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ELECTR ICAL-! NSPECTOR R ECOR D <br />[Jr.rr nA n7 Onl <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby afftrm undcr lf,nahy of Frjury that I u cxcmpl frcm thc Contracto6' Liccnsc ljw for thc following rcasn (Ss.70i1.5 <br />Busincss and Profcssion Codc): Any City or County which rcquircs a Frmit lo onstruct. altq, improvc, dcmlish or rcpair any <br />structw. Idor to its issuarcc, also rcquircs the applicant for such pemit to file r signcd statcmnt tha he or shc is liensd puomt <br />lo lhc pmvisions of thc Conraclor's Licen*d [lw (Chaplcr 9. Comncing with S$tion 7000 of Division 3 of thc EusiEss od <br />PmlcssionsCodc)orthathcorshciscxcmptth@fromundthcbasisforthcalhgc{cxemption. AnyviolationofSetionT03l.5byany <br />applicant for a pcmit subjccts thc applicunt to a civil pcmlly of not mre thsn five hundrcd dollrs ($500). <br />-t. <br />as owncr of thc propcrty, or my cmployces with wagcs as thcir sole comlrcnsation. willdo thc work and thc stnrclurc is not <br />intcndcd or offcrcd for salc (Sec.7044. Business and hofcssions Code: The Contractor's Liccnsc [^aw does not apply to an owncr of <br />thc propcrty whcl builds or improves thcrcon. ard who dcrcs such work himsclf or hcrsclf or lhrough his or trcr own cmployccs. <br />providcd that such impmvcnrcnts are not interdcd or offcrd for salc. lf. howevcr, the building or irnprovenEnt is sold within one )rcar <br />of complction. tlrc Owncr Builder will have thc burden of proving that he or shc did not build or improve the propcrty for the purynsc of <br />sale). <br />-1, <br />as owner of thc property, am exclusively contracting with liccnsed conlractors to construct thc projc.ct (Scc. lW. Busincss <br />and Profcssion Codc: The Contractor's Liccnse Law docs not apply to an owncr of propcrty who builds or improves thereon. <br />and who contracts for such projects with a Contracto(s) liccnsed pursuanl to thc Contraclor's Liccnsc hw). <br />-lamcxemptundcrScction-,B.&P.C.forthisreason'0wner: <br />IIIXf,EBSTAMTENSATON <br />DECI.AEAUAN <br />I hcrcby affEm undcr lEmlty of perjury orc of the following dsl8rstbN: <br />-l <br />haw ard will mintain a Ccfiilhat€ of Consnt to Sclf-lnsm for mrkm' smpensalion, as prcviled for by Sction 3700 of thc <br />trbor Code, for thc pcrforrc of the vo* for uhich thc pqmit is issued. <br />)&5aw and will minlsin workerc @mFnsatbn insurare, rs rcquircd by Setion 37OO of thc kbor Codc. for thc perforrrc of <br />/thc work for whbh this pmit is issrd. My workc' @mpensation insuree wbr ard polky oumbcr rc: <br />t.-i-.. <br />Policy Numbcr: Expircs: <br />-l <br />ccrtify that in thc Jrcrformance of thc work for which this grcrmit is issucd, I shall not cmploy any lrcrson in any manlrcr <br />so as lo bccomc subject to the workcrs' compcnsation laws of California, and agrce that if I should bccomc subjcct to thc <br />workcrs' compensation provisions of Scction 3700 of thc L,abor Codc. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failurc to sccure workers'compcnsation covcragc is unlawful. and shall subfct an cmploycr to criminal pcnaltics and <br />civil fincs lo onc hundrcd thousand dollars ($100,0m). in addition to thc cost of damages as providcd for thc <br />Scction Codc, intercst and atlorney's fecs. <br />IUTCLAILl'tl()N <br />I hcreby affirm undcr pcnalty of perjury that I am liccnscd undcr provision of Chapter 9 (commcncing with Scction 7000) of Division 3 <br />of thc Busincss and Profcssions Code, and my licensc is in full force and cffcct. <br />Liccnsc <br />CONS'I'RUC'I'I()N t,IiNI)IN(; AG ITNCY <br />I hcrcby allirm undcr Fnslly of pcrjury thal lh@ is a @nstruction lerding lgcrcy for thc perfomre of thc work for wNch this pcmil is <br />issucd (Se. 3097, Civ. C.). <br />hndcr's Narc: <br />l.cndcr's Addrcss: <br />APPI ICANT DT'CLARATION <br />I lrcrcty affrnn under pcnalty of perjury onc of the following dcclarations: <br />Dcmolition Permits-Asbestos Notification Fcderal Rcgulations (Title 40. Part6) <br />_Rcquired Lrttcr of Notification <br />-l <br />certify that thc fcdcral regulations rcgarding asbestos rcmoval are not applicabh to lhis projcct. <br />_l certify that I have read this application and stale that thc above information is correct. I ugrcrc to comply <br />ordinanccs and Statc Laws relating to building construction, and hereby aulhorizc rcprcsentativcs of this City <br />with all City and County <br />abovc nrcrrtioncd propcrty ftlr inspcction <br />Applicant or Agenl <br />Pernritee name <br />and to upon thc <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildins <br />Under Slab / Floor <br />Bondinq I Groundinq I UFER ?, _Le_zl Eu 31 <br />Transformers <br />Torqueincr <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinss (Hard & Soffit Rouqh <br />Ceilings (T-Bar Roush) <br />N/eter Release 8 -ze-zl Rt-r 31 <br />Rough <br />Service Meter ,-4.. <br />FINAL D-ll'Ll IDthq <br />Notes, Remarks, Etc.\-/ <br />u-Applicant: