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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underoround Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under SIab / Floor Bondinq I Groundinq I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush)?- 14.Lt YrfxvC 4v Ceilinqs (Hard & Soffit Rouqh 'l -l 4 -Ll o*t**z- Ceilinqs (T-Bar Rouqh) Meter Release Rouqh Service N/eter -a-- FINAL lC I )4/ t-l D-t) 8.,, Notes, Remarks, Etc.- 4 OWNII.R l|t,Il,l)t,.R I hereby affirm under lrcnalty of perjury that I am exempt fnrm the Contractors' License Law ftrr the following reason (Sec.7031.5 Business arxl Profession Ctxle): Any City or County which requires a permit to construct. alter. improve, dennlish or repair any struclure, prilr to its issuance. also requires the applicant for such prrmit to file a signed staternent that he or she is licensed pursuant to the prlvisions of the Contractor's Licensetl Law (Chapter 9, Commencing wilh Section 7fi)0 of Division 3 of the 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 applicant for a perrnit subjects the applicant to a civil penalty of not nnre than five hundrerl dollars ($500). _1. as owner tlf the property. or my employees with wages as thcir srh comJrcnsation, will do thc work arrl ttp stnrcture b not intended or offered for sale (Sec.7O44, Business antl Professions Code: The Grntractor's License Law does not apply to an owner of the property whr builds or impnrves thercon, and who does such work himself or herself or through his or her own employees, provided that such improvenrnts are not inten<led or offered for sah. If, tnwever. the building or inpnrvenrcnt is soltl within one year of completion, the Owner Buikler will have the burrlen of proving tlra he or she dil not build or improve 0re prugrrty for the prrynse of sah). -[, asowner of the property, arn exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and hofessirn Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Law). -l am exempt under ftrr this a I hereby affirm under penalty of perjury one of the following declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as pruvided for by Section 3700 of the Labor Code, for the performance of the work for which the permit is issued. _l have and will maintain workers' compensatkrn insurance, as required by Section 3700 of the l-abor Code. for the performance of ttre work for which this permit is issued. My workers' compensatkrn insurance carrier and policy number are: Carrier: Policy Number: Expires: _l certify that in the lrcrformance of the work for which this grcrmit is issued, I shall not empk)y any frcrson 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 latxrr Code, I shall, forthwith comply with those pnrvisions.. WARNING: Failure to sEcure workers'comJrensation coverage is unlawful, antl shall civil fines up to one hundred thousand dollars ($100.m0), in atldition to the cost of suhject employer to and Section 3076 of the Lahlr Code, interest and attorney's fees. ,,*, b-/ ?' 7l /w I hereby affirm under penalty of perjury that I am licensetl under provision of Chapter 9 (comnpncing with Section 7m0) of Division 3 of the Business and Professions Code, and my license is in full ftrrce and effect. I License Class: License Number: CONSTRUCTION I TNDING AGENCY I hercby affirm under penalty of prjury that therc is a construction hnding agency for the performance of the work for which this permit b issued (Sec. 3097. Civ. C.). Lender's Name: Lender's Address: APPLICAN'I' DECLARA'I'ION I hereby afhrm under penalty of perjury one of the following declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Require<l Letter of Nrlifrcation certify that the federalregulations regarding asbestos removalare not applicable to this project. certify that I have read this application and state that the ahrve information is conect. I agree to cornply with all City and County and State Laws relating to building construction,this City and atxrve nrcntioned prolrcrty for Applicant or Agent Pernritee nanle representatives o enter uJxln the Flev. 08-07-2015 (print):-