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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS COMMENTSDATEID/SIG. <br />Site-Work <br />Underground , <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq I Groundinq I UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit)I <br />7t70Walls (Roush)1t I 7 l lrt <br />Ceilinqs (Hard & Soffit Rouoh tlc I lt-O \ Y+-fr-E{a Ir u atrl>*4fr <br />Ceilinqs [-Bar Rouqh) <br />N/eter Release <br />Rough <br />Service [Vleter <br />rlFINALto ll I ,{S'qo <br />r--lNotes, Remarks, Etc.\\-/ <br />OWNER BI.'II,DI'R DTiLCA RATION <br />I hereby affirnr under penalty of perjury tlrat I anr exenrpt from the Contractos' License law for thc following neason (Sec.7031.5 <br />Busincss and Prolbssion Codc): Any City or County which requires a pcrmit to construct, alter. improve. dcmolish or rcpair any <br />structure, prior to its issuance. also requires the applicant for such grernrit to fih a signed slaternent that lre or shc is licensed pursuanl <br />to thc provisions of thc Contractor's l.iccnscd law (Chapter 9. Commcncing wilh Section 7fi)0 ol' Division 3 of the Business and <br />Professions Code) or that lrc or she is exen4rt therefrom and tlrc basi.s for the alleged exenption. fuiy violation of Section 7031.5 by any <br />applicant for a pennit subjects thc applicant lo a civilpenaltyof not more than fivc hundred dollars ($500). <br />_1. as owncr ol'the propcrty, or my ernployees with wagcs as thcir solc comgrcnsalion, will do the work and thc structure is not <br />interxled or offered for sale (Sec.7G4. Business and Profcssions Ctxlc: The Contractor's License Law does not apply to an owner of <br />the pruperty wlro builds or inproves tlrermn, and who does such work hinnelf or lrerself or througlr his or lter own enployecs, <br />provided that such improvcrncnts arc not intcndcd or ollercd for sah. Il, hnwevcr, thc building or inprorrcnrcnt is sold within one )car <br />of conpletioq thc Owner Buikler will have the burden of proving ttra he or she did not buikl or inpmve thc propary for thc purposc of <br />sale). <br />_1. as owner of thc propetly, am exclusively contracting with licensctl contraclors to construct thc project (Sec. 7044, Busirrcss <br />and Prolbssi<ln Code: The Contractor's License Law does not apply to an owner of proSrcrty who builds or improves thereon. <br />and who conuacts for such projects with a Contracto(s) liccnscd pursuant to thc Conuaclor's Liccnse [:w). <br />-IanlexemptutxJerSectitltt-,B'&P.C.tbrtlilsreason.l)ate: <br />WORKERS' COM PET{SATTON <br />DECLARATION <br />I hereby afTirm undcr penalty of pcrjury one of the tbllowing declarations: <br />-l <br />have and will nuintah a Certificate of Consent to Self-Insurc for workers' compensation, as prcvided for by Section 3700 of the <br />I-abor Code, for thc perforrnance of the work for which the permit is issued. <br />QGn"r. and will maintain workers' conrgrcnsation insurance, as required by Section 3700 of thc l-abor Code, for rhe perfornunce of <br />flt>uork for which this permit is issucd. My workers' compensation insurance carrier arxl plicy number are: <br />11 <br />Policy ?(L1(La <br />_l ccrtify that in thc pcrfornuncc'o[thc work f<rr which this pcrnrit is issucd, I .shall not cmploy any lrcrson in any manncr <br />so as to bccomc subject to thc workers' compcnsation laws of California. and agree that if I should become subjcct to thc <br />workers' conrlxnsatiorr provision.s of Section 3700 of the Labor Code, I stull, forthwith conrply with thosc provisions.. <br />WARNING: Failure to secure workers' compensation coveragc is unlawful, and shatt subject an cmployer to criminal penalties and <br />addition to the cost of comgrcrsation, danrages as provided for lhecivil fines up to one lrurrdred thousand dollars ($100.m0). <br />Scction 3076 of thc Latnr Code, intercst and attorney's fcc's. <br />lll <br />o^,,,lf b110 t( <br />I hereby affirnr under penalty of pcrjury that I anr licensed <br />of the Busincss and Professions Code. and my license is in full force antl etTect. <br />Applicant or Agent <br />,n <br />Chapter 9 (contnrcncing with Section 7000) of Division 3 <br />ryL't rlLicenseNunrber: <br />CONSTRUCTION LENDING AGENCY <br />I hereby affirrn undcr pcnalty of pcrjury that thcrc is a construction lending agency for thc performancc of the work for which this pcrmit is <br />issucd (Scc. 3097, Civ. C.). <br />lrnder's Nanre: <br />APPLICANT DECLARATION <br />I Hry aflirm under penalty of perjury one of the folkrwing declarations: <br />Demolition Pcrmits-Asbcstns Notification Federal Regulations (Title 40, Part6) <br />Required lrttcr of Notification <br />_t certify that thc fcdcral rcgulations rcgarding asbcstos rcmoval are not applicable to thls project. <br />6."nify tlrat I luve read this application uxl state thar ilre above infornnrion is correct. I agree to conrply with all City and County <br />-gtinarrces and State Laws relating to building construction, and hereby auttnrizc represcntatives of this City and County to enter upon the <br />above rnentioned property for <br />*", Tf 8l 1-O <br />0B-07-2015 <br />o DKeSe <br />lt,