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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNE,R BUILDER DELCARA'I'ION I hereby affirrn under penalty of perjury that I am exempt from the Contractors' License Law for the following reason (Sec.7031.5 Business and Profession Code): Any City or County which requires a permit to construct, alter, improve, rlenmlish or repair any structure, prior to its issuance. also requires the applicant for such permit to file a signed staternent that he or she is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9, Commencing with Section 7fiX) of Division 3 of the Business and Pnrfessions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by any applicant for a permit subjects the applicant to a civil penalty of not mure than five hundred dollars ($5001. -1, as owner of the property, or my employees with wages as thâ‚¬ir mle compensation, will do the work antl the struc'ture is not intended or offered for sale (Sec.7(Xa, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who buikls or improves thereon. and who does such work himself or herself or through his or her own employees. providetl that such improvernents are not intended or offered for sah. If, however. the building or inqrrcvefis s<rld within one )â‚¬ar of completk)n, the Owner BuiUer will have the burden of proving thar trc or she did not buikl or improve thilfrny for the purgrse of s:rle). -1. asowner of the property, amexclusively contracting with licensed contractors to construct the pmject (Sec. 7044. Business and hofessbn Code: The Contractor's License Law does not apply to an owner of proJrcrty who builds or improves thereon. and who contracts for such prujects with a Contracto(s) licensed pursuant to the Contractor's License Law). -IamexemptunderSection-,B.&P.C.forthisreason. WO RK EILS' COMPENSATI ON DT'CI IRATION I hereby affirm under penalty of perjury one of ttre following declarations: -lhaveandwill maintainaCertifrcateofConsenttoSelf-lnsureforworkers'compensation,as providedforbySection3T00ofthe Labor Code, for the performance of the work for which the permit is issued. _l have and will maintain workers' compensation insurance. as required by Section ST00 of the Labor Code. for the yrcrfirrmance of the work for which this permit is issued. My workers'tnsurance and gxrlicy number are: a Poricy *,^*,, '* CV...E IWO% Expires: b -l certify that in the Srerformance of the work for which this prmit is issued. I shall not employ any F,erson in any manner so as to beconp subject to the workers' compensatbn laws of California. and agrce that if I shoukl becorne subject to the workers' compensation provisions of Section 3700 of the Latnr Ccxle, I shall, forthwith comply with thor pmvisions.. WARNING: Failure to sâ‚¬cure workers'comJrensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000). in of comlrcnsation, damages as provided 6,11fire attorney's fees. ( I hercby affirm under penalty of prjury that I am licensed un<Ier provision of Chapter 9 (comnrncing with Section 7m0) of Division 3 of the Business antl hofessions Code, and my license is in full force arxl effect. License e B t I hereby affirm under penalty of Srerjury that there is a construction lending agency for the performance of the work firr which this permit is issuetl (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: A PPLICAN'I' DECLARAI'ION I hereby affirm untler penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Recluired Letter of Notification with all City and County and County l0 enter uprn the above mentioned property for inspection Applicant or Agent l)e rnritee D( Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding I Grounding / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Rouqh Ceilings (T-Bar Rouqh) Meter Release Rough Service Meter ,a-I h.n */a FINAL lUt/l v\-tt (/I Notes, Remarks, Etc.I Rev. 0B-07-2015 ,,r", " bllalLl