Laserfiche WebLink
APPROVALS DATE !D/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Torqueing <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 />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />qt2//%Rough '/4,ZZJQ t 0r 7-19-2-b*.ff" /o- <br />Service Meter <br />FINAL Ltc-"2 \r{ rr> <br />Notes, Remarks, Etc <br />OWNER BUILDER DELCARATION <br />I hoeby affum undr penalty of perjury thal I m exempt fiom the Contractors' Liccnse Larv for the following rffi (Se.70-11.5 <br />Busines ad Profmion Code): Aoy City or County rrhich require a pornit lo coBlruc{. alto, improvq dmolish or rcpair my <br />structuc, pdor to its issumce. also rcquirG the applicant for silch p€mit to file a signed statcment thal he or she is,lic@sed pusui\nt <br />to the provisions of lh€ Contractor's Lic€nsed law (Chapler 9. Commencing with S(tion 7000 of Dir isir/c -1 of th: Busins od <br />ProfessionsCode)orthatheorshcisexemptthtrefiomandtheb6isforthcallegc<lexmption. AnyvioteionofsectionT03l.5byany <br />applicant for a pmit subj(ts the applicmt to a civil pcnalty of not more thil five hundred dollas ($500). . ' <br />D <br />_1. 6 owns ofthe propeny. or my employe with rrago a their mle composation. $ill do lh€ work md the slructm b nol <br />intmded or offqed for mle (Se.7044, Businss od hofasiou Code: The Conlraclor's License Law doe not apply to m ownq of <br />the pmperty u'ho builds or improve th@n, md s'ho do6 such rvort himself or hmelf or through his or he om cmployee. <br />provided that such improvmots tre not intmded or offoed for sale. lf howsq. the building or improvemmt is sold within one ,q <br />ofcomplc{ion. lhe O*nq BuiHq will have thc hrdo ofpreving thd he or shc did rcl build or improve the progrty for th€ purfD* of <br />salc). <br />I <br />_1, m owner of the propffy, an exclusivcly contracting with lice6cd contractore to construct lhe preject (Src. 7044, Uuinss <br />ed Prof6sionCode:lheConlractor'sLicenseLarvdoenotapplytodownsofpropcnyrvhobuildsorimprovGthq@n. <br />and who contracts for such prejats with a Conlracto(s) licssed pursuanl to lhc Conlraclor's Licse l,aw). <br />-l <br />m erempt uder r]. &.c. <br />on", z-o<r-/:: <br />Dlr(I.,ilt\|loN <br />I hoeby affirnr undo pmalty ofpojury onc declaralions: <br />_l have md will maintain I Certificate of Coreent lo Self-lNure lor rvorkers' conrpensalion, 6 providcd for by S@tion 3700 of lhe <br />Labor Codc, for thc pqfommce of the wo* for which the ptrmil is issued. <br />-l <br />have and will maintain wo*ers' compcmalion ireurance, c required by Srction 3700 of the tibor Code, for thc pofommcc of <br />the work for which this pennit is issucd. My workers' compcnsalion ireurmce cu io od policy number a c: <br />Policv Numbo: Exoires: <br />-l <br />colify that in the perfornrance of the work for which this permil is issued. I shall not ernploy ary psson in any manner <br />e as lo become subj(l to lhe work6' compenetion laws of Califomia. dd agree that if I should become subjet to the <br />workes' cornpensation provisions ofSection 3700 oflhe Labor Code. I shall. foflhwith cornply with those provisiom.. <br />WARNING: [failure to wure workqs'compruation covqagc is unlawlirl. and shall subjet a onployo to qiminal penalliG and <br />civil fmcs up to one hundred thoumd dollm (in addition b the cost of dmages I provided for the <br />Scction 3076 oflhe l,abor Code. interGl 's fecs. <br />Orrrr?-F:-/? <br />I hqeby amrm undn pqalty ofpqjury that prc\'ision of Chaptq 9 (commmcing <br />I force md cffat. <br />7000) ofDivision 3 <br />of the Busines ad Profwiom Codc. md my licme is <br />Licc6e Class:-Liccme Numbs: <br />Dste: Contnctor: <br />CONSTRUCTION L}'NDINC AGFNCY <br />I hercby affrm undo paalty of ptrjury that lh6e is a coNtruction lflding agmcy for the pqfommce of the rvork for rvhich this pqrnit is <br />issued (Se. 3097, Civ. C.). <br />Lender's Ad&s: <br />APPLICAN'T DECI ARATION <br />I horby aflim under pmalty ofpcrjury one ofthc following declarations: <br />Demolition Pcrmits-AsbGtos Nolificalioo Fedqal Regulations ( fitle 40. Pan6) <br />-Required <br />lrtts of Nolification <br />_l cdiry that regulatiom Egffding Nbestos rqnoval ue not applicable lo lhis prcjet. <br />_l read this application ad state lhat the above infonnation is cord. I aSre to comply sith all City aod Couoty <br />ordinanc6 taws relatif,g lo building construction..oflhis Cily and County lo entcr ufxln the <br />above <br />Applicanl or <br />Pernilee nNnre <br />I <br />for inspeclion <br />*r" ? -6- /? <br />ELECTRICAL.INSPECTOR RECORD <br />Lender's Name: