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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire AIarm I Dampers Communications Cable Building Under Slab / Floor Bonding I Groundins / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) Meter Release Rouqh Service lVleter FINAL l0*fi.4.(l) , (.tg to n*<- Wn Notes, Remarks, Etc. I hereby affrrm under paralty of perjury that I am exempt from the Contractors' Liccnse law for the follow. Business and Profession Code): Any City or County which requires a pernrit to construcl. altctr, improve, den^ structure, prior to its issuancc. also requires the applicant for such permit to filc a signed statement that he or she is h. to thc provisions of the Contractor's Licensed Law (Chapter 9, Commencing with Section 7000 of Division 3 of the ^ Profcssions Code) or that hc or she is excmpt thercfrom and the basis for the alleged exemption. Any violation of Section 703, applicant for a permit subjects the applicant to a civil pcnalty of not more than live hundred dollars ($500). _1. as owner of the property. or my employees with wages as their sole comperuation. willdo the work and the structure is not intended or offered for sale (Sec.7M4. Business and Professions Code: The Contractor's License Law does not apply to an owner of thc property who builds or improvcs theron. and who does such work himself or herself or through his or her own employees, provided that such improvancnts arc not intcndod or offered for sale. I(, however, the building or improvement is sold within one year of cornplaion, the Orvner Builder will have the buden of proving that he or she did not build or irnprove the propo'ty for the purposeof sale). _f , as owner of the property. am exclusively contracting with licensed contractors to construct thc project (Sec. 7U4, Brsiness and hofession Code: Thc Contractor's License Law does not apply to an owner of propary who builds or improves ther@n, and who contracts for such p,rojects with a Contracto(s) licoxed pursuant to the Contractor's Liccnse t aw). -l am exempt under Section-. B. & P.C. for this reason. l )itl r WORKERS' COMPENSATTON DECLARATION I hereby alTinn 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 provided for by Section 3700 of the Labor Code, for the poformance of the work for which thc pennit is issued. _l have and will maintain workers' compensation insurance, as by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'carrier and policy number are: Policy -l certi& that in the performance of the work which this permit is issued. I shall not exrploy any person in any manner so as to become subject to the workers'cornpensation larvs of California, and agrec that if I should become subject to the u'ork6s' compensation provisions of Section 3700 of the Labor Code. I shall. forthwith comply with those provisions.. WARNING: Failure to serure workers' compensation coverage is unlarvful. and shall subject an anployer to criminal penalties and civil fines up to one hundrcd thousand dollars ($l to the cost of cornpcnsation. darnages as provided for the Scction 3076 of the t^abor Code. interest and I hereby affrm under penalty of perjury that I am licensed under provision of Chapter 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and efteg.4'l C)o 3s,,8qat 'k).$.)lI);r t o' I h@by affm unda pqElty of pojury thar thqc is 8 @nsrucliotr kading agacy for thc pgfol]mcc of thc wtrk for which this pqmit b issucd (Se. 3097, Civ. C.). Lender's Name: Lender's Addrcss: APPLICANT DECLARATION I herdry affrrn under penalty of perjury one of the follor+'ing declarations: Demolition Permits-Asbestos Notification Federll Regulations (Title 40, Part6) -Rcquired Letter of Notification -l certi$, that the fbderal regulations regarding asbcstos removal are not applicable to this project. _l ccrtify that I have read this application and that ordinanccs and State Laws rclating to thc above rnentioned property for { t?J-a.7 IApplicant or Agent Permitee name Dnrr na n7 4tr, -Expiresr .