Laserfiche WebLink
COMMENTSAPPROVALSDATEID/SIG. <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht 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 / 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 i. ".\ <br />t <br />I <br />FINAL t{\\iil},l)Wi\wrr v \ <br />'l INotes, Remarks, Etc. <br />OWNER BUILDER DI]I,CARATIOFI <br />I hereby affrm under penalty of pffjury that I an exernpt frorn the ContractoN' Licmse Law for the following reale (Sec.70-l l.t' <br />Busines md Proission Code): Any City or County shich requirs a pmil lo constnrct. alt6. improvc. denolish or repair any <br />structue. prior Io its isuance. also require the applicml for such permit to file a signed statmot lhat he or she b liccnsed pursuml <br />to the provisions of lhc Conlractor's Licenscd larv (Chaptq 9. Commencing rvilh Sction 7000 of Division 3 of the Busincs md <br />ProfessionsCode)orthathcorsheisexempllhqcfrommdthebasisforthcallcgedcxmption. AnyviolalionofsectionT0-1l.5byany <br />applicantforapmnitsub.i((sthe applicanttoacivilpenaltyofnolmorelhanfivehundreddoll&s($500). <br />I. m owno ofthc propcrty, or my employces with wags 6 lheir solc conpensation. will do the work md lhe structue is not <br />intoded or olTered for slc (5€.7044. Busines and Profsiom Code: l he Contractor's Licrue Law do6 not apply to an ownq of <br />theprep€rty rvhobuildsorimprovsthqen.mdwhodossuchworthirnselforhenelforthroughhisorhoownemployes. <br />provided that such imgrovonmts re not inlfldql oro{Iqed for sle. lf. horvos. the building or imprormot is mld rvhhin one }a <br />ofcomplaion. the Orvns BuiHs $'ill have the btrdm ofgnoling thal he or she did not build or impove the preJuty for lhe purlnsof <br />mle). <br />l. 6 ou,ne oflhe propfiy. an exclusively contracting wilh licmsed contractoG lo coNtmcl the prejd (Sec. 7044. Busins <br />ad ProfssionCode:TheContraclor'sLicenseLawdoesnotapplytoanownsofpropertywhobuildsorimprovesthoeon. <br />and u,ho contracls for such pojects wilh a Contmctor(s) licensed pursuanl lo the Contraclor's l-icose Law). <br />. I m e\empt under Sation-_. tt. & P.C. for this reNon. <br />l)ale:Orvncr: <br />lvdnkins corr ren.s,r i'iiin <br />DECLARATION <br />I hseby amrm under penalty ofpqjury one ofthe following dCldalioNi <br />_l have md will maintain a Certificate of Consmt to Selflnsur€ lor rvorkos' cornpmsation, d provided for by S(tion -3700 of thc <br />Labor Code. for lhc pqfomdce of the work for which the pmit is issued. <br />I have ild will maintain u'orkm' compensalion insurance. d required by Scction 3700 of lhe Labor Code. for the pgfomdcc of <br />lhe sork for rvhich this pcnnit is issued. My rvorkm'imurmcc cmio md policy nunrbe ue: <br />Cmis:- <br />Iblicl <br />-Expirc: <br />-'1"certify lhat in lhc perfornrance ofthe rvork which this pcrmit is issued. I shall not empkry nny person in any manrer <br />so m to become subjecl lo lhe Nork6s'laws ofCalifomia. and agree that ifl should becomc subjet to the <br />workm'compmsalionprovisionsofSrlionlT00otlhetaborCode,lshall.fonhrvithcomplyrviththorprovisions.. <br />WARNING: Failurc lo sure workm' compqEalion is unlas'ful. and shall subjrt an enployq lo and <br />thecivil finc up to one hundred thousmd dollan ($l in additkrn lo the cost of compcNation, dmag6 6 <br />Setion 1076 ofthe tibor Code. intqBt <br />Date: tl-?-za <br />l)l!( 1.,\lt,\ I l()N <br />I hreby aflim undo penalty of pcrjury thar I un licmsed undo provision of Chapto 9 (commmcing with Sation 7000) of Division 3 <br />of the BusioN md Profsiore Code, md my licrue is in full force od cfTct. <br />t <br />CONS'TRUCTION LENDTNC AGENCY <br />I hoeby affirm undo ptrally of psjury that thse is a construclion loding agmcy for the pqfomacc of the work for which this ponit is <br />issued (Se. 3097. Civ. C.). <br />Lends's Nme: <br />l-ends's Addressr <br />A PPLICAN'I DECLARATION <br />I hottry affnn under pmalty ofpojury one ofthe following delaations: <br />Demolition Pmnits-Asbeslos Notification Fedqal Regulations (Title 40. Pd6) <br />_Required t-etts of Notification <br />I cdiry that the fedsal regulations reguding asbeslos remolal are not applicable to this prejet. <br />that the above is corecl. I rvith all City and (bunty <br />and County to entq upon lhehereby <br />above ilrenlioned property for <br />Appliraill or Agcnl Sigilstu <br />Permite nsme (prinl): <br />l)nlc: <br />ELECTRICAL.INSPECTOR RECORD <br />A"ryrr{I*'-- A) ^Q,J <br />License Clasr <br />orr", -/-\- 1C) <br />t -?-!_p