Laserfiche WebLink
ELECTRICAL.INSPECTOR RECORD <br />DATE ID/SIG COMMENTSAPPROVALS <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht 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 />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 Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />)-2q-2oU J r'cSot z, CvlFINAL <br />Notes, Remarks, Etc. <br />OWN l'R BUII,I)ER DEt,('ARA'I'IoN <br />I hreby aflinn undqrbJly c+ryury thal I dn e\empt fron the Conlraclom' l-icose I-aN for the follou'ing rea{n (Se'.70]l.j <br />lJusin6s af,d Profssion Code): Any City or Counly $'hich requirc a pmnit lo constnrcl, allo, improve. dmolish or repair any <br />structure. prior to its issuance. also requirG the applicant for such pennil to file a signed staleillcnt thal he or she is licensed pursuant <br />lo the flr)\isions ofthe Conlractor's l,icensed taN (Chapler 9. Conrmcncing $ilh Section 7000 ofDilision 3 ofthe Busines and <br />Professions Code) or lhat he or she is exempt lhqefrom and the basis for lhe alleged crcrnplion. Any \ iolation ofS(lhn 7031.5 by any <br />applicantforapennitsubjrctsthe applicanttoacivilpenahyofnotrnorethanfivehundreddolltrs($500). <br />l. as orwer of the properl,v. or my enrployes rvilh sage c their sle cotnpqsalt)n. $illdo the rvork md the stnrclue is not <br />intodcrl oroflqedforsle(SE.T044.LlusinsandProfasionsCode:'lhcContractor'sLicose[,arvdoenolapplyloanoN'neof <br />theprcpqty rvhobuildsorimprovethoon.andrvhodoqsuchrvo&hinrselforherselforthroughhisorhoownemployees, <br />providelthatsuch improvmroilsilenolintmdedoroffsedformle. lf.how6q.thetmildingorimprcvenenliszuldtithinone)ryu <br />ofcompldion. rhe o$nq Buildo *'ill have the burdo ofJnoving tha he or she did not build or improve the prefEty for the purpo* of <br />sale). <br />I. as oNner oflhe profffiy. an exclusivel;_ contracting r ith Iicensed conlr actors 1o constnrct thc project (Scc. 7[H4. l]usin6s <br />and l1ofi-sionCode:l-he(onlractor'sl.icensel-as'docnolag)plvloailoN'nerofpropenyrrhobuildsorirnpro(esthereon. <br />and Nho contrscts for such projects with a Contracto4s) license<l pulsuanl to thc (i)ntractor's l-icmse Larv). <br />I an cxempt undq S(tion -. B. & P.C. for this rcason- <br />Date: Owner: <br />WORKERS' CO]\IPENSATION <br />DECLARATION <br />I h6eby amrm under pmally of Jujury one of the follorving dalarations: <br />_l have od rvill maintain a Ce(ificalc of Consent to Self-lnsure for workqs conlposation. as provided for by Section 3700 of the <br />Labor Code. for the psfonrancc ofthe rvork for $hich lhe pmnit is issued. <br />I harc and rvill maintain *nrkers' corrpensalion insuance. as rerpirecl by Seclion .'lT00 oflhc l,abor Code. for the pq'fonnancc of <br />lhe rtork for shich lhis pennit is issued- My rvotkos' contpensalion insurance canier and Jrclicy nurnbe aer <br />CarTier: <br />['olicy- Nurnber:Irpir6: <br />I cedify thal in the pa'l'ormance ofthc *ork for rvhich this pcrnril is issucrl. I shall nol enploy any peson in any manner <br />so aslohecornesubjectlolhe$ork6s'contpensationlarvsof('alifomia.an(lagreelh.liflshouldbecontesubirctlothe <br />sork6s'coilrpens.tionprovisionsofS<tion-l700oflhet,ahn(ode.lshall.fonh\\ilhcornpl)'\!'ithlhosprovisions.. <br />civil fines up lo one hundred thousand dollars 00.000). in addilion lo lhe cosl of compemation. dmages s provided for the <br />strlion 1076 oflhe l-abor (bde. intsd fce. <br />l)elo: <br />I herehy amrnl undcr penalty of prjury that <br />Profqsions Code. md <br />I anl of('hapts 9 (cornrnencing with Scction 7000) ofDivision -1 <br />cff<t.of lhc l]usincss and my license is in full force and <br />LicenseClass: 4 <br />o,," [, Ei l \(, <br />l-icense Nunll)cr: <br />q13t7 <br />$WLY'AEJzEs <br />I hmby affirm undr poalty of perjury <br />issucd (Sa. 3097. Civ. C.). <br />l"ender's Narne: <br />construction lmding agency for the pefonnmce oflhe rvork for Nhich this IEfinh is <br />Lender's Addrss: <br />APPLICANT DECLARATION <br />I ruuy* affm under penalty of perjury onc of the follorving delarations: <br />Demolition Ptrmils-Asb6los Notificalion Federal Regtrlalions ('tille 40. Part6) <br />Required Lelt6 of Notifi cation <br />I colify that lhe federal rcgulations regoding asbeslos rcn()lal arc ilol applicable to lhis proiecl. <br />md stale lhal the atnvc infonnation is corel. I agre to comply wilh all City and Counly <br />oflhis City and Counly to eots rlnn the <br />c/27 <br />constnrction. and hereby aulhorize <br />ln <br />9