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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondino I Groundinq I UFER LTransformers Torqueing L Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) Meter Release Rouqh Service N/eter FINAL N Etc. I hereby affirnr under penalty of perjury that I am exenlpt from the Cbntracton$' License Law f<rr the following reason (Sec.7031.5 liusincss and Prol'cssion Codc): Any City or County which requires a pcrmit to construct, altcr. irnprove. demolish or repair any structure, prior to its issuance. also requires the applicant for such Jrenrrit t<l file a signed statement that lre or she is licensed pursuanl to thc pmvisions of thc Contractor's Liccnscd law (Chapter 9. Commencing with Scction 7fi)0 ol' Division 3 of thc Busincss and Professions Code) or that lrc or she i.s exempt therefronr and tlre basis for tlre alleged exemption. Any violation of Section 7031.5 by any applicant for a pcnnit subjects the applicant to a civil penalty oI not more than five hundred dollars ($5tlO;. _1, a.s owner ol'thc propcrty. or tny crnployce.s with wages as their sole compcnsation, will do the work and the stnrcture is not intendcd or offered for sale (Sec.7M+. Business and Pnrfcssions Code: The Contractor's Licensc Law does not apply to an owner of the pruprty wlxl builds or inrproves thereorl and wlro does such work himself or lrerself or through his or her own enployees, providcd that such improvcnrcnts arc not intendcd or olTercd for sale. If, howevcr, the building or inprovenrcnt is sold within onc ycar of completioru the Owrrcr Buikhr will have the burden of proving ttrat he or she did not build or improvc tlr propoty for thc purpose of sale). _1, as owner of the prolrctly, am exclusively contracting with licensed contractors to conslrucl the project (Sec. 7(X4, Business arrd Prolbsskrn Cotle: The Contractor's License Law rJtrs not apply to an owner of property who builds or improves thereon. and who contract.s for such prr{ects with a Contractor(s) licenscd pursuant to thc Conuactor's License l-aw). -IanrexemptunderSectiort-,B.&P.C.forthisreason. WORKERS' COM I'ENSATION DECLARATION I hcrcby aflirm undcr penalty of perjury onc of tltc tbllowing declarations: _l have arxl will nnintah a Certilicate of Consent to Self-lnsure for workers' comgrnsation, as provided for by Section 3700 of the Code, for thc Jrerlorrnancc of thc work lbr which the grcrmit is issued. have and will nraintain workers'conpensation insurance, as required by Section 3700 of the l-abor Code, for the Srerfornrance of lbr whiclr this is issrrcd. My workcrs' compcnsation insurance carricr and policy numbcr are: U/n Policy ZA2) _l ccrtity tlrat in thc lxrfornuncc of tlrc work for which this pcrmit is issued, I shall not cnrploy any pcrson in any manner so as to bccomc subjcct to the workers' compcnsation laws of California, and agrce that if I stnuld beconrc subject to the workers' con4rcnsation provisions of Section 3700 of the Labor Cqle, I strall, forthwith comply wilh thosc provisions.. WARNING: Failure to secure workers'compensation coverage dollars ($100.000). in , is unlawful, and shall subject an employer to criminal penahics and civil fines up to otrc hurrdred thousand addition to tlrc danrages as provided for lhc Scction of Labor Code, intcrcst and attorney's DECI,ARATION I hereby affirnr under penalty of pcrjury tlut I anr licensctl under provision of Chapter of the Busincss and Profes.sions Code. and my license is in full forcc arxl effect. with Section 700O) of Division 3 Cr{o I dl Liccnse Number: I hercby aflirrn under penalty of perjury that therc is a construction lending agency issued (Sec. 3097. Civ. C.). perlbrmance of the work lbr which this pcrmit is [.cnder's Name: [rnder's Addrcss: APPI,ICANT DECLARATION I hxcby aflirm undcr pnalty of pcrjury onc of the following dcclarations: Demolition Pcrnrits-Asbcstos Notification Fedcral Regulations (Title 40, Pan6) _Rc<luircd l.cttcr of Notification ccrtily that the fcdcral rcgulations rcgarding ashstos removal are not applicable to this project. tlrat I havc rcad this application antl statc tlut thc abovc inltrrmation is correct. I agrcc to comply I represcntatives o[ this City with all City and County and Statc laws rclating and to entcr upon thc above rrrcntioned \tAllplicant or Pernritec nonlc propcrty fitrr to building construction,authorizc v 2-Ozt Flev. 08-07-2015