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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affirm under Fnalty of pcrjury that I am cxcmpt frcm thc Conlmctos' License law for lhe following rcuson (Scc.7031.5 <br />Busincss airC Profcssion Codc): Any City or Counly which rcquircs a Frmil to construcI. altcr. impmvc. dcmlish or rcpir any <br />slructurc. prkr to its issumcc. also rcquircs lhc applic.nt for such lErmit lo lilc a signed slalcmnl thal hc or $c is liccnsd .pursuant <br />to lhc prcvisions of thc Contrelor's Liccnsd tiu (Chrptcr 9, Commncing wilh Sstion 7000 of Division 3 of thc Busincss and <br />PmfcssionsCodc)orthathcorshciscxemptthscfrcmandlhcbasisforthcallcgcdcxcmplion. AnyvklaIionofSGtknT0Sl.5bysny <br />applicant for o pcrmil subjsts thc applicant to a civil pcnally of not mrc lhan fivc hundrcd dollus ($500). <br />_1, as owner of the propcrty, or tny employces with wagcs as thcir solc comlrcnsation. willdo thc work and thc structurc is nol <br />intcndcd or offcrcd lbr salc (Sec.7B4. Busincss and Profcssions Codc: Thc Contraclor's Liccnse Law does not apply to an owncr of <br />thc propcrty who builds or itnproves thcrcon. and who docs such work himsclf or hcrsclf or through his or hcr own cmployees. <br />providcd that such improvcrncnls arc not intcndcd or offcrcd for salc. lf. howcvcr. thc buihing or improvcrnnt is soh within onc )tar <br />of complction, thc Owner Builder will havc thc burdcn of proving that hc or slre did not build or improvc the propctty for lhc purynrc of <br />salc). <br />-1. <br />as owncr of thc propcrty, am cxclusivcly contracting with liccnscd contractors to construct thc projcct (Scc. 7M4, Business <br />and Profcssion Codc: Thc Contractor's License Law does not apply lo an owner of property who builds or improves thereon. <br />and who contracts for such projccts with a Contracto(s) licenscd pursuant to thc Contractor's Licensc l-aw). <br />-lamcxcmptundcrScction-,B'&P.C.forthisreason. <br />Date:Owner:- <br />\T'ORKI.' RS' COt\ I PEN SATION <br />DBCLAITATION <br />I hcrcby alfirm undcr pcnalty of pcrjury onc of thc following dcclarations: <br />-l <br />havc and will rruintain a Ccrtificate of Conscnt to Sclf-lnsurc for workcrs' compcnsation. as provided for by Scction 3700 of thc <br />I-.abor Codc. for thc lrcrfornrancc of the work for which thc prrnit is issued. <br />_l havc and will nraintain workcrs' cornpcnsation insurancc. as rcquircd by Section 3700 of thc [:bor Codc, for thc pcrformancc of <br />thc work for which this pcrmit is issucd. My workcrs' compensation insurance carrier und plicy number are: <br />+! <br />2l ,o{,/o1 ^>I'olicy <br />t )f) <br />_l ccrtify that in thc lrcrforrnance of thc work for which lhis prmit is issucd. I shall not cmploy any pcrson in any manncr <br />so as to bccome subject to the workers'cornpensation laws of California, and agree that if I should hccome subject to the <br />workcrs' comlrcnsation provisions of Section 3700 of the Latnr Codc, I shall. forthwith comply with those provisions.. <br />WARNING: Failure to sccurc workers' compcnsation covcrage is unlawful. and shall subjcct an employcr to crimirral pcnalt'rcs and <br />civil fincs up to onc hundred thousand dollars (S100.000). in addition to thc cost of compensetion. damages as providcd for thc <br />Scction 3076 of thc Lahlr Code, intcrest and attorncy's fccs.ra <br />Dare: oY//9/2/ftrran^ol.ez <br />LICENSED CONTRACTOR <br />DECLARATION <br />I hcrcby affrm under pcnalty of prjury thut I am licensed under pmvision of Chaptcr 9 (comnrencing with Section 7000) of Division'J <br />of the Busincss and Professions Code, and rny liccnse is in full forcc and effcct. <br />Liccnsc ,r^rr, ( <br />C-20 Licensc \ 7!tu7o <br />o,," .6tl 13/ ?/ <br />W <br />I hcrcby allirm undcr lrcmlty of pcrjury that thcrc is a construction bnding agcncy for the pcrfomce of thc work for which lhis lEntrit is <br />issucd (Scc. 3097, Civ. C.). <br />Lcnder's Narnc:I <br />[-cnder's Addrcss: <br />APPLICANT NT'CLARATION <br />I hcrcby affimr undcr penalty of pcrjury onc of thc following declarations: <br />Dcmolition Pcrmits-Asbeslos Notification Fedcral Regulations (Titlc 40. Part6) <br />-Rcquired <br />lrttcr of Notificatkrn <br />_l ccrtify that the fcdcralregulalions rcgarding astcstos rcmovalare not applicablc to lhis projcct. <br />-l <br />ccnify that I havc Md this .pplicarion md sratc that thc abovc informtion is corsI. I agre lo mmply wilh all Cilyarld County <br />odinanccs and Statc Laws rclaling to building construdion, snd hcrcby authorirc rcprcsntalivcs ofthis City xnd County to entcr ulDn thc <br />abovc mcntioncd proprty for inspcction <br />Applicant or Agent <br />Permilee n$me <br />,^,",-0Y)u/2/ <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Poo!, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / FIoor <br />Bondinq I Groundi ng I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Wails (Roush) <br />Ceilings (Hard & Soffit Roush <br />Ceilinqs [-Bar Rouqh) <br />Meter Release <br />Rouqh <br />Service N/eter I tl ,\ <br />FINAL t0 Ir "l DNv(i"fl <br />Notes, Remarks, Etc. <br />-t <br />r flGl n7 On{ tr <br />Carricr:-