Laserfiche WebLink
ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hseby affm undq penalty of psrjury that I m exempt from the Contractors' Licensc larv for thc following rwn 1Se.7031.5 <br />Busincs md Prof*ion Code): Atry City or County rvhich requirs a pomit lo construc(. alte. improve. doolish or repair my <br />structue. pdor lo its issuace. also rcquire the applicmt for such permit to file a signed stdmot that he or shc is licoscd pmuat <br />to the provisioN of the Contractor's Licensed law (Chapter 9. Commencing with S(tion 7000 of Division J of thc Busins and <br />PrcGsions Codc) or that he or shc is eicmpt thscfrom md thc b6is for the alleged exmptio0. Any violation of Setion 703 1.5 by any <br />applicant for a pmit subjels the applicant to a civil penalty of not more thm five hundred dolles ($500). <br />-1. <br />o ownq of the prolE ty. or my ernployG wilh wag6 6 thcir sle compffalion, $ill do the woIt ad the struclue is not <br />intaded oroffaed for sale (5@.7044, Busines md Profsions Code: The Contraclor's Licmse Law do6 not apply to an ownq o[ <br />the Ploperty who builds or improve th6@n. Md who do6 such work himelf or hoself or through his or hd own employeG. <br />provided that such tnprovmfits de not intodql oroffoed for sale. ll hou'qtr the building or improvcrncnt is sold within onc )w <br />ofcompletion, the Owns Buildq will have the burdm ofproving thd he or she did not build or improve the pmJury for thc purpos of <br />sle). <br />_1. m owno of the propay, an exclusively contracting rvith licmsed contractoB to construct lhc preicct (Ss. 7044. B6ins <br />ad ProfsionCode:TheConlractor'sLicenseLawdoenotapplyloilowf,erofpropertywhobuildsorimprovcsths@n, <br />and who contmds for such prcjsts with a Contracto(s) licmed pursuant to the Conlraclor's Licfise Las,). <br />-l <br />m exempt wds Srction-. B. & P.C. for this reoon. <br />Ds(er_ Owoer: <br />WORKERS' COIITPENSATION <br />PECI,AEAIION <br />I hoeby aflim under pemlty of pojury onc of the following d*lratiom: <br />_l have od will maintain a Cdificale of CoMt to Sclf-lruure for workers conlpensation. o provided for by Sation 3700 of the <br />Labor Code for the psfommcc of thc rvorlc for which the psmit is isucd. <br />_l havc and rvill maintain workers' compercalion imurancc. o required by Srtion 3700 of lhe t{hor Code. for lhe pqfomdcc of <br />the rvork for rvhich this pmit is issuql. My workers' compensation insurmce cmio md policy numbo uc: <br />PolicyNumbs: Expires: <br />_l coliry that in the perforrnancc of lhe work for which this permit is issued. I shall not ernploy any peBon in any maDner <br />s 6tobecornesubjectlotheworkqs'cornpfisationlawsofcalifomia,andagrethaliilshouldbecomesubislk)the <br />workfls' compensation previsions ofSection 3700 ofthe Labor Code. I shall. fonhrvith cornply rvith those prcvisions.. <br />WARNING: Failure lo ssue s'ork6s'compemation covqagc is unlawful. md shall subj<t an flployer lo oiminal tmaltiG md <br />civil fines up to one hundred thousmd dollm ($100.000). in addition lo the cost of dmaga r provided for thc <br />Sstion 3076 of the tibor Codc, intqBl md anorney's f6. <br />I-ICT]NSED CONTRAC'I'OR <br />D!]Ct, RAI]ON <br />I haeby aflim undo penalty of psjury lhal I m licmsed uodo provision ofChaptr 9 (commmcing with S(tion 7000) ofDivision 3 <br />of the Busins md Profsioro Code. and my licme is in full force dd cff(t. <br />License <br />Date:(-onlrrclor: <br />CONSTRUCTION LENDING AGENCY <br />I hereby affrm unde penahy of psjury thal thqc is a construdion loding agocy for the pofonnmcc of the work for which this pnnit is <br />issued (Sec. 3097, Civ. C.). <br />Lender's Name <br />Lender's Addrss: <br />APPI,ICANT DT'.CI.ARATION <br />I hothy affm unde poalt y o f pcrjury onc o f thc fo llow ing d( ltrat ions: <br />Dmolitiotr P6rnits-Asbetos Notilication Fcdsal RegulalioN (Tille 40. Pm6) <br />-Rcquired <br />tf,ttg of Nolification <br />-l <br />cdiry thd the fedqal regulatioN rrgeding sbstos rmoval ae not applicable to this prcjccl. <br />_l cdiry thd I have r@d this application ed slatc thar thc abovc infomatioo is corel. I agrcto comply with all City aod County <br />PerDilee ratrre (prin(): <br />Site-Work <br />Underqround 9t I '-16,t <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinss (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />I I --\Rouqh (/,t\U /( /U/q '//q/ <br />Service ltleter I <br />FINAL / zt-Zozc ,J)e t>,'rfr) <br />Notes, Remarks, Etc <br />o,r", 'fb4/r 7