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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNERBUILDERDELCARATION . I hcreby affrm under pnalty of prjury that I m cxctrrpt frcm thc CrntreloN' Licens kw for thc following rcasn (Scc.7031.5 Busincss and Profcssion Codc): Any City or County which rcquircs a lrcmit to construct, altcr, impmrc, dcmlish or rcpair any structurc, prior to its issuare, rlrc rcquircs the applicant for such pcrmit lo lilc a signcd st.hrenl thot lrc or she is liccnsd pursuant to lhe prcvisions of thc Contrrctor's Licenrcd taw (Choptcr 9, Comncing wilh Setion 700O of Division 3 of thc Busincss 8nd PrcfcssionsCodc)orthathcorshciscxcmptthcrcfromandthebasisforthcsllcgcdcxcmption. AnyviolotionofsstionT03l.5byany applicant for a Jrcrmit subjccts thc applicant to a civil pcnalty of not mrc than fivc hundrcd dollus ($500). -1. as owner of thc propcrty, or my employees with wagcs as thcir sole compcnsation. will do the work and thc structurc Ls not intendcd or offered for salc (Scc.7044. Busincss and Professions Codc: Thc Contraclor's License [:w docs not apply to an owner of thc property who builds or improvcs theruln, and who does zuch work himsclf or hcrself or through his or hcr own employees, providcd that such improvcnrcnts arc not intendcd or oflbrcd for salc. If, however. thc building or improvcrnent is rcld within one )Ear of cornplction, the Owncr Buildcr will havc thc burden of proving that he or shc did not build or improvc the propcrty for the purynse of salc). -1. as owncr of thc proprty. am exclusively contracting with licenscd contraclors lo construct the projcct (Scc. 7W, Busincss and hofcssion Codc: Thc Contraclor's Licensc Law docs not apply lo an owncr of proprty who builds or improves thereon, and who contracls for such projccts with a Contracto(s) liccnsed pursuant to lhc Contractor's Liccnse l-aw). _l am cxcmpt undcr Scction_. B. & P.C. for this rcason. I)atc:Owrter: w(fRKE rts' COMPENSATT(rN DECLARATION I hcrcby affirm under pcnalty of pcrjury one of the following dc.clarations: -l havc and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the labor Codc. for the pcrformance of the work for which thc p,crmit is issued. -l havc and will maintain workcrs' compensation insurance, as required by Section 3700 of thc labor Codc, for the performancc of thc work for which this pcrmit is issued. My workcrs' compensation insurance carricr and policy number arc: Cu,ri.r, ' <-OAP (, e t f l}v OO g -LLoPolicy -l certify that in thc pcrformancc of thc work for which this pcrmit is issucd. I shall not employ any pcrson in any manncr so as to bccome subjcct to-thc workers' compensation laws of California, and agrcc that if I should bcconrc subjcct to the workcrs' compcnsation provisions of Scction 3700 of thc Latnr Code, I shall, lbrthwith comply with thosc provisions.. WARNING: Failure to securc workcrs'comgrcnsation coverage is unlawful. and shall subject an cmploycr to criminal pcnalties and civil fines up to onc hundrcd thousand dollars ($100,000), in addition to thc cost of compcnsation. damages as providcd for the Scction 3076 of the [:bor Code. intcrcst and attorney's fccs. I r}-'Ll I hcrcby affirrn undcr pcnalty of pcrjury 3 of lhc Busincss and Professions Codc, and my license is in full force and effcct. Liccnscctass:. C-{S LicenseNumbcr:- -}tltSlf S- Date:D ?aZ?-' Z* W I hcrcby affrm under pcnalty of JErjury that thcrc is a onstruction hnding sgcrcy for thc lf,rfomc of thc work for which this pcrmit is issucd (56. 3097. Civ. C.). bndcr's Namc: lrnder's Address: APPLICANT DECLARATION I hcreby affrrm under penalty of pcrjury one of thc following dcclarations: Dcrnolition Pcrmits-Asbestos Notification Fcderal Rcgulations (Title 40, Parl6) _Required trtter of Notification lrtcnitythat the fedcralrcgulations regarding asbestos rcmoval are not applicablc to this project. -l ccrtify that I have read this upplication and statc that thc atrove infornution is corrcct. I with all City and County and County to entcr uJnn theordinanccs and State laws rclating to building construction. and hereby abovc nrcnlioncd propcrty lbr Applicant or Agent Pernrilce n$me K K orr" *'L?-L Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor A Bonding I Grounding I UFER Transformers \J Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush) Ceilings (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouoh) [Vleter Release Rouqh ff-Dr.zl Service N/eter V'I \A'\ FINAL k-"74J ut[/ t Notes, Remarks, Etc.(/'\-/ -D CJ,-.., nO n7 Onltr /n\ VWIIT