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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work Underqround Pole Bases Liqht Standards x Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable \ Buildinq Under Slab / Floor l- ^.1 \.J Bondino / Groundinq / UFER 7.-ll*[a 'f7[$ Transformers ,l Y Torqueing Sub-Panels Air Conditioners Roof Top Equipment / Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouoh \ Ceilinqs (T-Bar Rouqh) [Vleter Release Rough Service lVeter n ^.- l^I / A;il FINAL tlrl I ll lz 'r/Wrlq ,lNotes, tRemarks, Etc.., t -tl t/t f,/ T Tlr / owNltR BtJlt.D],,R I hereby affirm under penalty of perjury that I am exempt from the Contractors' License Law for the folklwing reason (Sec.7031.5 Business and Profession Code): Any City or County which requires a permit to construct. alter, improve, dennlish or repair any structure, prirlr to its issuance, also requires the applicant for such permit to file a signed statenEnt that he or she is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9, Commencing with Section 7000 of Division 3 of the Business and Professions Crxle) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031..5 by any applicant for a permit subjects the applicant to a civil penalty of not nrore than five hundred dollars ($5001. owner of the proJrerty, or my empkryees with wages as their sole compensation, will do the work and the stnnure is not or offeretl for sale (Sec.7044. Business and Professions Ccxle: The Contractor's License Law does not apply to an owner of the propcrty whr huilrts or impnlves thereon, antl who dtrcs such work himself or herself or through his or her own employees, provided that such improvements are rxlt interxled or offeretl for sale. If, however, the building or inprovenpnt is sokl within one )â‚¬ar of completion. the Owner Buikler will have the hrden of proving thd tre or she did not buikl or improve thc property for the purgrse of sale). _1. as owner of the property. am exclusively contracting with licensed contractors to construct the prcject (Sec. 7014. Business antl Pnrfessirn Cotle: The Contractor's License Law does not apply to an owner of progrcrty who builds or improves thereon, and who contracts for such pmjects with a Contracto(s) licensed pursuant to the Contractor's License Law). -l am exempt under B. & P.C. I )1..('1.,\ l{,\'l'l( )N I hereby affirm under penalty of perjury one of the following tleclarations: _l have arxl willmaintain a Certifrcate of Consent to Self-lnsure firr workers'comfrcnsation. as provided for bySection 3700 of the Latxlr Crxle. firr the perftrrmance of the work for which the prmit is issued. _l have and will maintain workers' comJrcnsation insurance, as required by Section 3700 of the Labor Code, for the performance of the work firr which this permit is issued. My workers' compensation insurance carrier and grlicy number are: Carrier: Policy Number: Expires: certify th:rt tn the performance of the work ftrr which this permit ls issued,shall not empkry any person in should become subject any rnilnner s()ils to become suh.iect Itl the workers'cornpensation laws of Califrrrnia,and agree that if to thc workers' compensation pnrvisions of Section 3700 of the [:bor Code, I shall, forthwith comply with those pnrvisions.. WARNTNG: Failure to secure workers'compensation coverage is unlawful, and shall subject an employer to criminal yrnalties and civil fines up to one hundred thousand dolleus ($100,U}()), in addition to the cost of compensation, damages as providetl for the Scction 307(r of the Latxrr Code, interest and I ):rtr:6lz lc t-t l-' DF,CI,ARA'I'ION I herchy affirm under penalty of perjury that I am licensed under provision of Chapter 9 (comrnencing with Section 7Un) of Division 3 of the Business and Professions Code, and my license is in full force antl effect. License Number: CONS'TRUCTTON LENDING AGENCY I hercby aftirm under penalty of perjury that there is a construction lending agency for the perftrrmance of the work for which this permit is issued (Sec. 3O97, Civ. C.). [.ender's Name: \ l-ender's Address: APPLICAN'T DECLARA'I'ION I hereby alfrrm untler Jrenalty of prjury one of the following declarations: Dennlitkrn Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Requiretl Letter of Notifrcation _l certify that the federalregulations rcganling asbestos rernovalare not applicable to this project. ify that I have read this application and state that the atnve information is correct. I agree to comply with all City and County ordinances and .State Laws rclating to buikling construction, and hereby autlxrriz.e representatives of this City and County to enter upn the mentioned property for inspectit)n puryx)ses. or Agrnl I'ernritee nome Rev. 08-07-201 5 )tl , 4_ / I Contrector: