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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq I Groundinq / UFER (l6l?L bkr*g Transformers Torqueing Sub-Panels Air Conditioners I Roof Top Equipment (,1 ' lâ‚¬ l"L DW*r Factory Wired Unit T Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh)I N/eter Release ItSl zr AKYY 7 v I Rouqh Service Meter l/ FINAL 7 (5tu T#> Notes, Remarks, Etc.l -+ OWNER BUILDER DELCANATION I hercby aflirm undcr penalty of perjury that I m cxempt frcm thc Contracto6' Liccns kw for the following reen (Ss.7031,5 Business ard Profcssion Codc): Any City or County which rcquircs a prmit to construct, altr, improrc, dcmlish or rcpair any structurc, prior to its issure, also rcquircs thc applicant for such lEmit to lile a sigrcd statcmnt that hc or slE is licensd pusuet to thc prcvisions of thc Contrsctor's Liccnsd [:w (Chaptcr 9, Comrcrcing wilh Scction 7000 of Division 3 of lhc Busiress 8nd PmfcssionsCodc)orlhalhcorshciscxcmptthcrcfrcmildthcbasisforthcallcgcdcxcmption. AnyviolslionofSEli,nT03l.5byany applicant for a lErmit subjccts the applicant to I civil pcmlty of not mrc the fivc hundrcd dollrs ($500). -1, as owner of the propcrty, or my cmployees with wagcs as thcir soh compcnsation. will do thc work and the structurc is not intendcd or offcrcd for sale (Scr.7044, Business and hofcssions Codc: Thc Contractor's Liccnse l.aw does not apply to an owner of thc pmpcrty who builds or improves thcrcon. and who does such work himself or hcrself or through his or hcr own cmployees, providcd that such improvcnrnts arc not intendcd or offcrcd for salc. lf, howcvcr. thc building or improvcnrnt is sold within onc )aBr of complction, thc Owner Buildcr will have the burden of proving that he or she did not build or inqrrovc the proprty for the purynse of salc). _1. as owncr of the prolrcrty, am exclusivcly contracting with liccnsed contractors to construct thc projcct (Scc. 7W. Busincss and Profession Codc: Thc Contractor's License Law docs not apply to an owncr of propcrty who builds or improves thereon. and who contracts for such projects with a Contractor(s) liccnsed pursuant to thc Contraclor's Licensc taw). -IamcxemptundcrScction-.B.&P.C.forthi.srcason.I)tte: \V()RK ERS' COt\,I PENSA I'ION DrCLARATION I hcrcby affirrn under pcnalty of prjury onc of thc following dcclarations: -l havc and will maintain a Ccrtificatc of Conscnt to Sclf-lnsurc for workcrs' compensation. as providcd for by Sc.ction 3700 of thc I-abor Codc. for the Jrcrformancc of thc work for which thc pcrmit is issucd. _l havc and will maintain workcrs'comJrcnsation as rcquircd by Scction 3700 of thc [:bor Codc, for thc pcrforrnance of thc work for this pcrrrrit insurancc carricr and policy numbcr are: Policy a _l ccrtify that in thc grcrformancc of thc work for which this pcrmit is issucd, I shall not employ any pcrson in any nranncr so asto bccomc subjcct to thc workcrs'compcnsation lawsof California, and agrce that if I should bccome subject tothc workers' compcnsation provisions of Section 3700 of thc l-abor Code, I shall, forthwith cornply with thosc provisions.. WARNING: Failurc lo sccurc workcrs' comlrcnsation coveragc civil lincs up lo one hundrcd thousand dollars ($100,0ffi). in is unlawful, and shall subjcct an employcr to criminal pcnaltics and addition lhc cost of compcnsation, damages as provided for thc Scction 3076 of Lrtnr intcrcst and attorrrcy's fccs. Applicant: X I hcrcby affirm under pcnalty of perjury that I am liccnscd undcr provision of Chapter 9 (comnrcncing with Scction 7000) of Division 3 of the Business and Professions Code, and my license is in full forcc and cffect. Liccnsc b W I hcrcby aflirm undcr lEnalty of lErjury that thcrc is a construction bnding agcncy for thc Frfomncc of lhc uork for which lhis Frmit is issucd (56. 3097, Civ. C.). lrndcr's Name: L,ender's Address: APPLICANT DECLARATION I ffiy affrrm under pnalty of pcrjury onc of thc following dcclarations: Dcmolition Pcrmits-Asbestos Notification Fedcral Rcgulations (Titlc 40, Part6) _Rc<luircd lrtter of Notifrcation lffi,::fcdcralrcgulations rcgarding asbcstos removal&re not applicablc to this project. rcad this application that thc atxrve inlbrnration i.s correct. I agrcrc to comply with all City and County ordinanccs and State laws rclating to rcprcscntativcs of this City and County I abovc mcntioncd propcrty for Applicanl or Pernritee nanre ( and I q thc r ACI n-7 rrnl tr I , Owner:_ .a