20170087 - Permit - Laserfiche WebLink

Home Browse Search

ELECTRICAL.I NSPECTOR RECORD f)n.nQ n'7 1^4 A APPROVALS DATE ID/S!G.COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire Alarm I Dampers Communications Cable Building Under SIab / Floor Bonding I Grounding / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit)-/ I tl Walls (Roush)(/1,t 7T Dr+Ja 7 Ceilings (Hard & Soffit Roush q f)7i htr44 ,q Ceilings (T-Bar Rough)tl Meter Release Rough Service Meter FINAL I tl,?/2 rMxot Notes, Remarks, Etc. OWNER BUILDER DELCARA'TION I h6cby amrm unda penalty of perjury that I m cxmpt from thc ConlmcloF' Liccrc law for thc following rwn (Qe.7031.5 Busincs and Profssion Code): Any City or County which requira a pamit to construct, altc. improvq dmolish or rcpair uy structuc. prior to ils isuacc. ds rcquirc rhc applicmt for such pcnnit to filc a signcd stalmot that hc or dr. is licmscd plNant to the prcvisiom of thc Contrutor's Licensed Law (Chaptc 9. Commencing wilh Setion 7000 of Division 3 of thc Busines ad Prcfeions Codc) or that hc or shc is exmpt th6e&om ud thc besis for thc allcgcd oonpion. Any violation of Sdbn 7031.5 by uy applicantforapflnilsubjGtsthe applicanttoacivilpenaltyofnotmorclhmfivehundrcddolla!($500). _1. 6 oms ofthc prcperty. or my cmployG with wag6 6 their mlc ompmsalion, will do thc wort and the structrc b rcl intodcd or oflercd for sle (Sc.7M4, Bsins ild PrcfsioG Codq Thc Contractor's Lic6e lrw do6 not apply to e omtr of thc prcpcrry uho huilds or improvc th6@[ md who dG such uort himsclf or hmclf or thrcugh his or ha om mploys. providcd that such imprc@ots rc rct intadod or ofErcd for slc. lf, horvqq, thc building or imprcv@t is mH within onc )qr of mmplaion, the Orunq Builds will hrvc thc hrda of prcving tha hc or $e did not huild or improve thc popoty for tlrc prposof elc). _1. as owner of the property. am exclusively contracting rvith to construct the project 1Sec. 7M4, Buiness and t'rofession Code: The Contraclor's License Larv of property who builds or improves thereon. and who contracts for such projects with a to the Contractor's l,icense Law). _l arn exempt under l)atc: t)t ('1.,\RA]'t0N I hereby afTinn undcr penalty of perjury declarations: I -l have and will maintain a Certificate of Consent to Self-lnsure ftrr workers' cornpensation. as povided for by Section -1700 of the Labor Code. for the performance of the work for which the permil is issued. -l have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for thc performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number arc: Carrier:- I'olic) Nulnlrcr': Ijrpitcs: _l cenify that in the performance of the rvork for which this perrnit is issued. I shall not employ any p€rson in any manner so as to becorne subject to thc workers' compensation laws of California, and agree that if I should become subject to the workers' cornpensation provisions of Section 3700 of the Labor Code. I shall. forthwith cornply with those provisions.. WARNING: Failurc to secure rvorkcrs'and shall subject\ anployer to crirninal penalties and civil fines up to one hundred to the cost of compensation. darnages as provided for the Section 3076 of the Labor Code. interest Date: I hereby affrnn under penalty of perjury that licensed under provision of Chapter 9 (commencing with Section 7000) of Division -3 of the Business and Professions Code. and nry liccnse is in full force and effect. License Class:- Date: ! in--or"Nurnber: Contractor:_ CONS'TRUC'TION LENDING AGT'NCY I haeby alfirm unda pculty of pcrjury that thqe is a construction lcnding agocy for rhe pcfomucc of thc rcrk for which this psmit is isucd (S€. 3097, Civ. C.). Lender's Name: Lender's Address: APPLICANT DECLARATION I hereby affrnn under perralty of perjury one of the follorving declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Parr6) --Required regarding asbestos are not applicable to thilproject. -I is con'ect. I agree to cornply rvith all ('ity and County represenlatives of this City and County to enter upon theordinancesand hereby authorize above Applicant or ( (l'crrrrilcc nanre Law's inspection purposes. (v i