Laserfiche WebLink
ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWN I]R BUII,I)F]R I)F]I,CARATION <br />I hcrcby aff[m undcr Fnalty of lf,rjury th.t I m excmpt frum lhc Contraclo6' Licenrc Lrw for thc followhg rcasn (Scl.70]1.5 <br />Busincss ailt Prcfcssion Cqlc): Ary City or County which n1uircs a Jrmit to construcl. alten iDprcvc, dcmlish or rcpait ay <br />structre, prior to its issuarec. aLo rcquircs thc applicmt for such Fmit to frle a sigrcd slatcmnl that lE or slt b liensd pwant <br />to rhc provisions of th. Contracror's Liensd llw (Chaptcr 9. Comrcing with Scclion 7(XX) of Division 3 of thc Busine$i md <br />pmfessions Co.lc) or that he or shc is crcmpt thqehom and thc basis tbr lhe allegcd eremption. Any violation of Scctbn 7031 ,5 by any <br />applicant for a lEmit subjcrts thc applicant to a civil pcnally of not mrc than five hutxlrcd dollils ($500). <br />_L as owncr of the ln [rctty. or my employccs wilh wages as thcir slc comlEnsalion. will do tlE wffk ad the structw is mt <br />intenlel or otfercd Is stc (3c.70&, Susif,css and Prrfcssions Codq The Controctor's Licenrc kw d@s not apply to il owmr of <br />thc pNpedy who builds or in{mws thcprl .nl who des sreh utk himsclf or hcEclf or thrtugh his or lrcr own cmployees, <br />pro;ide.l th{t such impowmnts & rot interxlql or ollbrql for eb, If. ]Dwcrcr, thc buiuiry or inlprcrcmnt ir soll within orc }44 <br />of urmplctkrn. thc Owrcr Buillcr will hare [E hurhn of pruving thar hc or shc dil mt huill or itr{rorc thc [xotEty for the FtrFsc of <br />sb). <br />_t, asowncr of thc p()pcny, mcxclusively contretirg with liccnsd conlBctoN to q)nstrucl thc prtjsl (se. 7M4, Busircss <br />a[t profasix Codc: Thc Contrrctor's Licensc L.w d@s not .pply to an ovncr ofpruJErly vho builds or improvcs thereon' <br />anrl who sntrcts for such pf,rFcis with a Contmcto(s) liccnFd puruut lo the Contraclor's Lkensc law), <br />-l.mexcmpt <br />undcr Sccliotr-. B. & P.C. for lhis rcasn. <br />Dal€:- owner: <br />WORKERS' COIITPENSATION <br />DECIdEAIION <br />I herchy atTirm undcr pcmlty of lErjury one of the followinS dcclamlions: <br />_t havc 4l will mintain s Ccnifrcatc of Consent to SclElnsurc for ulrkcr' smJEnsatk n, as prcvidcd tbr by Sstbn l7m of lhc <br />khor Cqlc, for ltrc [rcrfomrec of lhc sr* for shbh thc ,mil is issued. <br />_l have and will m.inlain workcs' comFnsalion insurarcc, ss rcquircd by Scction !700 of thc ktDr Gxle, for the pcrfomc of <br />lhc mrk for which thls pcmit Ls isswl. My worke6' smlEnsation insuruce wicr all Jrolicy numbcr rc: <br />Policy Numher: ExPircs: <br />_l ccrtily rhat in thc Jrcrtilrnuncc of the work tor which this prmit is issucrJ, I shall not cmpk)y any Jrcrson in any manncr <br />so as to hccgmc sutrlcci to thc workers' compcnsation laws of Calitirrnia, and agrcc that if I shrluld bcconrc subjcct to thc <br />workcrs' comlrcnsation provisk)ns of Scction ]700 of thc Latxlr CrxJc, I shall, tbrthwith comply with thosc provisions.. . <br />WARNING: Failure to sccurc workers'comlrcnsation coveragc is unlawlul. and shall suhjcct an cmpklycr to criminal pcnalties and <br />civil tines up to onc hundretl thousand rlollars ($l00.Un). in arllition to the cost of compcnsation, damagcs as providcd ftrr the <br />t'Sectir>n 1076 ol'lhc l"-atxrr Ctxle, intercst and attorney's l'ccs. <br />I,I('I.]NSEI) CONTRACTOR <br />DI.]t]I,ARATION <br />I hcrcby allirm undcr pcnalty of pcrjury that I am liccnsctl undcr pr)vision of Chapter 9 (commcncing wilh Scction 7firu) of Division -l <br />of the Busincss and Prolbssions Code, and my licensc is in l'ull tirrcc and cttect. <br />Conlractor: <br />CONSTR,UCTION LENDTNG AGENCY <br />t hercby affrm undcr penalty of pcrjury that thcrc im*ructirn bnling agercy for thc 1xrfrrue of the rcrk for whfuh thir Fmit i3 <br />issued (Sec. 3097, Civ. C.). <br />kndcr's Namc: <br />lrnder's Address: <br />APPLICANT DECLARATION <br />I hcrcby all-lrm undcr Jrcnalty of pcrjury one of the lolkrwing declarations: <br />Demolitkrn Pcrmits-Ashcstos Notil'ication Fedcral Rcgulations ('title 40, Part6) <br />-Rcquircd <br />[-ctlcr of Notiticatfurn <br />-l <br />cntily that thc fcdcral rcgulations rcgarding asbesk)s rcmoval rc nol applicahlc to this pNjcct. <br />_l certify lhat I havc rcad lhls application dxl statc that rhc atilvc inform.tion is corot. I agre to @mply with_all City and Counly <br />or,linanccs an.l State Laws rclating io building construction, arrl hcrcby aulk)riz rcprcsntalivcs ofthis City and County to cntcr ug)n the <br />abovc mnlioncd prelrcdy for hsfBution purlnscs. <br />Applicant 0r Agenl <br />P€mite mmc (prinl): <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under SIab / Floor <br />Bondinq I Groundins I UFER /A -?z-/,t /I*l/tt <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 />Nleter Release <br />Rouqh ft -27-/g Oz,T) / lt <br />Service Meter I 6t\ <br />FINAL lrLhgl 14 1-7^z- .. irL U <br />Remarks Etc <br />\t, nQ n )f\ <br />Date:-