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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEITARATION I hrcby allim undq penalty of pcrjury that I m cxcmpt from the ContracloB' Licffi law for thc following rcer (Sc.7031,5 Bwin* and Profsion Codc): Any City or County which rc1uirc a pamit to conslruct, alte. improvq dlmolish or rcpair uy stIuclurq prior to its isuilcc, also requiG the applicut for such pennh to filc a sigoed statwot thst hG or slrc b [ce$â‚¬d pulsust to the prcvisioE of tlrc Contractor's Licased kw (Chapt6 9. Commcncing with Sction 7000 of Division 3 of the Bulnqs md Prcfc$ions Codc) or that hc or shc is qcmpt thftfrom md thc basis for thc allcgcd crmption. Any violatiotr of Sclion 7031.5 by my applicant for 8 pcrmit subjcts thc applicmt to a civil pcmlty ofnot morc thm livc hundrcd dollm ($500). -I. as owner of the property. or my employecs with wages as their sole compcnsation, will do the work and the stnEture is not intended or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License law does not apply to an owner of the propa'ty who builds or improves thcron, and who does such work himself or herself or through his or her own employees, provided that such funproveinents are not intcnded or ofFercd for sale. I[, howwer, the building or improvement is sold within onc year of complaion, the Orvner Buildcr will have the huden of proving that he or she did not build or improve the property for the purpose of sale). _1, as owner of the propo'ty, am exclusively contracting with liccrsed contractors to construct the project (Sec. 7044, Busincss and Pnofcssbn Code: The Contractor's License Law does not apply to an owner of property who builds or improvcs thereon, and who contracts for such projecfs with a Contraclo(s) licensed pursuant to the Contractor's License [aw). _l am exempt under Section-. B. & P.C. for this reason. Dete: WOStrESTSOMEENSAIIAN DECI.AEAIION I h@by rffm undq paalty of pqjury onc of rhc following delealioro: -l havc ud will mintsin E CqiificEte of CoMt to SclfJBurc for wrk6' compqtsarion a providcd for by S*tiotr 3700 of tbc La$r Codc, for the pafome of thc wo* for vhich thc pqmit b isued.tv Ahavc md will mintain worko' compcroation imurucc, a rcquircd by Sction 37OO of thc lzbor Codc. for rhc pGfolmcc of the pennit is My insurance carrier and policy number are: Policy _l ccrtify that in the performancc of the work for which this perrnit is issued, I shall not employ any person in any manner so ,ls to become subject to the workers'compensation laws of California. and agree that if I should becomc subjcct to the workers' cornpensation provisions of Section 3700 of the kbor Code, I shall, forthrvith cornply rvith thosc provisions.. WARNING: Failurc to secure workcrs' compersation and shall subject an to and civil fines up to one hundred thousand dollars ($100,000). in to the cost of the Section T "!!fl':ry1'|**'i and attorney's fees. DECII\RATTON I hereby affrrn under penalty of perjury that I anr licensod under provision of Chapter 9 (commencing with Soction 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License -28-z W I hrcby aflim udo pemlty of perjury that thft is a @ostructiotr lcnding ag6cy for thc pqfomce of thc wol.k for which this psrtrit b issued (Se. 3097, Civ. C.). knder's Name: Lender's Address: APPLTCANT DECLARATION I hâ‚¬reby aflirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Required Lctter of Notification _l certify that the federal regulations removal are not applicable this project. that I have read this application state that I agree to comply with all City and County hereby above mentioned property for Applicant or Agent [\4 Permitee neme (print): of this City and County to enter upon the Site-Work Underground Pole Bases Liqht Standards Spas, Pool. Fountains Signs (monument) Life Safety /Low Voltaqe Fire AIarm I Dampers Communications Cable Building Under Slab / Floor Bonding I Grounding / 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 I FINAL tck/a rlrtr 4e Notes Rema Etc. D,^.rr na n7 ,n{ tr p-*n;r.rZ'7+-Z> Contractor:Date: n^a^,