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E LECTRICAL.I N SPECTOR RECORD <br />a <br />a <br />APPROVALS DATE ID/SIG.COMMENTS OWNER Bt'ILDER DET,CARATTON <br />I hcrctry aflim undcr pcnrlly of psjury lhst I m cxcmpt from thc Contndols' Licose lrw for thc following rcaron (Scc.70.1 1.5 <br />Busincss and Prof6sion Codc): Any City or Couirty which rcquire r pcmit to @nstnrct. altc. improvc. dcmolish or rcpcir any <br />slructur€. prior to ils issurncc. alrc rcquirc thc applicant for such pcmit to filc r rigncd slstcmcnt that hc or sh. b liccnsd puBuant <br />lo thc prevhions of lhc Contr.clor's Liccnscd kw (Chapts 9. Commcncing sith Scction 7000 of Division 3 of thc Buincss and <br />PrcfcssionsCodc)orthlthcorshciscxcmptthcrcfromatrdthcbasisforthc.llcgedcxmption. AryviolationofScaionT03l.5byany <br />applicant fo. s pcmit subjets thc spplicant to a civil pcralty of not morc thrn fivc hundrcd dollars (9500). <br />--1. as owner of the prope(y. or my employees with wages as their sole compensation. willdo the work and thc stnrcture is not <br />intended orofferedforsale(Sec.T044,BusinessandProfessionsCode: TheContractor'sLicense[,awdoesnotapplytoanownerof <br />the propetty who builds or improves thermn. and who does such wort himself or herself or through his or her own employees. <br />provided that such improvements are not intcnded or offered for sale. I[, however. the building or irnprovement is sold within one year <br />of cornpletion. the Orvner Builder rvill have the burden of proving that he or she did not build or inrprove the prop€fly for the purpose of <br />sale). <br />-1. <br />as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Btsiness <br />and Pmftssion Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improvcs thereon. <br />and who contracts for such projects with a Contraclo(s) licosed pumuent to the Contractor's License t aw). <br />-IamexemptunderSection--,B.&P.C.forthisreason.Dntc:- O*nert <br />WORKERS' COITPENSATION <br />DECI"ARATION <br />I hereby afTirm under penalty of perjury one of the following declarations: <br />-l <br />have and will maintain a Certifrcate of Consent to Self-lnsure for workers' compensation. as provided for by Section .1700 of the <br />Labor Code. for the performance of the wor* for which the pcrmil b issued. <br />-l <br />have and will maintain workers' compensation insurance. as required by Section 3700 of the labor Code. for the performance of <br />the work for which this permit is issued. My workers' compc-nsation insurance carrier and policy number are: <br />Carrier: <br />Policy Number:_ Expires: <br />6(unfy that in the performance of rhe work for which this perrnit is issued. I shall not employ any person in any manner <br />so as to become subject to the workcrs' compensation laws of California. and agree that if I strould become subject to the <br />workcrs' compensation provisions of Section -1700 of the hbor Code. I shall. forthwith cornply with those provisions.. <br />t <br />WARNING: Failure to seture u'orkers'compensation coverage is unlawful. and shall subject an anployer to criminal penalties and <br />civil fines up lo one hundred thousand dollars ($100,000). in addition to of compensation. danrages as provided for the i <br />Section 1076 of the l.abor Code. inlerest and <br />I hereby affinn under penalty of perjury that I arn licensed 9 (comrnencing s'ith Seclion 7000) of l)ivision l <br />of lhe Business and Professions ('ode. and my license is in full force and effect. <br />l,icense Class:. \ C> <br />onrc:6-?2.\f <br />W <br />I h@by 8lfim undtr porlty of pqjury thrt tlsr b s oBtruc{bn kading lgcncy for thc pGforoncc of the worl for which this p6mit b <br />issucd (Sc. !097. Civ. C.). <br />Lcnder's Namc: <br />l,ender's Address: _ <br />APPLICANT DECLARATION <br />I hoeby aftirm under penalty of perjury one of the following declarations: <br />Dernolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) <br />_- Required Letter of Notification <br />u'ith all City and County <br />and County to enter uSron the <br />above mentioned property for <br />Applicent or Agent Signnlure: <br />Perntilee n&nre (prinl): <br />-^,,34t1-E <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire AIarm I Dampers <br />Communications Cable <br />Building <br />Under SIab / Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Roush) <br />Meter Release <br />Rough <br />Service Meter I I <br />F!NAL <br />Notes Remarks Etc. <br />runrber: <br />('onrr""tlr, {* <br />I certifv that the federalregulations regarding asbcstos removal are nol applicahle to this project. <br />and State larvs relating and hereby aulhorize representatives of this