|
APPROVALS
<br />Site-Work
<br />Unde rqround
<br />Pole Bases
<br />Light Standards
<br />Spas , Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm/ Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Fa ctory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />DATE
<br />Meter Rel ease -'t / )-/i 1-
<br />Rouqh
<br />Se rvice Mete r
<br />FINAL
<br />Notes , Remarks, Etc. I
<br />ID/SIG.
<br />ELECTRICAL-INSPECTOR RECORD
<br />COMMENTS O\\'N ER IIUILIJER DII L.CA llATION
<br />I hereby nnirm under penalt y or pc1j ury th:it I am cxcmpl from the Co11lrnL·tors· License Lnw fo r t he fol lim•111g l'l'.1~111 \~'(·. 703 15
<br />Businl-ss and Prorcssim 1 Code): Any City or Count y which rcq\drcs a permit to c.-om,1ru ct. niter. improve. dc molis11 t1r rt11~ ""Y
<br />structure. prior to its issuance . .l l so requires the npplicm11 fo r stu:h per mit t o fi le a signed s1 :11c m en1 t hat hem she is l il'.•~1scd pu
<br />10 1he provisions of 1he Contrnc1or·s Licensed Law (Chapter 9. f'o111 111enci11g \\'i1h Sec1ion 7000 o f IJ i\·ision 3 o r 1hc n usint .,
<br />Professions C'odc) o r tlml he or she is exempt 1h crefro m :md the basis for the a lleg ed c,cmpticin. Any ,·ioh1tio11 <1fS n·till11 7UJ 1.5 by any
<br />.i pp licant fo r a permi t subj ects t he applicant to a civi l penally of nu t murc than Jive h undred dollars lS500).
<br />_I. as o wner o f the propc11y. or my employees with w.i gcs .is I heir sole cnmpensat iu n. wil l dl, !he m ,rk aud the strrn:1urc is not J
<br />intenck"(I or offered for sa le (Sec.7044. Business and Pro fessions C'od e: The Contractor's Lice11se Lnw does 11(11 npply 1<1 an owner of
<br />the prnpci1 y who bu ilds or improves lhcrcon. nnd who do es such work himself or herself or th n,ugh his t'II" her ow11 L't11 pk1y1;\--s .
<br />provided that such improvemems are no t intended oroni.,-ed fo r sale. If. hll \\'C\'C'f, tht.: building. m impro\'cm cnt is sold w i1hin o ne year
<br />of complctitm. the Owner Duild1..1· will ha\"l.: th e bunlt..11 of pro\'ing th :11 he or she did 1101 build or imprcl\c the propt"11)' fcir lhc puqXlsecf
<br />sale).
<br />_I, a." owner of the pmpcl"I)'. am exclusively c.::onlrm:li11g with licensed contraL·tors to cons truct 1he pr(l_ject (~ec . 70 "1 . B11~i11(.'SS
<br />nnd Pm rcssion Code: The Cont ractor ·s License Lnw d~1cs not apply to an owner o fprnpcrty who builds l'r impnH'C!-1h1.n~o11 .
<br />and who cont racts for such projects wit h a Contracto r(s ) licensed pursua111 10 the Co11tra,1nr"s Lk:e11se La \\·).
<br />_I nm e.xc mpt un der Section ________ . B. & P.C. fo r th is rcnson.
<br />Da te: __________ O wncr:.~=====~====~---------
<br />1\'0RKEllS' CO~ll'ENSATIUN
<br />DEC L.A llATION
<br />I hereby .iITirm under pcn.ilty o f pc1jury one of the follow ing dc..-c l.irnt ions:
<br />_I have and will 111ai111 a in a Ce11 iftcatc of Consent lo Self-In sure for ,,·orh,...-s· cc1111 pl'nsatio11. as prn\'idcJ fo r b~ St.:diun J 700 of the
<br />L1 bor Code. for the perfo rm ance oft he work for wh ich the p<.·rmil is issued .
<br />_I have and will mninrn in workers' compensnt ion insurance. ns required by Sec1 ion 3700 of t he Lnbor ( "ode. for the ))l't'formm1cc of
<br />lhc work for whic h this pennit is issu ed. !Vly workers· co mpensat ion insurnnce cni,·icr mid pCllicy m1 111bcr arc:
<br />Corrico: '-R. C ~~ u-.,..c)e,w,;\f'!, \A,1. (<J _____ _
<br />Polic y Num ber: -, 4 .; l ~ --~ ~ I (_ l:l fap ircs: ~~ (3 / / 2 () 18
<br />.l...; l<", ':':,e_ a.. ~ OS I-,. ..
<br />_I r.::c11ify th::ii in the Jm r fonn .incc of1he work for whi c h this permit is iss ued. I sli::ill no! employ any per~t111 in ;my mmme1
<br />so as to become suqjcct 10 the workc,·s' compcnsntio n lnws ofC'alifomin. n11d ngrec that if I shnul d heccime s u~ject t1.i the
<br />workers' compe nsat ion provisions of Seel io n .HOO o f t he Ln bor Code. I s ha ll. fmthwith rnmply w ilh th<)SC prm ·isiti ns ..
<br />W A H N I NG: F.iilurc lo secu re wc,rkcfs ' r.::0111pcnsn1ion CO\'crage is unl::iwful. n11d shall subject an employer to criminnl pcmtltil'S and
<br />c ivil fines up to o ne hundred thousand dollars (S100.000). in nddit io n 10 the cost o f co 111 pc11s,11iu11. da 111ag r.::s :is pnwidcd for the
<br />Sectio n 307& oft he Lnbor Code. in1crest nncl allomey ·s recs.
<br />IMc: lOl'-1 ( 2,-<r l (, Applican1_'.k{ s~~ It 1-\-1.!(" . ...J
<br />I "ENSF,D CONT llACTO R
<br />r Ul'.("LA RATI O N
<br />I hereby n ffir m u nder penalt y or peijur y 1hm I am licensed under provision o f Chapter 9 (cmnmcm.:ing with Sei.:tir,11 7000) of Div ision J
<br />o f the Ousiness and Professions Code. and my license is in full force mk.l cffct·t
<br />,-
<br />License Clnss: C -\ \) ~"o51r Licens e Nl11111Jcr: _______________ _
<br />C ONSTIIUCTION LENDI NG AGE NC Y
<br />I hereby affirm under penalty o f pc1:iury that th ere is n conslniction lending. ag.cnc y for the pcr fonnnnce or the \\'t)I k fr1r whi<."11 th is pcnnit is
<br />issued (Sec. 3097. ('iv. C.).
<br />Lender's Na me: __________________________ _
<br />Lender 's Ad dress · _________________________ _
<br />A l'l'LICANT DECL.AllATIUN
<br />I hereby aninn tinder penalty or pc1j ury o ne of t he followi ng. d ec laratio ns:
<br />Dcmoli1iun Pcrmi1s•Asbcslos NQl ificati()n Federnl Regula1it111s (T itle 40. Pnrt6}
<br />_Rcq11ircd LellerofN01 ific:ilio 11
<br />_I cc..'11ify 11ml t he fcdcn1 I reg ulat ions regardin g asbc..>s los remo vn l nrc UN ap plic,,blc 10 this projec1.
<br />_I cc11 ify lhr1l I hm·c read this np plicallon and state that the abo\'c infi:mnatio n is con-cct. I ngrcc to comply wi1h .i ll City and County
<br />ordmn nces nnd St.tic Lm,s 1clm111g to b11dd 111g cons;~rnc ll n nnd he,eby a 11tho11z e 1ep1ese111.,11ves t1 r 1111s City and Co u11 I\ to c ntcr u pon the
<br />above mcnt ,oned p1o p c11y for mspect,on put pose.,; 11----
<br />A pplic:mtcn Agcnl Sig n nt u r c , / 5 " l).,:_~o / '--1/Z.O'IC,
<br />l'crm i1l'c name (In-int): 1---~ SA~ I-{ H~-!I_: ti'-~
|