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ELECTR ICAL.I NSPECTOR R ECOR D <br />, no n7 on{tr <br />APPROVALS DATE ID/SIG.COMMENTS I hcrcby allirm undcr lEmlty of Frjury that I m cxcmpt from thc Contraclorc' Liccnre kw for thc following rcarcn (Se.7031.5 <br />Busincss and Profcssion Ct{c): Any City or Coutrty which rcquircs a lsmit to construct. alIer, improvc. &mlish or reJnir any <br />structure. prior to its issumcc. als rcquircs thc applicant for such lErmit lo lilc a sigrcd statcmnt lhat hc or shc Ls liccnscd pursuant <br />to thc prcvisions of the Controctor's Liccnrcd law (Chaptcr 9, Comcncing with Sstion 7000 of Division 3 of thc Busiress and <br />PrcfcssionsCodc)orrhalhcorshciscxcmptth@fromsndthcbasisforthcallcgcdexemplion. AnyviolalionofScrlionT03l.5byany <br />applicant for a Jrcrmit subjcts lhc applicant lo a civil pcnalty of not mre thsn fivc hundred dollus ($500). <br />_1. as owncr of thc propcrty, or my cmployces with wagcs as thcir sole compcnsation. willdo thc work and thc structurc is not <br />intcndcd or otTcrcd for salc (Sec.7044. Business and hofessions Coclc: 'fhc Corrtraclor's Liccnse [-aw does not apply to an owner of <br />lhc proJrcrty who builds or inrproves thcrcu. and wtrc dcrcs such work himsclf or hcrsclf or through his or hcr own etnployccs. <br />providcd that such improvcnrcnts arc not intcnded or <lffcrcd for salc. If, howcvcr. thc building or inprovcnrcnt is sold within one ycar <br />of conrpletion. thc Owner Buildcr will have thc burdcn of proving that hc or shc did not build or improve thc propcrty for thc purposc of <br />salc). <br />-1. <br />as owncr of thc propcrty. am exclusively contracting with liccnscd contraclors lo construct lhe projcct (Scc. 7W, Busincss <br />and Profqssion Code: Thc Contractor's Licensc Law docs not apply to an owncr of property who builds or intprovcs thereon, <br />and who contracts for such projects with a Contractor(s) liccnscd pursuant lo thc Contractor's Liccnsc Law). <br />-lantexcmplundcrScction-.B.&P'C.forthisrcastln.I \... ^. <br />WORKI'RS' CONI I'ENSA'I'ION <br />DECLARA"I'ION <br />I hereby affirrn undcr Jrcnalty of prjury onc of thc folklwing dcclarations: <br />_l havc and will maintain a Certificatc of Consent to Sclf-lnsurc for workcrs' compcnsalion. as providctl tbr by Section 3700 of thc <br />Codc, l'or thc Jrcrformancc of thc work for which thc pcrmit is issucd. <br />have and will nraintain workcrs' compcnsation 3700 of thc [-abor Codc, for the ;rcrformancc of <br />and plicy number are:work fbr ts\ <br />tctl-'LlPolicy <br />_l ccrtify that in the pcrforrnance of thc work for which this pcrnrit is issucd. I shall not crnploy any pcrson in any nlanncr <br />so as to bccorrc subject to thc workcrs' conrJrcnsation laws of California. and agrcc that if I should bccomc subjcct to thc <br />workcrs' compcnsation provisions of Section 3700 of thc labor Codc. I shall. forthwith comply with thosc provisions.. <br />WARNING:to sccurc workcrs' compcnsatiort coveragc is and shall subjcct an cmploycr to criminal pcnalties and <br />civil fines r{one thousand dollars ($100.00O). in to thc cost of damages as provided for thc\Scctiorr intcrcst and <br />I hcreby aflirm undcr pcnalty of perjury that I arn 9 (cornrncncing with Scction 7ffn) of Division 3 <br />of thc Busincss and Profcssions Codc, and in efl'ccl. <br />, <br />Liccrtse <br />I hcrcby affirrn undcr pcnalty of pcrjury that there is a <br />issucd (Scr. 3097, Civ. C.). <br />for the pcrforrnance of thc work for which this Jrcrmit is <br />Lcndcr's Narnc: <br />[-cndcr's Addrcss: <br />A PPLICANT DT'CLARATION <br />I hcrcby affirm under pcnalty of pcrjury one of thc following dcclarations: <br />Dcmolition Pcrmits-Asbcstos Notification Federal Rcgulations (Titlc 40, Part6) <br />-Rcquired <br />lrttcr of Notification <br />_l certity lhat thc fedcral rcgulations runovalarc not applicahlc lo this projcct. <br />that thc above inforrnation is correct. I agyce to comply with <br />rcprcsentativcs <br />abovc rncntioncd propcrty tbr <br />Applicant or Agent <br />Pcrnrilee nanre <br />and <br />and <br />Z <br />and <br />rugnn thc <br />7) <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq I Groundinq I UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouqh) <br />lMeter Release <br />Rouqh <br />Service N/eter <br />FINAL <br />Notes, Remarks, Etc. <br />, <br />is,l