Laserfiche WebLink
ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DELCARATION <br />I hcrchy affirm undcr pcnalty of pcrjury lhat I am crcmpt frcm thc Contrnctors' l,iccnsc l;rw for thc folk)wing reason (Scc.70.ll.5 <br />Busincss and Profcssion Codc): Any City or Counly which rcquircs il Jrcrorit lo construcl. alter. irnprovc. dcmlish or rcplir any <br />struclurc. prio, to ils issuancc. also rcquircs lhc appliconl for such frcrmil b lilc a signcd stnlcmnt lhnl hc or shc is liccnscd pursuant <br />k) lhc provisions of thc Conlractor's I-iccnscd [nw (Chaptcr 9. Conuncncing wilh Scclion 7(M) oi Division 3 of lhe Busincss antl , <br />Prolcs\ions Codc) or thal hc or shc is cxcmpl lhcrcliom and thc hasis for thc allcgcd cxcrnption. Any violati(r ofSccli)n 701 I 5 by any <br />applictrilt for { pcrmit subjccts lhc applicant to a civil pcnalty of nol nbre than fivc hundrcd dollars (gsfi)). <br />-1. <br />as owncr of thc pre[rcfly. or my cmployccs with wtgcs as lhcir solc coDrpcnsali()n. will do the work and thc stMturc is n(il <br />irilcndcd orofl'credlbrsalc(SL{.7044.Busincssandl'rolcssionsCodc:TheContrackrr'rLiccnscLawdocsnolnpplyloanowncrol <br />lheprcFny whobuildsoriilrF()vesilEton.aftlwk)d@ssuchwo*himselforhcrsclforthroughhisorhcrowncmphyccs. <br />providcd that such inlpmvcmnls m nol intendcd oroffcred tbr salc. lf. however. thc building or irprovctmnt is sold within oilc yciu <br />ofconrplclion. lhc Owncr Buildcr will havc lhc burdcn of proving lhal hc or shc did not build or intprovc thc pmpcny for thc puryns of <br />salc). <br />-1. <br />as ()wncr ol-thc propcrty. im cxclusively contrncting wilh licensc(l conlrnclors lo coDslruct lhc pr()jcct (Scc. 704.1. Busincss <br />and Pn){bssi)nCodc: lhcConlracmr'sLicenscLawdocsnotapplyk)rnowncrofpropcrtywhobuildsoriillprovcslhcrcon. <br />and who contmcls li)r such projccts with a Collrack)r(s) liccilscd pursuanl kr lhc Conlracl()r's Liccnsc Law). <br />I rrrr cxcurrt untlcr B .C. lirr <br />o,r", 5- lf' / t 0wner:_ <br />I hcrcby alfirnr under pcnalty ol perjury onc ofthe dcclaralknls <br />-l <br />havc arrd will ruinlain a Ccrtilicalc of Conscnt k) Sclf-l[surc for workcrs' comJnnsation. as providcd tor by Scclion 37{D of thc <br />tit()r Code. li)r thc pcrfornlancc oflhc work for which thc pcrrnit is issucd. <br />-l <br />huvc and will ntinlain workcrs' compensalion itrrurrncc, us rcquircd by Scction 37U) ol lhe [:hor Codc. for thc ;rcrtbrrruncc of <br />thc work for which lhis pcrmit is issucrl. My workcrs' compcnsiltion insurancc caricr and policy numhcr re: <br />Policv Number: Eroircs: <br />-l <br />ccnify Ihal in lhe perfornlnncc o[ lhc work for which lhis pcrmit is issucd. I shull not cnrpk)y any person iil any nrflnncr <br />so as lo hcconr subjccl lo thc workcrs'conrpcnsnlior hws ofCalitornir. and agrcc that il l should hccotrc suhjccl lo lhc <br />workcrs'contpcnsatt)nprovisionsofScctionlT(noflhcL;ttx)rCodc.lshall.li)nhwithcomplywiththospiovisions.. <br />civil lincs uP lo onc hundrcd thousand dollxrs ($l(X).0U)). <br />Sccli()n .1076 ol the Latx)r Codc. iilcrcsl and alk)rncy s lccs. <br />in addilion to damugcs as providcd lbr thc <br />D"r., F /?l{Applicant: <br />I hereby affirrn undcr pcnalty ol pcrjury lhat I atn <br />of thc Busincss and Profcssions Codc. zutd nry I <br />prcvision ofChaptcr 9 (comrncncing with Scclion 7Un) ofDivision l <br />Iirll li)rcc nild cllccl. <br />l,iccnsc <br />Do(e: <br />Nunlhcr: <br />Conlrsclor:_ <br />CONSTRUCTION LFNDINC AGENCY <br />lhcrcbyrffirnrundcrpcnaltyofperjurylhallhcreisaconstruclionlcndirgagcncyforlhcpcrformanccoftheworkforwhichlhislrermitis <br />issucd (Scc.3097. Civ. C.). <br />[*ndcr's Nanrc: <br />kndcr's Addrcss: <br />APPLICANT NECI ARATION <br />I lrcrchy affirrn undcr pcnally of pcrjury onc of thc following dcclarations: <br />Dcmolilion Pernrits-Ashcslos Notification Fcdcral Rcgulations (Tillc 40. Pan6) <br />_Rcquircd [.ttcr ()f Notilicrtbn <br />_l ccnify that thc lcdcral rcgulalions rcgtrding ashcstos rctilovllarc [ol rpplicrblc Io lhis pr(rjccl. <br />_l ccaify that I havc rcad this applicalioil .md slalc that thc rtx)vc infortruilion is corcct. I agre to comply <br />ivcs oflhis ('ity <br />wilh all Cilyand County <br />orrlinunccs and Slrtc [-rws rclalinS k)ion. and horizc rcprcscntat and Counly lo enlcr upon lhc <br />atx)vc ilrcillioncd profcrly lbr <br />Appli(trnt or Agc[t Signslur(: <br />I'cmritee name (prinl):I 1/-a2 Aarilg *," 5:-tFt( <br />Site-Work <br />Underground <br />Pole Bases <br />Lioht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouoh) <br />Meter Release <br />Rouqh <br />Service Meter <br />FINAL i -7-rB J /<- 3z 7 Srdr.tl <br />Notes, Remarks, Etc.