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ELECTRICAL-I NSPECTO R RECORD <br />no n7 ont tr <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEL(LIRATION <br />I hcrcby affum undcr pcnalty of pcrjury Ihal I an cxcmpt ftom thc ContractoE' Liccns Law for thc following res$n (5&.7031.5 <br />Busincss ard Profcssion Code): Any City or County which rcquircs a lf,rmil to @nstruct. allq, improvc, dcmlish or rcltsir any <br />slrucluc. prk r lo its issuecc. also rcquircs thc applicant for such Frmit lo filc s signcd statcmnt lhal hc or slE is liccnsd prjuant <br />lo lhc prcvisions of thc Contractor's Liccnsd ljw (Chaplcr 9, Commcncing with Sction 7000 of Division 3 of lhc Busircss and <br />PrcfcssbDsCodc)orlhathcorshciscxcmptthncfrcmildthcbrsisforthcallcgedcxcmption. AnyviolationofSccliotrT03l.5byany <br />applicant for a JErmil subjcts lhc applicant lo a civil pcnalty of not mrc than fivc hundrcd dollus ($500). <br />-1. <br />as owncr of thc property, or my cmployccs with wagcs as thcir solc compensation. willdo the work &nd thc structurc is not <br />intendcd or offercd for sale (Scc.704+. Busincss and hofcssions Code: The Conlractor's Liccnsc [-aw does not apply to an owner of <br />the propcrty who builds or improves thcrcon, and who docs such work himsclf or hcrsclf or through his or hcr own cmployccs. <br />providcd that such improvernenls arc rrtt intcndcd or offcrcd for salc. If, howcvcr. the building or improvcnrnt is sold within one yc:u <br />of cornphtion. thc Owncr Buildcr will have the burdcn of proving that he or shc did not build or inprore thc propcrty for thc purpose of <br />salc). <br />_1. as owncr of thc property, am cxclusively contracting with liccnscd contractors to construct the projcct (Scc. 7W, Busincss <br />and Profcssbn Codc: The Contraclor's Licensc Law does not apply to an owncr of proSrcrty who builds or improvcs thcreon. <br />and who conlracts for such projccts with a Contracto(s) Iiccnscd pursuant to the Contraclor's Liccnsc hw). <br />_l amcxcnrpt undcr Scction_, B. & P.C. for this rcason. <br />Il..r^. <br />}VORK E ILS' COI\T PENSA'tION <br />DI'CLARA'I'ION <br />I hcreby alllrm undcr pcnalty of pcrjury onc of thc tbllowing declarations: <br />-l <br />havc and will maintain a Ccrtificatc of Conscnt to Self-lnsurc for workcrs' compcnsation. as providcd for by Scction 3700 of thc <br />Lahor Codc. for thc ;rcrformancc of thc work for which thc pcrmit is issued. <br />-l <br />havc and will rnaintain workcrs' cornpensation insurance, as rcquircd by Scction 3700 of thc Labor Code, for thc pcrformance of <br />thc work tbr which this pcrmit is issucd. My conrgrcnsation insurancc carricr rmd prlicy nunrbcr arc: <br />Policy Numbcr:4L - c)o*/ ?a i ' O I ' l8 Expircs:L/, / eoar,,--( <br />-l <br />ccrtify that in thc lrcrformancc of thc work for which this permit is issucd. I shall not cmploy any lrcrson in any manncr <br />so as lo bcconrc subjcct to the workcrs' compcnsation laws of California, and agrcc that if I should bcconrc subject to the <br />workcrs' compcnsation provisions of Section 3700 of the l^atnr Code, I shall. forthwith conrply with thosc provisions.. <br />WARNING: Failurc to sccure workers'comJrcnsation covcrage is unlawful. and shall an cnrploycr lo criminal pcnaltics and <br />civil fincs up to onc hundred lhousand dollars ($100,0001. in addition to thc of damages as providcd for thc <br />Scction 3076 of thc Labor Codc. intcrcst and attorncy's fccs. <br />o*u, L' 00' ea L? <br />I hcrcby atlinn undcr pcnalty of pcrjury that I am liccnsed undcr of Chaptcr 9 (conrmcncing with Scction 70m) of Division 3 <br />of thc Busincss and Professions Codc. and rny liccnse is in full force and cllcct. <br />Liccnsc <br />Da,": h' %. eo z.) <br />I hcrcby atfirm undcr pcnalty of pcrjury that thcrc is a construction <br />issucd (Sec. 3097, Civ. C.). <br />lrndcr's Namc: <br />agcncy fbr thc pcrlbnnancc of thc work for which this prnrit is <br />hndcr's Addrcss: <br />APPLICANT DECL.TIIA TION <br />I trcrcby afl'irm undcr penalty of prjury onc o[ thc following declarations: <br />Dcrnolition Permits-Asbcstos Notification Fcdcral Regulations (Titlc 40, Part6) <br />_Recluired lrttcr of Notification <br />_l ccrtify that thc t'cdcral rcgulations rcgarding asbestos rcmovalare nol applicable to this projcct. <br />_l certity that I havc read this application and statc that thc utrrve with all City and County <br />and County lo entcr u6rn theordinanccs and Statc Laws rclating to building <br />abovc nrcntioncd proprty for <br />Applicant or Agent <br />Pernrilee nanle D ,,ru. L.lo . eoz) <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq I Groundi ns I UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit)tl It , <br />Walls (Rouqh)ft?3t2r Wkh,tbt rffi <br />Ceilinqs (Hard & Soffit Rouqh t <br />twbl UUU(%YK A?/ <br />Ceilings (T-Bar Rough)I 'trufta/CUgrlca/d ) <br />N/eter Release <br />Rough <br />Service N/eter t//h ,a <br />FINAL /a/1//22 AArZU Tfr(X/ <br />Notes, Remarks, Etc. <br />'l <br />Owner:_ <br />and <br />is corrcct. I