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ELECTRICAL-INSPECTO R RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondinq / Groundinq / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouoh Ceilinqs [-Bar Rouqh) lVleter Release Rough Service N/eter It t FINAL ln I 1t lX.ae Etc. I ! OWNER BUI LDER DELCA RATION I hereby affirm under pnalty of prjury that I am exempt fmm the Contractors' License law for the following reason (Sec.7031.5 Business and Profession Cule): Any City or County which requires a permit to construct. alter. improve, dermlish or repair any structure, prior to its issuance, also requires the applicant ftrr such grrmit to file a signed statenrcnt that hc or she is licensed pursuant to the provisions of the Contractor's Licensed t-aw (Chapter 9, Commencing with Section 7fiD of Division 3 of thc Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any appficant for a permit subjects the applicant to a civil penalty of not rxrre than five hundretl dollars ($500). ^t/^rlCrJ,, as owner of the property. or my employees with wages as their srle compensation, will tlo the work and the structure is not - intended or offered for sale (Sec.7(84. Business and hofessions Code: The Contractor's License Law does not apply to an owner of the property wlxr huilds or improves thereon, and whr dtrcs such work himself or herself or through his or her own employees. provided that such improvenrcnts are not intended or offered for srh. If. hrwever. the building or impmvenrcnt is sold within one year of completion. the Owner Buikler will have the burden of proving thrt he or she dil not buiH or impnlve the property for the prpose of sah). -I, as owner of the property. am exclusively contracting with licensed contractoni to construct thc pnrject (Sec. 7044. Business and Professbn Code: The Contractor's License Law does not apply to an owner of property who builtls or improves thereon, and who contracts frlr such projects with a Contracto(s) licenscd pursuant to the Contractor's License Law). _l am exempt undcr B. & P.C. for this WORK TiRS' COM I'E,NSA'I'ION DECLARA'I'ION following tleclarations:I hereby affirrn under penalty of perjury one of the _l have and will maintain a Certifrcate of Consent to Self-lnsure for workers' compensation. as pnlvi<Ied firr by Section 3700 of the I-abor Code, for the performance of the work for which the permit is issued. _l have and will maintain workers' comgrcnsation insurance, as required by Section 3700 of thc Labor Code, for the performance of the work for which this prmit is issued. My workers' compensation insurance carrier and plicy number are: in the performance of the work for which this permit is, issued, I shall not empk)y any person in any manner and agrce that if I stxluld become subict to the shall. forthwith comply with those pruvisions.. subject to the workers'compensation laws of Califirrnia. workers' compensation provisions of Section 37fi) of the l,ahrr Cotle, I WARNING: Faiture to secure workers' compensation coverage is unlawful. and shall subject an empkryer to criminal pnalties and civil fines up to one hundred thousand dollars ($Ifi),fittl;, in addition to thc cost of compensation. damages as provided for the Section 3076 of the Labor CtxJe, interest and attorney's fees. K,",5)&\- il'\ DE,CLARA'NON I hereby affrm under penalty of perjury that I am licensed under provision of Chapter 9 (comnrencing with Section 7Un) of Division 3 of the Business and Professions Code, and my license is in full force an<l effect. License Class: License Number: CONS'I'RUC'I'ION LTNDING AGENCY L I hereby affrm under penalty of prjury that there is a congruction hnding agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: I Lender's Address: APPLICANT DECLARATION I hercby affrm under pnalty of prjury one of the following declarations: Dernolition Permits-Ashestos Nrxification Federal Regulations (Title 40, Part6) -Required l,etter of Nuilrcation J certify that the federal regulations rcgarding asbestos renxrval are not applicable to this project. 4-U --r-Jcertify that I have read this application and state that the ahrve information is correct. I agree to comply with all City and County ordinances and State Laws rclating to building construction, and hereby authoriz.e representatives of this City and County to enter upon the Grnritee name firr inspection ,",", 5-L\- &l Date: or \