, Remarks, Etc.l'l fJ^. Dale:_