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ELECTRICAL.! NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hqeby aflim undo panalty of pcrjury thst I m qcmpt ftom thc ContretoB' Licw law for thc following ren (Se.7031.5 Buincs ard Profcssion Codc): Any City or County which rcquira a pcrnit to coNtruct, altq, imprcvq damlish or rtpoir uy structuc, prior to its issumcc. also rcquirc thc applicot for such permil to file I signcd ststmot that hc or dE b licoscd pmuanr to thc provisio$ of the Contractor's Liccnscd taw (Chsptq 9, Commmcing wilh Sslion 7000 of Division 3 of thc Buin6 ed PrcfsionsCode)orthatheorshcisexcmptthscfrommdthcbsisforthe allcgcdamption. Anyviolationofsâ‚¬lion703l.5bymy applicut for a pmnit subjets the applicant to a civil penalty of not morc thil tivc hundrcd dollm ($500). _1, its owner of the propcrty, or my employecs with wages as their sole compcnsation. willdo the work and thc structure is not intended or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's License l-aw does not apply to an owner of the property who builds or improves theron. and who docs such wo* himself or hersclf or through his or her own employecs. provided that such funprovanents are not intended or ofltrod for sale. If, however. the building or improverncnt is sold within one )rcar of complaion, the Or,nner Builder will have the hrden of proving tha he or she did not build or impnove the pnopoty for the purpose of sale). _1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Business and Profcssion Code: The Contractor's License Law does not apply to an owner of propdy who builds or improves thereon, and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License Law). _l am exempt under B. & P.C. for this reason. Owner: WORKERS'COMPENSATIM DECLARATION I h6eby amm undc penalty of po;jury onc of thc followiog delamioro: -I have md will mintain a Cenificatc of CoMt to Sclflmurc for work6' composalion. re providcd for by Sction 3700 of thc labor Codc for thc pqfolrmce of thc wrt for which thc pqrnit b isucd. !(l heve md will maintain work6' compcreation imunncq u rcquircd by Sation 3700 of thc Labor Codc, for thc pafomce of thc rcrt for which this pcrmit is isrcd My work6' sfiipasation ireumc miq and policy numbc rc: t o tr \a-a ar-\i r-lPolicy _l certify that in the performance of the work for rvhich this perrnit is issued. I shall not employ any pcrson in any manner so as to become subject to the workers'compcnsation laws of California, and agree that if I should become subjcct to the workers' compensation provisions of Section 3700 of the Labor Code. I shall. forrhwith comply with those provisions.. WARNING: F'ailure to secure workers' compensation coverage is unlawful. and shall to and civil fines up to one hundred thousand dollars ($100,000), Section 3076 of the Labor Code, intercst and attorney's fees. in addition cost of the la Z\ I hereby affrrnr under penalty of perjury that I arn licensed under provision 9 (comnrencing with Section 7000) of Divtion 3 of the Business and Professions Code. and my license is in full force and effect. a A4s a \gELicenseNunrbc-r: P W I heeby aflirm undo pemlty of perjury that thm is a comtruction lâ‚¬nding agocy for thc pqfonmcc of thc work for which this pqmit is issued (Se. 3097, Civ. C.). Lcnder's Namc: Lender's Addrcss: APPLICANT DECLAITATTON I hereby affirm under penalty of perjury onc of thc following declarations: Demolition Permits-Asbcstos Notification Federal Regulations (Title 40, Part6) _Requircd Lcttcr of Notification with all City and County and County to slter upon the above mentioned property for inspection Applicant or Agent \ Permitee nrme not applicable to this project. .D Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire AIarm I Dampers Communications Cable Building Under Slab / Floor Bonding I Groundins / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Roush Ceilinqs (T-Bar Rouqh) Meter Release Rouqh Service Meter n FINAL b-n'L pL{7) Notes, Remarks, Etc. -it Dr.rr nO nn1 tr above V6 E<,9fr-Sc-Ng6 t>