Laserfiche WebLink
APPROVALS DATE ID/SIG.COMMENTS OWNI.]R BI.]II,DER DI'I,CARATION <br />I lrcrcby aflirnr undcr penally ofperjury that I eD crcnrpl frunr thc C'ontftctoN'Liccnsc law for the followinS rcaen (Scc.7031.5 <br />llusincss md Prolbssion Codc): Any City or County which rcquircs a lErrnit lo construct, altcr, irnprovc. demolish or rcpair any <br />structure.prirrrtrils issuance.alsorequireslheal)plicunlbrsuchpcnililbfileasignedstatemenl thallForshcislicclrcd pursuant <br />lo lhc provisions ol thc Contractor's l,icenscd liw (Chaptcr 9. Cohrncncing wilh Scction 7000 ol Division 3 of thc Busincss and <br />ProltssjursCodc)ortlrrthcorsheiscxcnrlrttherefronrmdllEbasisfortlEalle8edexenrptioD. AnyviolatioDofSeclionT03l.5byany <br />npplicrnl for a pcrmil subjecls lhe applicdnl to n civil penillty of nol rmrc thaD fivc hundred dollars ($500). <br />_1, as owncr ol thc prolrny, or my cmployccs wilh wagcs as thcir slc Nmpcnsalion, willdo ttr wftk and thc stM@ is mt <br />inoJcr.l or offcred for ele (S6.7(x4. Busincss ild PrufcssioDs Cod.: Thc Contractor's Liccnrc [:w des not apply to m ownd of <br />the pmFfly wlx) builds or irprows lltsrmE snd wlE d(Es such wo* lrimself or IE slf or lkough his o! he! own enrployees, <br />providcd that such improvetrcnts m mt iilcndcd or ollcrcd for eb. ll, howcwr, thc building or itrprowmnt is $H within orc Jcd <br />ofconipLrb[ rhc Owrcr Buikhr will haw the bsrdcn ofpovi[8 ltu h. or slE di.l mt buill or ifiprcvc thc prcpdry for thc purpos of <br />ele). <br />/. ^o*n , ut tt* propcny, !m cxclusively conradin8 with licctred confacloB to construct thc pmjcd (Scc. 7&4, Busirc$ <br />aryl Prolsirn Codc: Thr Contracbr's License llw d(ts nd apply (o u ownet of propeny who builds or improves thereo[ <br />and who conlracts for such projccts wilh a CoilBcto(s) liccnsd puasuet to thc Contrrclor's Licemc [iw). <br />_l ailr cren\t utrdcr & P.C. lor this reason. <br />,,,",/s/t r/<o woRKult^s' coNt PENsA't]0N <br />DECLARATION <br />li'lh,wing dccluati(nrs:I hcrchy allirnruD(lcr lrnaltyof pcrjuryone ofthc <br />_l have md will nraiilain a Cenificale ofConscnl b Sell:lnsure for workss'coDrpensation, as providcd for by Section 3700 ofthc <br />Latxtr Codc, for rhc pcrfonmncc of(hc work lbr which thc pcrillil is issucd. <br />_l havc and will nuinlaln workem coD)pc[salion insuilnce, as rcquired by Section 3700 ofthc kbor Codc, for thc lErfomurEc of <br />tlc work for which this ltrni( is issucd. My workcrs' con4rcnsalion imurmcc cmicr ail lElicy numbcr oc: <br />Policy Nunrbcr: Expircs: <br />_l ccniti tlut i0lhc Frfornunce of rhc work for which this pc.nit is issucd, I shall not cmploy my lrcrson in dy memr <br />$ as to bccorrc suhjccl to thc workers' compcnsation laws of Califomia, and a8ree thd if I slnuld becorre subjcct to thc <br />workcrs' compensation provisions of section 1700 of (hc Labor C'odc, I shall, fonhwilh conply vith thos provisions.. <br />WARNING: Failure to secure workers'compensution covcra3c is unlawful, and shall subjecr an employer to riminal Fnaltics und <br />civil tiuesupk)oNhutrdredthousanddollars($100.m0).inadditiortrthecostofcompcNatiur,datrragesasprovidcdlbrlhc <br />Scction 3076 ofthc titnr intcrc$ and atbrncy's lacs. <br />,o <br />LIC[NSDD CON'I'RA(]ToR <br />I)ECt.ARAl tON <br />I hcrcby affrrr under lrcnalty of perjury that I anr lc.nsal undff provision of Chapt.r 9 (conmncing with <br />o[ thc llusinc\s and l'rcfessions Code. trxl rny liccnsc is in lull foa€ anl cffccl. <br />7000) of Division 3 <br />Liccnsc Class:-Liccusc Numbcr: <br />W <br />I hercby allirm undcr pcnalry of pcrjury (hat lhcrc is a construction hnding agcrcy tor the pcrforrorce of the work for which (his Frmit is <br />issucd (Scc. 1097. Civ. C.). <br />lrndcr's Nanrc: <br />[rtrdcr's Addrcss: <br />APPLICANT DECI,ARATION <br />I tscby aflimundcr Fnalty of pcrjury onc of the followiag deluations: <br />DenDlition Pcrmits-Asbcstos Notification Federal Rcgulations (Titlc 40. Pan6) <br />-Rcquircd <br />bficr of Nolifislion <br />_l cmify thal lhc fcdcral rc8ulatioN rcB{ding &sbcslos rcmval uc nol applicabb lo this prcjct. <br />$ ccnify tlur I lEve read thi5 applicalion ard stetc tlut lhe atnvc infornEtion is cord. I agrft to conply with all City and Couhty <br />ordimcB and Stale liws rclating to boildinS coNodio[ and hcrcby autlnrir rcpresnHives of this Ci(y ard County to cnt6 upon thc <br />abovc rrntiorcd prcpeny for <br />Applicrnt or Agmt <br />l'cmritcc nonrc <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq / 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 />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />lVleter Release <br />Rouqh <br />Service fvleter t rl \r, <br />FINAL f'11'Nw {Dfl4,',{Y,) <br />Notes, Remarks, Etc. <br />ELECTRICAL.INSPECTOR RECORD <br />Rev.08-07-2015