20468450 - Permit - Laserfiche WebLink

Home Browse Search

ELECTRICAL.INSPECTOR RECORD a owNt:R ltUil,DuR I hocby affm undr peralty of psjury that I m exempt frorn lhe Contractors' License Law for the following rcson (Str.7031.5 Businss ed Profcsion Code): Any Cily or County which require a;rcmit to con9ruct, altc, improve. donolish or rcpair my stntcture. prior to its issudce. also requirB lhc applicant for such pmnit to file a si8ned slatemtrt that he or she is liceoscd pu6udl to thc provisions of rhe Contractor's Licensed law (Chaptn 9, Comencing lvith Sstion 7000 of Division 3 of the Busins ild ProfessioosCode)orthatheorshcisexemptthqefrommdthebdisfortheallegedcxonption. AnyviolationofsetionT0ll.5byany applicant for a pmit subjats the applicant to a civil penalty of nol more thm five hundred dollas ($500). _1, o orvnq of the prop€rty, or my employG with wag6 6 their sle comperoalion. uill do the wort and thc strucluf is mt intmded orotTsedforsle(56.T044.BusinesudProfssionsCode:TheConlractor'sLiccnseLarvdoenotapplytomownoof the pmpcrty who builds or imprcv6 thq@n. ild who do6 such rvork himself or hmelf or thrcugh his or hs out mploye6, provided that such imprcvmots ue not intoded oroffqed for sle. If. howwfr. the building or irnprovcmot is mld within one yw ofcomplaion thc O*nq Builds will harr the budo ofproving tha he or she did not build or irnprove the propqty for the purpo* of sale). _1. 6 ownq of the ;ropoty. m exclusivcly contracting with licmsed contractos to comtrud the prcject (Sec. 7044. Businru md PofssionCodc:'l'heContractor'sLicenseLawdo6nolapplytodown6ofpropeny$'hobuildsorimproveslhs@n. and who contBcts for such proims with a Contraclo(s) licmsed puEuant to the Contractor's Licme l,aw)- Dtte:_ Owner:_ gQ8KE8$]CAUPIN.SAI]Q! DECLARATION I hereby allirm undr poalty ofpojury one ofthc following dcclaratiom: _l have md will maintain a Ce(ificate of CoBot to Self-lnsure for workers' conrpensalion, o providcd for by Section 3700 of thc Labor Code. for the pqfonnace ofthe work for which lhe p6mit is issucd. _l have and will maintaio workers' compeNation iNurance. u required by Srtioo -1700 of the tabor Code. for thc psfonnocc of the sork for which this pffnit is issued. My workers compmsalion imurance canier md policy numbo ue: I m excmDt undff Strtion-, B. & P.C. for this reaon. Policy Numbq: Expire: -- Lender's Ad&e: ficaity ttatin thc pqformance of the work for which this pmit is issued. I shall nol qnploy any pcon in my mmnr $ 6tobe{omesubjecttotheworkqs'comp$ationlawsofCalifomia.mdagreethatiflshouldb€comesubj(ttothe workm' compaetion provisiom of Scctioo 3700 of the tabor Codc. I shall. forthu'ith comply wilh thos provisioN.. WARNTNC: Failure to wwe works'compqsation coloage is unlarvful, and shall subject m onployer to dminal petrahie md civil fines up to one hundred thoused dollils ($100.0001 Seclion 3076 of the tnbor Code, inlerGt md anomey s f6. ). in addition to thc cosl of a provided lor the I horby aflinn under poahy ofpojury that I an licmsei of (commmcing with Sstion 7000) of t)ivision l of the Busin* md Prcfeiom Code, ard my licmc is in full force ed eff6t. Nunrlrer: J Liccnse CONS'I'RUCTION LENDINC AGENCY I heeby affim undo ;rtrahy o f psjury that th6e is a comtruction lending agency for the pofomance of the work for which this pornil is issued (Sec. 3097, Civ. C.). Lender's Name A?PI,ICANT DECLARA'I'ION I h6dry aflim unds pmalty ofperjuy onc ofthe follorving declaationsr Demolilion P€mits-Asb€tos Notification Fcdral Rcgulations (Tille 40. Part6) -Rquirerl Lctld of Notification -l cqtiry that thc fedad reSulatioc regading abcstos ronoval oe not applicable lo lhis prcjd. _l cdify thd I have red this application ild state lhal the above infomation is corst. I agrE lo comply *ith all City and County ordinancB md State Laws relating to building construction. ild htrcby authorizc repramtativG ofthis City md County to mta upon the above molioned prcpcrty for impetion Applicailt or Agcilt DATE ID/SIG COMMENTSAPPROVALS Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding / Grounding / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Rough Ceilinqs (T-Bar Rouqh) Meter Release Rouqh Service Meter /a-29 -fi , 2,,/oFINAL Etc.Notes Rema Permite name (print): l)nle: n*., l-/q,, /, /,', -'/ ' I orrc: ly' /, ,. /, /,coot,"to", f f <(€fl/Oed{,-r-/ '7 tl,ta "t rl[ -