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ELECTRICAL-I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq / Groundinq I UFER Transformers Torqueino Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) lt/eter Release Rough Service lVleter FINAL ilt/u J6/ Z Notes, Remarks, Etc.//V OWNT]R IIUI LDER DELCA RATION I hereby affirm untler pnalty of prjury that I amexempt from the Contractors' License law for thc fotlowing tJ"*n (Sec.7031.5 Business and Profession Code): Any City or County which requires a permit to construct, alter, improve, demolish or repailrny structure. prior to its issuance, also requires the applicant for such permit to file a signed staternent that he or she is licensed pursuant to the pnrvisions of the Contractor's Licensed Law (Chapter 9, Commencing with Section 70fi) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by any applicant fur a permit subjects the applicant to a civil penalty of not rxrre than five hundred dollars ($500). _1, as owner of the pn)frertyt or my employees with wages as their srle compensation, will do thc work and the structurc is not intendetl or offered for sale (Sec.7044, Business and hofessions Code: The Grntractor's License Law docs not apply to an owner of the proSrrty wtxr truiltls or impmves thererrn. arxl wlm docs such work himself or herself or through his or her own employees, provided that such improvernents are not intended or ofhred for sale. If, however, the building or inprovenrnt is sold within one year of completion, the Owner BuiHer will have the burden of proving ttut lre or she did not buiU or impnrve the property for the purynse of sale). _1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7(X4, Business and Pnrfqssbn Code: The Contractor's License Law does not apply to an owner of property whr builds or improves thereon. and who contracts for such projects with a Contractor(s) Iicensed pursuant to the Contractor's License Law). -IamexemptunderSectirrn-.B'&P.C.ftlrthisreastln. Date: WORKERS' COMPENSATTON Ill'CLAILA,'rlON I hereby affirm under penalty of perjury one of the following declarations: _lhaveandwill maintainaCertilicateofConsenttoSelf-lnsurefrlrworkers'compensation,as providedforbySection3T00ofthe Labor Code. for the performance of the work ftrr which the permil is issued. ?$rt and will maintain workers' compensation insurance, as requiretl by Section 3700 of the Lahor Code, for the perfrlrmance of t his is My workers' compensation insurance carrier antl plicy number are: Policy ID, I,L -l certify that in the performance of the work frlr which this permit is issuetl. I shall not empk)y any person in any manner so astobeconrc subject totheworkers'compensation lawsof California. andagreethat if I slnukl becorne subject tothe +,workers' compensation provisions of Section 3700 of the l-atxrr Code, I frrrthwith comply with those pnrvisions.. WARNING: Failure to secure workers'compensation ts and shall subject an employer to criminal Jrenalties and civil fines thousand dtlllars to the cost of damages as provitied for the Section interest and (_ I hereby affirm under penalty of perjury that I arn of Chapter 9 (commencing with Section 7m0) of Division 3 of the Business and Professions Code, and rny license and effect. [-icense CONSTRUC'I'IPN LENDING AGENCY I herchy affirm under penalty of prjury that there is a construction lending agency for the performance of the work for which this Jrermit is issued (Sec. 3S)7, Civ. C.). Lender's Name: Lender's Address: AI'PLICANT DE,CLARAI'I ON I trreby affnm under penalty of perjury one of the following declarations: Dennlition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Required Letter of Notification -l certify that the federalregulations asbestos rernrvalare not applicable to this project. that I have reatl this that the ahlve infrlrmation is correct. I to comply with all City antl County upon thc mentioned property for Applicant or Agent l'ernrilrc nnnle antl hereby authorizc ( 0B-07-2015 \ ./