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NSPECTOR RECORD:LE,U T FT APPROVALS DATE ID/SIG.COMIIIENTS Site-Work Underqround Pole Bases Lisht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding I Grounding I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouoh) Ceilinss (Hard & Soffit Roush Ceilinss (T-Bar Roush) N/eter Release Rouqh Service [Vleter rl ,l ,,, FINAL tOltl/2 iff Notes, Remarks, Etc. ()wNltR I hereby affrnr under penalty of perjury that I arn exenrpt from the Contractoru' License Law for the following reason (Sec.7031.5 Business and Prolbssion Code): Any City or County which rcquircs a permit l,o construct, alter. itnprove, demolish or rcpair any structure, prior to its issuance. also requires the applicart for such pernrit to file a signed statement that he or she is licensed pursuant to the pmvisions of thc Contractor's l.icenscd l,aw (Chaptcr 9, Cornmcncing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and tlre basis for the alleged exemption. Any violation of Section 7031.5 by any appticant for a pennit subjects the applicant to a civil penalty of not more than llve hundred dollars ($5Otl1. _1, as owner ol'the property. or my employces with wages as their sole compcnsation, will do the work and the structure is not interrrled or offeretl ftrr sale (Sec.7(Xa, Business and Professions Code: The Contractor's License Law does not apply to an owner of the prcpeny wlxr builds or inrproves thereorl ad who does such work himself or herself <lr through his or her own entployees, providcd that such improvcnrcnts arc not intcnded or ollered for salc. I[, howevcr, t]re building or improvemcnt is sold within one year of completion, tlre Owner Builder will have the burden of proving that lre or slrc did not build or improve the properry for the purpose of sale). _1, as owner of the property, am exclusively contracting witlr licensed conlractors to conslrucl the project (Sec. 7044, Business and Bnrfession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and Who confacts lor such projccts with a Contractor(s) licensed pursuant to thc Contractor's License Law). _l anr exempt B. & P.C. tbr tltis reason.n I hcrcby aflirm under penalty of pcrjury one of tlrc -I have and will nninlain a Certilicate of Conseltt to for workers' conrpensation, as provided for by Section 3700 of the Labor Code, for the performancc of thc work for which the pcrmit is issued. _I have and will nraintain workers'conpensation insurance, as required by Section 3700 of the Labor Code, for the perfonnance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Policy Nurnber: Expires: _l cerrify that in tlrc lrcrfornunce of thc work for which this pcrmit is issued, I shall not cmploy any [rcrson in any manncr so as to becornc subject to the workcrs' contpensation laws of California, and agree that if I should bccomc subject to the workers' conrlrcnsation provisions of Section 3700 of the Labor Code, I slrall, forthwith cortrply with those provisions.. WARNING: Failure to secure workers' cornpensation coverage is unlawful, and shall subject an employer to crirninal penalties and civil fines up to oue hundred thousand dollars ($100,000). in addition to tlrc cost of competnation, damages as provided for the attorncy's I hereby affrrn under penalty of perjury that I anr licensed of Chapter 9 (cournrcncing with Section 7000) of Division 3 of the Business and Profiessions Code. and my license License Class: License Number: Date: CONSTRUCTION LENDING AGENCY I hcreby allirrn under pcnatty of perjury that there is a construction lending agency for thc pcrlbrmance of thc work ltrr which this perrnit is issued (Sec. 3097, Civ. C.). knder's Name: [rnder's Address: APPI,ICANT DECLARATION I tmeby affirm under pcnalty of perjury one of the following dcclarations: Demolition Permits-Asbcstos Notification Federal Regulations (Titlc 40, Part6) -Required lrttcr of Notification _I ccrtify that the federal regulations regarding asbestos removal are not applicable to this project. _l certify tlrat I have read this application and statc that the abovc information is correct. I agrec to comply ordinances and State Laws rclating to building construction, and hereby authorizc representatives of this City with all City and County and County to entcr upon thc above nrcntioned properry for Applicant or Agent Pcrnrilce nanlc r Flev. 08-07-201 5 ,