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ELECTRICAL.! NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hoeby alfirm unds pmalty of perjury thal I m cxempt from thc ContractoE' Licffi taw for thc following @n (Se.7031.5 Businos and Profcsion Codc): Any City or County which rcquirs a pornit to @Ntruct. alt6, improvg dcmolish or rcpair uy structuc, prior to its issuoce, also rcquirc thc applicilt for such pmit to file a signcd stalm@t thd hâ‚¬ or drc b licscd pmwt to the provisioN of the Contractor's Liccnsed ljw (Chapter 9. Comencing with Setion 7000 of Division 3 of the Busincs ud Profesions Code) or that hc or shc is cxcmpt thqcfrom ed thc basis for thc allegcd cxcmption. Any violation ofSa-tion 703 t,5 by any applicot for a pouit subjsts the applient to a civil penalty ofnot more the fivc hundrcd dollffi ($500). -1, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structurc is not intended or offered for sale (Sec.7044, Business and Professions Code: The Contractor's Liccnse law does not apply to an owner of thc property who builds or improves theron. and who does such worli himself or herself or through his or her own employees, provided that such improvernents are nol intendocl or offâ‚¬rql for salc. If, however. the building or funprovernent is sold within one )rar of cornpletion, the Owner Builder will have the burden of proving that he or she did not build or inrprove the propoty for the puposeof sale). -1, as owner of the property, arn exclusively contracting with licenscd contractors to construct the project (Sec. 7M4, Business and Profcssion Code: The Contractor's License Law does not apply to an owner of property rvho builds or improves thereon. and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's Licerue Law). -l am excmpt under Section_, B. & P.C. for this reason. Date: Owner: WORI(ERS' COMPENSATION DECLI\RATION I hereby affirm under poralty of perjury onc of the following declarations: -l have and will maintain a Certifrcate of Consent to Self-lnsure for workâ‚¬rs' compersation, as provided for by Section 3700 of thc Labor Code, for the pcrformance of the work for which the pennit is issucd. ft nur. ancl will maintain workers'3700 of the Labor Code, for thc performance of the work for u'hich this permit is issued.and policy number are: t /tt n-LPolicy1rl -l certi& that in thc perforrnance of the work for rvhich this pernrit is issued. I shall not ernploy any person in any manner so as to become subject to the rvorkers'compensation laws of California, and agree that if I should become subject to thc rvorkers' cornpensation provisions of Section 3700 of the Labor Code. I shall. forthwith comply rvith those provisions.. WARNING: Failure to secure workers' compensation coverage is unlarvftrl, and shall subject an onployer to criminal pcnaltics and civil fines up to one hundred thousand dollars ($100,000). in addition to the co$ of compensation. damages as provided for the Section 3076 of the Labor Code, interest and attorney's fees. Dntc:tO lo /t\ I hereby affirm under pcnalty of perjury that i of the Business and Professions Code. and DECI"ARATION I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 rny license is in full force and effcct. License c- q, Nurnber: Contractor: CONSTRUCTION LENDING ACENCY I hrcby affm undo pqElty of pqjury thar thqâ‚¬ is a corstruction bndirg agocy for thc psfommcc of thc work for which this pqrnit is issucd (S*. 3097, Civ. C.). Lender's Nanre: I-cnder's Address: APPLICANT DECLARATION I hereby affrrn under penalty of pcrjury one of the following declarations: Dernolition Pcrmits-Asbestos Notification Federal Regulations (Title 40, Pafl6) -Required Letter of Notification -l certify that the federal regulations regarding asbestos removal are not applicable to this project. above mentioned propei'ty for inspcction Applicant or Agerrl l'crnritee nanrc state that a-/ Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire Alarm I Dampers Communications Cable Building Under Slab / Floor Bonding/@dns/UFER lo 1?t2l lZ-LvO 7 Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilinqs (T-Bar Rouqh) l\Ieter Release /o42-4 /k_z rl Rough Service Meter -a FINAL lo-lLru ll-'C-'l ;pru&* uztT Notes, Remarks, Etc. /f I Dnrr na n7 '>n4tr, Jo "",, la f o,f '?zl