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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Building Under Slab / Floor ,-a /Bonding@IUFER ,: -/6', Z loc 7rT Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Rouqh) Meter Release a -Ut--"4 .l/-c ( Rough Service Meter FINAL 7-%2N O,- (-l 9A e DsS vLt Notes, Remarks, Etc. it 9--/, OWNER BUILDER DELCARATION I hereby afflrrn under penalty of perjury that I am exempt fnlm the Contractors' License Law for the following reason (Sec.7031.5 Business and Profession Code): Any City or County which requires a permit to construct, alter, improve, derrxrlish or repair any structure, pri<rr to its issuance, also requires the applicant for such permit to file a signetl statenrcnt that he or she is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9. Comrnencing with Section 7fi)0 of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis ftrr the allegetl exemption. Any violation of Section 7031.5 by any applicant firr a permit subjects the applicant to a civil penalty of not nxrre than five huntlred dollars ($500). _1. as owner of the property, or my employees with wages as their xrle compensation. will do the work antl the struc'turc Ls not intended or offered for sale (Sec.7M4, Business and Professions Code: The Contractor's License Law does not apply to an owner of the proprty who builds or improves thereon, and wlxl does such work himself or herself or through his or her own empkryees, provided that such improvenrnts are not intended or offered for sale. If, however. the building or impnrvenrnt is sold within one year of completion, the Owner Buikler will have the burden of proving that he or she ditl not build or improve Ore pruperty for the purglrc of sale). _1. as owner of the property, am exclusively contracting with licensed contractoni lo construct thc project (Sec. 7044, Business and Pmfesskrn Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such pnrjects with a Contracto(s) licensed pursuant to the Contractor's License Law). _l am exempt under B. & P.C. for this reason. Il^r-. WORKEILS' COMI'ENSATION DECLAIIA'I'ION I hereby affrm under penalty of prjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as prcvided for by Section 37fi) of the L:bor Code, for the perforrnance of the work for which the prmil is issued. _lhaveandwillmaintainworkers'compensationinsurance,as requiredbySection3T(X)oftheLabrlrCode,fortheJrerformanceof the work for which this perm.it is issued. My workers' compensation insurance carrier and plicy number are: 't "rJak (-n J Poricy*r.*r'- 993164-3 e*pnrr, / _l certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner I so as to beconr subject to the workers' compensation laws of California. and agrce that if I should becorne subict to the workers' compensation provisions of Section 3700 of the labor Code, I shall. ftrrthwilh comply with those provisions.. WARNING: Failure to secure workers'compensation coverage is unlawful, and shall subjecr an employer to criminaltltnatties and civil fines up to one hundred thousand dollars ($100,U)()), in addition to the cust of comyrcnsation, damages as provided for the .Section 3076 of the latnr Code, interest and fees. f l.,r-. I hereby affirm under penalty of prjury that I arn licensetl under provision of Chapter 9 (comnrcncing with Section 7Un) of Division 3 of the Business and hofessions Code, and my license is in full force and effect. ct t0 7c4F t License CONSTRUCTTON LEN IuN(: AGENCY I hereby affrm untler penalty of perjury that there is a construction lending agency for the perfurmance of the work for which this permit is issuerl (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: AI'PLICANT DECLARA'I'ION I lrereby affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Requiretl Letter of Notifrcation _l certify that the federal regulations regarding asbestos removal are not applicable to this project. -, L,r, that I have read this appticarion and that the atxlve inlilrmltion is conect. I agree to conrply with all City and County ordinances antl State Laws relating to building antl hereby auttxrrize representatives of this City and County to enter ugln the above mentioned property for Applicant or Agent I'ermitee name ,,,,i f f 11 /yrz,l 0B-07-2015 t (