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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWN ER BUILDER DETCARATION I hqeby affm unda penalty of pcrjury that I m cxmpt fiom thc Contraclon' Licere trw for thc following rcmn (Sc.7031.5 Buinm and Profsion Codc): Any City or Couoty which rcluirs a pcrmit to @Ntruct, sltq. improvq &molish or npair my struciurq prior to its isumcc, also requirc the applicilt for such pqmit to filc 8 signcd statmot that hc or $c is licenscd p$mt to the Eovisio$ of thc Contrrctor's Liccnscd law (Chaptq 9. Commmcing with Scrion 7000 of Division 3 of the B$ins ed PrcfcsionsCode)orthsthcorshcisexcmptth@fromudthcbcisforthe allcgedcxmption. AnyviolarionofSslionT03l.5byany appliciltforapcmitsubjetsthc appliBttoacivilpemltyofnotmorcthufivchundrcddollm($500). _1, as owner of the propcrty, or my employec with wages as thcir sole compâ‚¬nsation, willdo the work and the structurc is not intended or offered for sale (Sec.7044, Business and hofessions Code: The Contraclor's License Law does not apply to an owner of the propory who builds or improves ther@rL and who does such wort hirnself or herself or through his or her own cmployees. provided that such imp,rovanents are not intended or offered for sale. I[, howe,ver. the building or improvemcnt is sold within one ]â‚¬ar of complaion. the Owner Buildcr will have the burden of proving that he or she did not build or irnprove the property for the purpose of sale). _1. as owner of the propefly. am e.\clusively contracting with licensed contractors to construct the project (Sec. 7U4, Business and ttofession Code: l'hc Contractor's License Law does not apply to zur orvnet of property who builds or improves thereon. and who contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License taw). -l arn exempt under B. & P.C. for this reason. WORKERS' COMPENSATION DECLARATION I hereby alfinn undcr pcnalty of perjury one of the following declarations: _l have and will rnaintain a Ceflificate of Consent to Self-Insure for workers' cornpensation, as provided for by Section 3700 of the I-abor Code, for the perfonnance of the work for which the po'rnit is issued. _l have and rvill maintain rvorkers' compensation insurance. as required by Section 3700 of the Labor Code, for thc perfonnance of the work for which this pennit is issued. My workers' compensation insurance can'ier and policy number are: Policv Number: Exoires: _l certify that in the performance of the work for rvhich this perrnit is issued, I shall not employ any person in any manner so as to become subject to the workers'cornpensation laws of California, and agrec that if I should become subject to the rvorkers' compcnsation provisions of Section 3700 of the tabor Code, I shall. forthwith comply with those provisions.. WARNING: Failure to secure workers' compensation and shall subject an onployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). Section 3076 of the l-abor Code, interest and attorney's fec. cost of compcnsation, damagcs as provided for the I hcrcby affirrn under pcnalty of perjury that I am under 9 (commcncing with Section 7000) of Division 3 of the Business and Professions Code. and rny license is in full force and License Drte: I hrcby affum unda pcnalty of pâ‚¬rjury that th@ is a @retructbn landing agocy for thc pafomcc of thc wrk for which this pqmit b issucd (Se. 3097, Civ. C.). ladq's Nmq Lender's Addrcss: APPLICANT DECLARATION I herdry affurn under penalty of perjury one of the following declarations: Dernolition Permits-Asbcstos Notification Fcderal Regulations (Title 40, Part6) -Required lrtter of Notification -l certi$, that the fedcral regulations regarding -l certi& that I have read this application ordinances and State Larvs relating to above mentioned property for Applicant or Agent removal are not applicable to this project. Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire AIarm I Dampers Communications Cable Building Under Slab / Floor lr , Bonding I Grounding / UFER \e)'V[1;5'7,7 Transformers I t \ Torqueinq Sub-Panels Air Conditioners lt ^ Roof Top Equipment ,U llz l DA#+-vv Factory Wired Unit v- r I Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Roush Ceilinqs (T-Bar Rouqh)I c lVleter Release v f)nr{Ha)1/ \ Rouqh 1l r Service Jtleter \u '"17Jt h\\dd.v FINAL ,l \;aA{-ffi Notes, Remarks, Etc.--l/ I v I I Dr-rr na n7 ?n{ q o Class: Pernritee namc (print): \\t'' t<tv //