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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hcrcby lfftrm undcr penalty of pcrjury that I m crcmpt frcm thc Contrrctos' Liccns t:w for thc following rcasn (Scc.7031.5 Busincss aul Prcfcssion Codc): Any City or County which rcquircs a pcrmit to consNruc't. alta, improrc. dcmlish or rcpair anj struclurc. prl)r lo its isswe, also requircs thc applicmt for such pcrmit to fih r signcd stalcrcnt th.l hc or shc is licnsd pusuet Io thc pmvisions of thc Contractor's Liccn*d law (Choptcr 9, Commncing vilh SGtion 7000 of Division 3 of the Busircss end PmfcssionsCodc)orthatheorshciscxcmptthcrcfromsndlhcbasisforthcalbgcdcxcmption. AnyviolationofscclionT03l.5byany applicant for a pcmit subjccts the applicant to a civil pcnalty of not mrc than fivc hundrcd dollars ($500). _1. as owncr of the propcrty, or my cnlployccs with wagcs as thcir solc compensation. willdo thc work and thc structurc is not intended or offbrcd for sale (Sec.7044, Business and hofcssions Codc: The Contractor's License law does not apply to an owncr of thc propcrty wtxr builds or improves thcrcon. and who does zuch work himsclf or hcrself or through his or hcr own employccs, providcd thal such improvenrnts Brc nol inlcndcd or offcrcd for sah. If, howcvcr. thc building or improvenrnt is soh within onc )aar of comphtion. the Owner Builder will havc thc burdcn of proving that hc or shc dlJ not build or inprove the propoty for lhc purF)sc of salc). -1. as owncr of thc proFrerty, am exclusively contracting with licensed conlractors to construct the pmjc'ct (Sec. 7W. Busincss and hrohssion Code: The Contractor's License Law docs not apply to an owncr of propcrty who builds or improvcs thercon. and who contracts for such projccts with a Contractor(s) liccnscd pursuant to the Contractor's Liccnse taw). -IamcxcmptunderSection-,B.&P.C.forthisrcason.ll..r ^. WORKERS' COMPENSATION DECLARATION I hercby affirnr undcr pcnalty of pcrjury onc of thc following declarations: -l havc and will maintain a Ccrtificatc of Conscnt to Self-lnsure for workers' compcnsation. as provided for by Scction 3700 of the Labor Codc. for thc pcrformance of the work for which thc prmit is issucd. -l havc and will maintain workcrs' compcnsation insurance, as requircd by Scclion 3700 of thc labor Codc. for thc lrcrformance of thc work for which this pcrrnit is issucd. My workcrs' compcnsation insurancc canicr and plicy numbcr arc: Policv Numbcr: Exoires: _l ccrtify that in thc pcrformance of thc work for which this permit is issucd, I shall not employ any pcrson in any manncr so as to tlc'comc subjcct to thc workers'comlrcnsation laws of California. and agrcc thal if I should bc.comc subjc.ct to thc workers' comgrcnsation provisions of Scction 3700 of the L:bor Code. I shall, forthwith comply with thosc provisions.. WARNING: Failurc civil lincs up to onc to secure workcrs' comJrcnsalion covcrage hundred thousand dollars ($100.000), in is unlawful. and shall subjcct an and lo of thc Scction 3076 of thc and all<lrncy's l'ccs.a I hcrcby att'irrn undcr penalty of pcrjury that I arn licenscd undcr 9 (comrncncing with Section 7000) of Division 3 of the Busincss and Professions Code, and my liccnse is in full forcc and cffcct. Licensc c53 I ty I hcrcby allirm under Fnalty of pcrjury that therc is s construclion lcnding agcrcy for thc pcrfoMce of thc work for which this pemil is i$sucd (Ss. 3097, Civ. C.). hndcr's Nanrc: Lrndcr's Addrcss: APPLICANT DECLARATTON I hcrcby allirnr undcr pcnalty of pcrjury onc of the following dcclarations: Dcrnolition Pcrrnits-Asbcstos Notification Fcdcral Rcgulations (Title 40, Part6) -Rcquirccl lrtter of Notification -l ccrtiti that lhc federal rcgulations rcgarding asbcstos rcmovalare nol applicable to this projcct. _l ccrtify that I havc read this thc infornration is corrcct. I agrcc to comply with all City and County ordinanccs and State l-aws relating to rcprcscntatives of this City and County to cnlcr thc above mentioncd propcrty for A;llllicrurt or Agcrtt l'('rilrilN ilililtr (pritrl): Site-Work Underground g - 4-Lr **42 Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safetv /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bondinq I Groundino I UFER Transformers Torqueincr Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rouqh) lVleter Release A Rough Pool - F"uy$ , ol-.70 aI \UL)t) Service [Vleter v \ FINAL [b -l r -Ll Notes, Remarks, Etc D^.no n7 .)n.r tr lo Dale:_