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ELECTRICAL-INSPECTOR R ECORD n.- DATE ID/SIG.COMMENTS OWNER, BUILDER, DELCARATION I hcrcby aflirm undcr pcnalty of perjury th|t I m cxcmpt frcm thc Contracto$ Liccns llw for thc following rcarcn (Ss.7031.5 lrusincss old Prcfcssion Codc): Any City or County which rcquircs o pcrmit to construct, alter. improvc. demlish or rcpoir any structurc, prior to its issuancc, ulso rcquircs thc spplicant for such lrcmit to filc a sigrcd statcmnt thot he or shc is liccnsed pusuant lo thc prcvisions of thc Contractor's Licenscd [lw (Chaptcr 9. Comrcncing wilh Sstion 700O of Division 3 of thc Busircss and PmfcssionsCodc)orthathcorshciscxcmptthcrcfromandthcbasisforthcallcgcdcxcmption. AnyviolationofscctionT03l.5byrny applicant for a pcrmit subjrcts thc applicrnt to a civil pcnalty of not mrc thrn fivc hundrc{ dollus ($500). _1, as owner of the propcrty. or my etnployees with wagcs as thcir solc compcnsation, will do thc work and thc structurc is not intcnded or ofl'crcd for salc (Scc.7044. Business and hof'cssions Codc: Thc Contraclor's License l-aw docs not Bpply to an owncr of thc propcrty who builds or improves thcrcon. and who does such work hinrsclf or hcrsclf or through his or her own employccs. providcd that such improvcmcnts arc not intcndcd or oflcrcd for salc. If. howcvcr. thc building or improvcnrcnt is sold within onc ycar of comphtion. thc Owncr Buildcr will havc thc burdcn of proving that hc or she did not buikl or improve thc propcrty for lhc purynsc of salc). _1. as owncr of the propcrty. am cxclusivcly contracting with liccnscd contraclors to construct lhc project (Scc. 7W, Busincss and Prrofcssion Code: Thc Contractor's License Law does not apply to an owncr of property who builds or improves lhereon, and who conlracts for such projects with a Contracto(s) licenscd pursuant to the Contraclor's Licensc Law). -latncxcmptunderScction-.B.&P.C'forthisreason.I)ate: WORK F'R.S I COM PT'NSATTON DECLARATION I hereby afflrm under penalty of perjury one of the following dcclarations: -l havc and will maintain a Ccrtificate of Consent to Self-lnsure for workers' compcnsalion. as providcd for by Section 3700 of the Labor Codc, for thc perfonnancc of the work for which thc permit is issucd. t\t havc and will maintain workers' compcnsation insurance, as requircd by Scction 3700 of the l-abor Codc, for the prerformance of thi work for which this pcrmit is issued. My workers' compcnsation insurance carrier and plicy numbcr are: so,ri.r. - S*c+-- F.,^J Policy ?t)2, ll-22- _l ccrtify that in thc lrcrformancc of the work for which this Jrcrrnit is issucd. I shall not cmploy any lrcrson in any manncr so as to bccomc subject to thc workers'compcnsation laws of California. and agrcc that if I should becomc subjcct to thc workcrs' compcnsation provisions of Section 3700 of thc l.atnr Code, I shall. forthwith comply with thosc provisions.. WARNING: Failurc to srcurc workcrs' compcnsation coveragc is unluwful, and shall subjcct an cmploycr to criminal penaltics and civil fincs up lo one hundred thousand dollars ($100.000). in addition to lhc cost of comgrnsation. damages as provided f$he Scction 3076 of the Latnr Codc, intercst and attorney's fccs. lnate: ? . a ' 2t Appttcant:K Jue..a^ tn 5ortlant LICENSED CONTRACToR rDECI ARATION I hcreby affirm undcr pcnalty of pcrjury that I am licenscd under provision of Chapter 9 (commcncing with Section 7000) of Division 3 of thc Business and Profcssions Code, and my license is in full force and eff'cct. Liccnsc Date: ct"rr, ' I LicenseNurnber:a . a . L , a\ W I hercby ofltrm under pcndty of pcrjury thrl thm is a @nstructbn lending agcrcy for the perfomre of the work for which lhis permit is issued (Scc. 3097. Civ. C.). [4ndcr's Narc: lrndcr's Address: AITI.ICAII.DECI.ABAION I hqEby 8ffm undcr penslty of pcrjuy onc of the following dclmtions: Dcmlition Permits-Asbcstos Nolification Henl Rcgul8tions (Titlc 40, Pafl6) -Requircd lrttn of Notifrcrtion -l cedify that thc federal rcgulations rcgaditrg sbcstos remval ae rct applicsble to this prcjct. }/ltn, ,* t have Md this spplication srd stste that thc abore irfomtion is corccr. I agre to comply wilh 8ll City and County ordimres md Strtc laws rchting to buiHing conslruction, ard hereby sutho.izE rcprcsntrtives of this City s]d County to enter ulDn thc abovc mcntioncd propcrty for Applicant or Agent l'ernritee x purF)scs. -a oare, r 01-0a.Lf Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding / Grounding I UFER '?. ?A.?1 .!r6np.lL Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) N/eter Release '7. ? 4-2f lld,*t&t Srtct*t Aour.r. ?-Et)g -'l -? t E\*..^frh Rough 'l-Aat 1 **"tlo Service N/eter 'l-Zn.?l'1 -anr?+lZ FINAL 4-7 -2)fuz^j4z- Notes, Remarks, Etc a>J2 -b [Jnr, nA n7 On{ tr r ! ttclil I