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ELECTRICAL-INSPECTOR RECOR D <br />Dnr na n7 onl tr <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby rfftrm undcr lEnalty of Frjury thot I m cxempt from thc ConlEcto$' Liccns Lrw for the following rcaren (Se.7031.5 <br />Busincss and Prcfcssion Codc): Any City or County which rcquires a yrcrmit to mnstruct. alts. improvc. dcmlish or rc1uir any <br />struclurc. prior to its issuane, llso rcquircs thc applicet for such pcrmit to lilc 8 sigred stotcmnl lhat hc or slrc is lircnscd pumant <br />to thc prcvisions of thc Contmcror's Liccnsd tiw (Chapter 9, Commrcing wilh Scction 7000 of Division 3 of Ihc Eusircss and <br />PrcfcssionsCodc)orthathcorshciscxcmptthcrcfrcmardthcbasisforthcallcgcdcxcmption. AnyviolationofSetkmT03l.5byany <br />applicant for a pcrmit subjccts thc applicant to a civil pcnalty of not mrc than fivc hundrcd dollds (5500). <br />-1. <br />as owncr of thc proprty. or my cnlployccs with wagcs as thcir sole compcnsation. willdo thc work and thc structurc is not <br />intcndcd or oflbrcd for sale (Scc.7044. Busincss and Professions Codc: Thc Contractor's Licensc Law does not apply to an owncr of <br />thc proprty who builds or irnprovcs lhcrc<ln. and who docs such work himsclf or hcrsclf or through his or her own employccs. <br />providcd that such improvcmcnts arc not intcndcd or olTcrcd for salc. lf, howcvcr. the building or improvcrpnt is sold within one ycar <br />of corrrplction, thc Owncr Buildcr will havc thc burdcn of proving that he or shc did not build or improve the property for tlrc purp)sc of <br />salc). <br />_1. as owncr of thc profrerty. am exclusivcly conlracting with liccnsed conlraclors lo construct thc project (Sec. 7W, Busittcss <br />and Prrotbssion Codc: Thc Contractor's Liccnsc Law does not apply to an owncr of property who builds or improves thcrcon. <br />and who contracts for such projccts with a Contracto(s) liccnsed pursuant lo thc Contractor's Licensc [,aw). <br />-lamexemptundcrSection-.B.&P.C.forthisreason.0wner: <br />woqxnRs' COMPEI\q Tltrx <br />NECLARATION <br />I hcrcby affirrn under penalty of pcrjury orrc of thc following dcclarations: <br />_l have and will maintain a Ccrtificatc of Consent to Sclf-lnsure for workcrs'conrpcnsation. as providcd for by Scction 3700 of thc <br />I-:tnr Codc. for thc pcrformance of the work for which the pcrrnit is issucd. <br />tYg havc and will rnaintain Scction 3700 of thc labor Code. for ltrc Jrcrformance of <br />thc work for which this carrier and plicy numbcr are: <br />Carricr:Lt <br />Policy 5 7 \o'l Ll <br />NIT| ccrtity rhat in thc pcrfbrmance of thc work for which this perrnit is issucd. I shall nor cmploy any pcrson in any nlanncr <br />so as to bccornc subjcct to thc workcrs'conrpcnsation laws of California. and agrcc thal if I should bccomc subjcct to thc <br />workcrs' compensation provisions of Scction 3700 of the l-atxrr Code, I shall. lorthwith comply with thosc provisions.. <br />WARNING: Failurc lo sccurc workers' compcnsation covcragc is unlawl'ul. and shall subjcct an cmploycr to criminal pcnaltics and <br />civil fines up to onc hundrcd lhousand dollars ($100.0001. in addition to thc cosl of compcnsation. damages as providcd for thc <br />Scction of thc Codc. inlcrcst and attorncy's [ccs. <br />B 7 H-<j <br />I hcrcby allirnr undcr pcnalty of pcrjury that I am liccnscd under 3 <br />of thc Business and Profcssions Codc. and my liccnsc is in full <br />Liccnsc <br />C^lo <br />zl conrracro. V \ t'f rTt Solor <br />W <br />I hcrcby afftrm under penalty of perjury that thse is a construction lending sgcrcy for thc pcrfow of rhe wk for which this pcmil k <br />issucd (Se. 3097. Civ. C.). <br />lf,ndcr's Nare: <br />knder's Address: <br />APPLTC.TNT DECLARATTON <br />I hcrcby afiinn undcr pnalty of pcrjury one of thc following dcclarations: <br />Dcnmlition Perntits-Asbcstos Notification Fcdcral Rcgulations (Title 40. Part6) <br />-Rcquircd <br />l*ttcr of Notification <br />_l certily that the fedcralrcgulations rcgarding asbcstos rcmoval are not applicablc to this project. <br />tlq ccrtily that I have read this application <br />ordinances and Statc laws rclating to <br />atxlve nrcntioncd propcrty for <br />Applicant or Agent <br />Pt'nnilee nanre <br />,,r",o l'q lzl <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 />Buildinq <br />Under Slab / Floor A <br />Bondinq I Groundinq I UFER ?'-ro YzJ l4w vu <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 />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinss (T-Bar Rouqh) <br />-f\rtEiler Release lnl tot>lu l3-zl UN IIu-- l\A <br />Roush Sotlo4-1' .6-71 I'llu v) <br />Service lVleter V\ <br />/\ <br />FINAL ? -[o -A vtu \J <br />Notes, Remarks, Etc r (\r