20168444 - Permit - Laserfiche WebLink

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ELECTRICAL.I NSPECTOR RECORD [."] ,.r r APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltase Fire Alarm I Dampers Communications Cable Building Under Slab / Floor Bondinq I Groundinq / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinss (T-Bar Rouqh) Meter Release tl ,l,l-w>aRough?t1 'lo Service Meter Ir FINAL )Dft rf lt.l *tr/ Notes, Remarks, Etc.\I OWN I.]R BU I l,DER DI]LCA RAI'ION thC l(rIlr'\\'lllt tCil.St\tl ^il'itttpltrrc. tlclttt,lislt ()t' rcpiir' ,uE that lrc t,r shc is liccnsetl p'rrsrrartl I hereby affrrm under penalty of pcrjury that I arn exempt from the Contractors' License Law for Business and Profession Code): Any City or County rvhich requires a permit to construct. alter, structure. prior to its issuance. also requires the applicant for such pcrmit to file a signed statement to thc p@visioN of thc Conuetor's Licnscd Lrw (Chapt6 9, Com@cing with Sction 7000 of Division 3 of thc Busir* ud pmfBions Codc) or th8t hc or shc is exmpt th@from ed thc basis for thc allegcd exmption. Any violation of Setion 7031.5 by any applicet for a pcrmit subjets the applicet to I civil pcmlty of not morc the fivc hundrcd dollm ($500). _1. c oma of thc p.opcrty, or my cmplo)6 with wag6 s thcir slc compcnsation, will do the wt dd thc stnEtw is not intqrded or offscd foi slc (Sc.?044. B6itre md Prcfeiom C.ode Thc Contrrctor's Licre Law doc not 4Ply to e oMs of thc propsty who builds or improrc thsoil @d who dG such wrk hirelf or hmclf or thrcugh his or ha om oployc. proridcd that such impro@ts rc rct intqrdcd or offscd for slc. l[ howq, thc building or impovmt is mH within one ]qr of onplaion thc olurc Buildq wi[ harc thc tuda of poving tha hc or shc did rct build or itrprorc thc propqry for the txrpos of slc). _1. s owns of thc propqty. m qcluively contracting with licqEcd contractoB to coNlruct thc projal (Se. 7044, BGinN ard profssbnCodc:ThcContractor'sLicoscLawdoenotapplyioeownoofprcpcnywhobuildsorimprov6th6@n. md who contracts for such prcjets with I Crntncto(s) licoscd purmt lo thc Contraclor's LicN taw). -l m cxmpt unda Sction-, B. & P.C. for this roon. ( )u rter' WORKER.S' COM PENSA'IION DECLAITATION I hereby afftrm under penalty of perjury onc of the following declarations: _t have and will maintain a Certificate of Consent to Self-lnsure for workers' contpensation, as provided for by Soction 3700 of the labor Code, for the pcrformance of the work for which the pcrmit is issued. _l have and will maintain workers' compensation insurance. as required by Section 3700 of the l-abor Code. for the performance of the work for which this permit is issuod. My workers' compensation insurance carrier and policy number are: L \i369,-\\ lrr uf,)r)L F\gE il.tS. (Js Policy I G3S\bol ol /or ( "4,2--e _l certi$l that in the perfonnance of the work for which this perrnit is issued, I shall not ernploy any person in any manner so its to become subject to the workers' cornpensation larvs of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvith comply with those provisions.. WARNING: Failure lo secure workers' compensation coverage is unlawful. and shall subject an onployer to criminal panalties and civil fines up to one hundred thousand dollars ($l in addition to the cost of compensation. damages as provided for the Section 3076 of the tabor Code. interest and fees. \./'--q 5 r1 I hereby aflirm under penalty of perjury that I arn licensed under 9 (cornmencing with Section 7000) of Division 3 of the Busincss and Professions Code. and rny liccnse is in full force and effcct. \312--t\q,License .-\>Nurnbcr: CONSTRUCTION LENDING AGI]NCY I hwby affirm unds penalty of pcrjury that th6e is a constBction lmding agency for thc pafomuce of the work for which this permit is Civ. C.). Lender's Address: APPI ICANT DF'CI ^RATION I herdry affrm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. PaI16) -Required Letter of Notilication -l ceni$ that the fueral regulations regarding asbestos removalare not applicable to this project. _l cerrify that I have read this application and state that the above infonnation is corect. I agrce to cornply with all City and County representatives of this City and County to enter upon theordinances and State Laws relating to construclion. and hereby authorize above nrentioned property for Applicnnt or Agent I'erlrrilce nanrc Pe J .9 tq, Dft (V) I)ate:_ or,., *{ | lf/ l 1,