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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/S!G COMMENTS OWNER BUTLDER DEICARATION I hocby affim undo pcnalty of pcrjury that I m cxâ‚¬mpt from thc ContracloE' Licw hw for thc following r@n (S6.7031.5 Buincs and Profasion Code): Any City or County which rcquire a pamit to coctruct, altc, improvc dqnolish or trpair uy structurq prior to its issumce, als rcquira thc applicut for such psrnit to file a signcd statmot that hc or shc b licoscd pmust to thc prcvisions of thc ContEctor's Licqscd taw (Chapt6 9, Comcncing with Sation 7000 of Division 3 of thc Busincs ud PrcfcsionsCodc)orthathcorshciscxcmptth@ftomedthcb6sisfortheallegedexilption. AnyviolatiotrofScrionT03l,5byuy applicut for a pcrmit subjcts thc applicant to a civil pcmlty ofrct more thil five hundrcd dollm ($500). _1, as owner of the property. or my employecs with wages as their sole compensation. will do the work and the structure is not intcnded or offered for sale (Sc.7044, Business and hofessions Code: The Contractor's Licensc [aw does not apply to an owner of the propoly who builds or improves thereon. and who does such work himself or herself or through his or her own cmployees. provided that such improvonents are not intended or offered for sale. If, however. the building or improvement is sold within onc )er of complaion. the Orvncr Builder will have the burdcn of proving thd he or she did not build or improve the propo'ty for the purpose of salc). --1. as owner of the properly, am exclusively contracting rvith licensed contractors to construct the project (Sec. 7044. Business and hofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thercon. and who contracts for such projects with a Contracto(s) licerued pursuant to the Contractor's Licerse taw). _l am under B. DECLARATION I hereby affrrm under penalty of po'jury one ofthe following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensalion. as provided for by Section 3700 of the Labor Code, for the performancc of thc work for which the permit is issued. _l havc and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code, for thc performance of the work for which this permit is issucd. My workers' compensation insurance carrier and policy number are: Policv Nurnber: Exoires: _l ccrtify that in the perforrnance of the work for which this permit is issued, I shall not anploy any person in any manner so as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall. fonhwith cornply with those provisions.. WARNING: Failure to serure workers' conrpensation coverage is and civil fines up to one hundred thousand dollars ($100.000), in thc attorney's fees. I,I(: I'NS ED CO N'TRAC'I'OR DECT,ARATION I hereby affrm under penalty of pcrjury that I am licensed under p,rovision of Chapter 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code, and my licerue is in full force and effect. License Class: License Number: Il.r t o. W I hcby affm undo psulty of pojury that th@ is 8 @Eiructbo leoding agacy for thc pcfomcc of the work 6r which this ponit b issucd (56. 3097. Civ. C.). Lndtr's Nmc: I-errder's Address: APPLTCANT DECLARATION I hcreby allirm under pe'nalty of perjury one of the follorving declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Tille 40, Pan6) _Required Letter of Notification _l cerrify that the fcderal regulations regarding asbestos removalare not applicable to this project. -_-l ccrtify that I have read this application and state that the above infonnation is correct. I agree to comply with all City and County ordinances and State Laws rclating to building above rnentioned property for inspection A;rplicnrrt or Agertt Perrnilee nanre and hereby authorize representatives of this City and County to enter upon the Site-Work Underground Pole Bases Liqht Standards Spas, Poot, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Building Under Slab / Floor Bonding I Groundinq / UFER lol iz /r,lAlao Transformers (I Torqueincl Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Wails (Roush) Ceilings (Hard & Soffit Roush Ceilinqs (T-Bar Rouqh)tl Meter Release tol Lfl-4D I lv Rouqh Service Meter I IL FINAL lo fih^fJ/\oo Rema Etc. Dnrr nQ n7 nn4tr I ,,,",u7h1,/za\ tl ,