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ELECTRICAL.INSPECTOR RECORD O,-,.t nO n7 On1tr APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION I hcreby affirm undcr penalty of pcrjury thal I u crcmpt frcm thc Contracto6' Liense hw for the folloving rcasn (Scc.7031.5 Busincss and Profcssion Codc): Any City or County which rcquircs a [rcrmit to @nstrucl. .llci imprcw, dcmlish or rcpair any structurc, prior to its issumce, dso rcquircs the applicant for such lErmit to filc . signed slslcrcnl that hc or shc is liccnsd pursanl ro thc prcvisions of the Contractor's Licensd llw (Chrptcr 9, Comrcnci[g with S$tion 7000 of Division 3 of the Busincss md ProfcssionsCodc)ortharlEorshciscxcmptthmfromandthcbssisforthcallcscdcxcmptio[ AryviolationofsslhnT03l.5byany applicanl for a pcrmit subjcTts thc applicant lo . civil pcnahy of not mrc lhan fivc hundrcd dollus ($500). _1. a.s owncr of thc propcrty. or my cmployees with wagcs as thcir solc comlrcnsalion, will do the work md the structurc is not intended or offcrcd for salc (Scc.?M4. Business and Profcssions Code: Thc Contractor's License [:w does not apply to an owncr of thc propcrty who builds or improvcs thcrcon, and who docs such work hinrsclf or hcrsclf or through his or hcr own cmployccs, providcd that such improvcnrcnts arc not intcndcd or oft'crcd for salc. If, howcvcr. thc building or improvcrcnt is sold within one ycar of comphtion. thc Owner Buildcr will have thc burden of proving that he or shc dkl not btrild or improvc thc proprty for thc purpsc of sah). _1. asowncrof thc propcrty. amcxclusivclycontracting with liccnscd conlractorsto construct thc projcct (Scc. 7U4, Business and Rotbssion Code: The Contractor's Licensc Law does not apply to an owncr of propcrty who builds or improvcs thcrcon, and who conlracts for such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Liccnsc taw). _l am cxcnlpt undcr B. & P.C. for this rcason. Owner:_ WORKF'RS' COM PENSATION DF'CLARATION I hereby affirrn undcr pcnalty of pcrjury onc of the following dcclarations: _l have and will maintain a Ccrtificate of Consent to Sclf-lnsure for workcrs' compensation, as providcd for by Section 3700 of thc [:bor Codc, for thc pcrformancc of thc work for which the pcrmit ls issucd. _l have and will maintain workcrs' compcnsation insurancc. as required by Scction 3700 of the labor Code, for thc pcrformance of the work for which this pcrrnit is issucd. My workcrs'insurancc carricr and policy numbcr arc: Policy ,t0 I 7l _l ccrtity that in thc lrcrformancc of thc work for which this pcrmit is issucd. I shall not cmploy any frcrson in any manncr so as to bccome subjcct to thc workers' compensation laws of California. and agrec that if I should bccome subject to the workers' compcnsation provisions of Section 3700 of thc Labor Code. I shall. forthwith comply with thosc provisions.. WARNING: Failurc lo securc workcrs' comgrcnsation covcragc is unlawful. and shall subjcct an cmploycr to criminal pcnaltics and civil fines lo onc thousand dollars ($100.000). in addition to thc cost of compcnsation. damagcs as providcd for thc Scction of thc Code, interest and attorney's 0 ly I hcreby afhrm undcr pnalty of prjury that I am liccnscd undcr provision of Chaptcr 9 (commencing with Section 7000) of Division 3 of thc Busincss and Profcssions Code. and my license is in full forcc and cffcct. Liccnse Numbcr:bSL|LVg W I hcrcby affrm under lEmlty of pcrjury that thcrc is a @nstruction bnding agcncy for Ihc performrcc of the work for which this tmil i! issucd (Scc. 3097, Civ. C.). [-cnder's Namc: lrnder's Addrcss: APPI ICANT DT'CLAITT{TION I hcrcty aflirm under penalty of pcrjury one of thc following dcclarations: Dcmolition Permits-Asbestos Notification Fcderal Rcgulations (Title 40, Part6) -Requ ircd L,ct tcr of Notificalion _l certify that thc federal regulations regarding asbcstos rcnrcval arc not applicablc to this proict. _l ccrtify that I havc read this application and statc thal the abovc information is correct. I agrce to conrply ordinances and Statc Laws rclating to building construction. und hercby authorizc representatives of this City with all City and County cnlcr above mcntioncd property for Applicant or Agenl Pernritee nilnrt I purposes.Z'(lt;n,L and 7 upon thc Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safetv /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq I Groundinq I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Roush) lVleter Release Rough Service N/eter FINAL lzoQpLt {L& .h 4,c#AfT Notes, Remarks, Etc conrracro,, COAgf Stri,L *4n c