Laserfiche WebLink
ELECTRICAL.INSPECTOR RECORD <br />ID/SIG.COMMENTSAPPROVALSDATE <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <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 <br />Rouqh <br />Service l\tleter <br />FINAL 0-7)V{-rr <br />Etc. <br />-+ <br />OWNER BUILDER DIX,CARATION <br />I hcrehy affirD) undcr penalty of pcrJtrry thal I anl cx€nDl fronr rhe CbntracloN' Liccnsc l:w for thc following rcaen (Scc.70Jt.5 <br />Busincss and Prolcssirln C'odc): Any Cily or County which rquircs a pcfinil to construct, altcr, irnprovc. dermlish or rupair any <br />slructure. pri()r t) ils issuatrce. dso requires the applicant for such lEnrit b file a siBDed slatetEnt thal lE or shc is licened pusuant <br />to thc prcvisions o[ thc Contraclor's l,iccnscd liw (Chaptcr 9. Comrncncing with Scction 70/\X) ol Division 3 of thc Busincss and <br />ProltssionsCode)orthatleorshcisexeilrptlhereliomandtlEbasisforll*allegederenrption. AryviolalionofSectionT03l.5byany <br />applicant for 0 pctrnit subjecls the npplicaDt to il civil penalty oI not rmre lhun fivc hundrcd dollars ($500). <br />_1. as owncr ol'thc proJrcnv. or rny crnployccs wilh wagcs as thcir slc comlEnsation, willdo thc work ard thc stMuc is mt <br />iitcfrlcd or offered ft)r sala (Se.7044. Business and Prcfcssions C<xlc: Thc Contractor's Liccnsc Law docs nol apply lo an owner of <br />the pR)tEdy wlx) huilds or in{rroves llErHnL url wls d(Es such cr}rk himself or lErslf or ihruuglr his or her own enployees. <br />providcd that such imprcvcrrents trc ml intcndcd or olTcrcd lbr sat. Il, howevs, thc building or irprovcrrcnl is $ld wilhin onc yctr <br />ofconrplelk)n, tlE OwrEr Buikler will havc lhe bsrden ofpR)viru lhat he or she did xil boild or imprcve tlrc pmpany for lhc purF)€ of <br />slc). <br />_1, as owncr ofthe propeiy, !m exclusi!ely contracting wilh liiankrl contraclos to construcl lhc project (Scc. 7044. Business <br />and PnrtlssirnCode:TheContrack)r'sLiccDseLawdoesnotal)plytoanowDerofpropenywhobuildsorinrprovc$theEofl. <br />and who cootracls for such proi'cts wilh a Contrachr(s) liccnsd pursuml to lhc Conuaclor's Liccnsc kw). <br />-lanrexcn4nundersccti(trl-,B.&P.C,lbrthisreasotr. <br />WORKI]RS' COMPENSATION <br />DECLARATION <br />I hcrcby allirm utrdcr pcnalty of perjury onc of lhc lolk)win8 dccltrations: <br />_l have md will nuintaiD u Cenificate of Consent b Self-lnsurc for workcrs'conlpehsalion, as providcd for hy Scction 3700 of the <br />[3tDr Codc, for lhc Frrfonrurcc ofthc work for which thc permi( is issucd. <br />_lhavcandwillnrarntainworkers conrpcnsnti(ninsurancc,as raquircdbySeclion3T00ofthaLahorC:ode,forllre[ErforDurreof <br />thc work for which this lErnlit is issucd. My workers' conrpcnsation insurillcc wicr uxl Jxrlicy nunrbcr ue: <br />a <br />-t c-€/r\(q <br />Policy <br />o <br />_l ccnify lhat in thc pcrtirrnlancc of thc work for which this lcrnlil is issucd, I shall not colploy aoy Nrson in any manncr <br />so rs to becorrc suhjcc I lo t hc workr'rs' conrlrcnsation laws o f Cali forn ia, and agrcc that i f I shou ld becom subjccl to t hc <br />workers'coDrpensa(ionpru!iJioDsofSeclionlT00ofthcljborCbde,lslull,fonhwilhcorrrplywilhtlp*provisioN.. <br />WARNING: Failura lo scura workcrs'compcnsalion covcrogc is unlawful,subjcct sn nod <br />civil tiilcs up k) oile huildred thousrnd dolhrs ($100.000). in additi('n rhe <br />atktrncy s ltcs. <br />DECLARATION <br />I hereby affirmunder penalty of perjury that I nnl licensd under prcvision ofChalrter 9 (comnEncin8 with Scction 7000) ofDivision 3 <br />of thc Business and Profcssions Code. anl my liccn* is in full fore aftJ cffcct. <br />67€ <br />Liccnsc <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby all'irm under ltnalt)i of pcrjury lhal thcrc is a construction lcnding agcrcy for thc pcrlbrmarcc ofthe work lor which this pcrmit is <br />issucd (Sec. 3097. Cir. C.). <br />l:ndcr's Addro.: <br />APPI,ICAYT I)ECI,ARATION <br />I hfrty afirnrundq ltnalty ofpcrjury onc of thc folklwing dccluations: <br />DcnDlition Pcrnlils-Asbcst)s Notificiltion Fedcral Rcgulaliols (Titlc 4{), Pd6) <br />_Rcquircd trllcr of Nolificrtion <br />_l ccltili lhal thc fcdcral regulations rcgadin8 asbcslos remval &c not applicable lo this proi{t. <br />f9t.*ify tt rt I luvc rcad this applicalion ard state tlut lhc ah)ve inforDuliotr is corcd. I agre to conrply with all City and County <br />ordinanccs and Statc Laws rclntinS b buildinS construction. ul hcrcby authorizc rcprcscnhtivcs ofthis City and Counly to cnter <br />abovc rrchtioncd propcny for inspcction purpo$s. <br />Applicant or Agflt <br />l'cmritc( trrnr( <br />*5 <br />tl* <br />Hev.08-07-2015 <br />/r-\ <br />, <br />kndcr's Namc: <br />- <br />CGO