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ELECTRIGAL.I NSPECTOR REGORD <br />APPROVALS DATE ID/SIG.GOMMENTS Omc-Buildo Dcclmtim <br />I hmby affim undcr pcnalty of pcrjury that I m cxmpt fom thc Conrrctos' Liccnse Law for thc following rcuon (scc.7031.5 Buinos <br />ed Prcfsion Codc): Any City tr Couty which Equim a pmit to @iltruct, altcr, imprcyc, &molish or rcpair uy structu., prior to its <br />issuscc, slso rcquird thc appliut fc such pcmit to filc 8 signcd $atcmot thst hc tr shc is licmscd pmumr to thc prcvisions of thc <br />Corets't Liccrucd kw (Chspt6 9, Comacing with Setion 7000 of Division 3 of thc Dsincs ed Profcssions Codc) or that hc fi <br />shc is cxcfipt thdcfrom md thc basig for thc alleged exmption ,Any violation of Scction 7031.5 by try applicur for a pcmit subjccs thc <br />applicmt to a civil pcnalty ofnot m@ the fivc hudrcd dolls ($500). <br />-1, <br />6 ownq of thc Frcpcfty, or my cmployccs *ith wagc r thcir iolc compmsatioo, will do lhc work ud thc srudw it not intodcdq olTqcd fa 38le ( Scc.7044, Buitrs ed Prcfcsims Codc: Thc Cotrrctq's Limsc Law dcs trot apply to I omcr of thc prcpcny <br />who builds or improve thmo, ud who des suclt work hiruclf u h6clf s thrcugh hir o ha own cmploye, providcd that such <br />improvcmats uc not intsndcd o off@d fd salc, I( howcva, thc building or imprcvmar is sold within onc ycr of complction, thc <br />Oma-Builda will havc thc burdm ofproving that hc o shc not build or improvc for thc purpmc of salc). <br />-1, <br />o owncr of thc prcpcrty, m cxcluivcly mtrcting with licmscd contrrctm to construct thc projcct ( Scc. ?044, Buinqs md <br />Prof6sion Codc: Thc Confrrctor's Licasc Llw dm nor apply to u owncr of propcrty who builds c improv* thaon , md who <br />contrrcts for such prcjccts with a Contracto(s) limscd pursumt to thc CoEactor's Liccnsc Law.). <br />_l arn exempt under Section ,B. & P.C. for this reason. <br />WORKERS COMPENSATION DECLARATION <br />I hereby affirm under penalty of perjury one of the following declarations: <br />_thrvcmdwillmaintainaCcatificatcofConsfittoSclf-lnsucforworkm'compasation,r prcvidcdforbyScction3To0ofthr <br />Labor Codc, for thc pcrfmmcc of thc wok for which thc pcmir is isrucd. <br />_l have and will maintain workers'requircd by Section 3700 of the Labor Code, for the perfornance of the <br />insurance carier and policy numhr are:work for which this permit is <br />Policy <br />(This section need not completed pamit is for One hundred dollars {$100} or less) <br />this is issued, I shall not employ any person in any manner so as to <br />agrce that if I should become subject to the workers' <br />compensation provisions of Section 3700 of the Labor Code, I with those,s <br />( <br />Failure to secure workers' compensation <br />fines up to one hundrcd thousand dollars ($100,000),in addition <br />the Labor Code, interest and attorney's fees. <br />I hereby allrm under penalty of pcrjury <br />the Business and Professions Code, and <br />LICENSED CONTRACTORS DEC LARATION <br />that I am licensed undcr provision of Chapter 9 (commencing with Section 7000) of Division 3 of <br />my license is in full force and effect.rLicense <br />(D <br />CONSTRUCTION LENDING AGENCY <br />I hrcby allim undcr pmalty of pcrjury that thm is a comtructim lcnding agency fs Oic pcrfmmcc of rhc wsk ftr which this pcmit is <br />issucd (Scc. 3097, Civ. C.). <br />Lcrds's Nmc: <br />Lender's Address: <br />APPLICANT'S DECLARATION <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part 6) <br />_ Required Letter of Notification <br />_l certify that the federal regarding asbestos not applicable to this project. <br />lfniry that I have read this information is correct. I agree to comply with all Ciry and County <br />ordinances and State Laws relating <br />above mentioned property for <br />Applicant or agcart <br />Permittee name <br />and <br />hercby authorize rcpresentatives of this City and County ro enter upon the <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm I Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough)7p7/a-;VJ <br />Ceilings (Hard & Soffit Rough ?bz/L{.t(tL <br />Ceilings (T-Bar Rough)I / <br />Meter Release \D *Y <br />AP'I tl <br />Rough ryz,Og,^l! [ l' <br />Service Meter <br />-A fl)Lf ,/ r\v <br />FINAL q-A'{ / A\nPthn yL \ tl sr <br />Notes, Remarks, Etc. <br />oL <br />a44<2 <br />d( <br />U <br />e <br />Date: Owner: <br />ts and shall