Laserfiche WebLink
ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Omcr-Builds Dcluation <br />I hqcby affirm undcr pcnslty of p€riury thtl I m cxcmpr fom thc Contrrctors' Lienrc Law for thc following rcen (w.?03 t.5 Bu{itrcss <br />ud Profssion Codc): Any City or County which rcquircs a pcrmit to @nsrucl, dtcr, improve, demolish or rcpair uy sructuc, prior to its <br />issuancc, rlso requircs thc appli@t for such pmit to filc r signcd ststcmcnt thrt hc or shc is liccn*d pursuet to thc prcvisions of thc <br />Contnctor's LiGtrscd Lrw (Ch8pt6 9, Commcncing with Setion 7000 ofDivirion 3 ofthc Busincss ud Profcssions Codc) or that hc or <br />shc is acmpt thercfrom and thc bris for thc allcged cxcmption .Any violation of Swrion 7031.5 by oy applient for r pemit subjcas thc <br />applicut to a civil pcoalty ofnot morc rhe livc hmdrcd dollus (S500). <br />-_1, u omq of thc prcpcrty, or my cmploys with wag6 s their rclc ompensrtioq will do thc work ud thc struclue is not intcndcd <br />or offacd for salc ( 58.7044, Busincas md Profcssions Codc: Thc Conrebr's Liccns Lsw docs trot rpply to u ow ofthc prcpcny <br />who buildr or improvcs thcr6r! ed who dq such work him*lfor hcrslfor tkough his or hcr om cmployes, provided that such <br />improvemcnts uc not intrndcd or olfcrcd for salc. If, howwcr, thc building or improvcment is rcld within onc yw ofomplaioq thc <br />Owner-Buildcr will hEvG thc burdcn ofproving lhat he or shc not build or improvc for thc purpos ofsalc). <br />__1, ss oMcr of thc propcny, am cxclusivcly conirscling with liccnscd @ntrsctors to @nstrud thc prcjcct ( S@. 7044, Busines! ed <br />Profcssion Codc: Thc Conraaor's Liccnrc hw docs not spply to m omcr of propaty who builds or improvcs thcron , md who <br />@nracE for ruch prcjetE with ! Contractor(s) liccnsd pursuant to thc Cotrtr.clor's Licnsc Law.). <br />_l arn exempt under Section & P.C. for this reason. <br />Date: Owner: <br />WORK ERS COM PENSA'I'ION DECLA RATION <br />I hereby a(Tirm under penalty of perjury one of the following declarations: <br />_t hsvc ud will maintlin s Ccrtifi@rc of Consnt to Sclf-In$rc for workcs' compcmrtion, rs providcd for by Setion 3700 of rhc <br />trbor Codc, for thc pcrfomue of thc work for which thc psmit is isucd. <br />__l havc md will maintain workcrs' ompcmtion insurance, s rcquircd by Section l70O of lhc Llbor Codc, for thc prfome of thc <br />work for which rhis pcrmit is isucd. My workcrs' compcnsation insurme wicr md policy number uc: <br />Carrier: <br />Policy <br />(This section need not be One hundred dollars {$100} or less) <br />__l certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to <br />became subject to the workers' compensation laws of Californiq and agree that if I should become subject to the workers' <br />compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with those provisions.. <br />WARNING: Failurc to wurc workcrs' compcnsation ovcrrge is unhwful, sd !h&ll sbj6t u cmploycr b siminrl pcmltiG md civil <br />fitrca up to onc hundrrd thouud dollrs (t 100,000),in sddhiotr to thc os of compcnstioq dmagcs a providcd for thc Scrion 1076 of <br />thc Lrbor Codc, intsGt ud rttomcy's fes. <br />LICENSED CONTRACTORS DECT.ARATION <br />I hcrcby e,Iirm undo pcmlty ofpdjury that I m lienscd undcr prcvision ofChaptcr 9 (ommencing with Setion 7000) ofDivision 3 of <br />thc Busincss snd Profcssions Codc, md my liccnsc is in full fore md cffwt. <br />License Class: License Number _ <br />Date: Contractor: <br />CONSTRUCIION LENDING AGENCY <br />I hacby rllim undcr pcDdry of psjury thrt th6c i! r 6Etruc1ion lcnding agcncy for thc psfomue of thc wdk for which this psmir is <br />issucd (Sc. 3097, Civ. C.). <br />Lcnder's Namc: <br />Lender's Address: <br />A PPLICANT'S DECLARAT'ION <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part 6) <br />__ Required Letter of Notification <br />*--l certify that the federal regulations rega.rding asbestos removal are not applicable to this project. <br />_ I ceniry thar I havc rcsd this applicition ud state that thc above informrtion is @rcci. I agre to comply with all City and County <br />ordinances and State Laws relating to building hereby authorize representatives of this City and <br />above mentioned property for inspection <br />Applicant or agent <br />Permittee name (print)2 q <br />to enter upon the <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm I Dampers <br />Communications Cable <br />Building <br />Under Slab I Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release E\,Errr )En <br />-r <br />-! !! <br />Rough rFc tl.I ?ffn <br />Service Meter .)A <br />FINAL ,,.tM\., V{+Or 4l |% uDtt, w7 <br />Notes, Remarks, Etc.\,/V \L/ <br />Date:_ <br />l- <br />t)