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APPROVALS . DATE ,lD/slG.COMMENTS <br />Site-Work \I n I [l,rrr <br />Underground -)tl ,A a \WN I}(rtv16 { Y 1'/ <br />Pole Bases r <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding I Grounding I 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 />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouqh) <br />N/eter Release <br />I LN ^a <br />Rough l/at k rrut <br />Service N/eter <br />FINAL Wttz <br />Notes, Remarks, Etc. <br />L <br />I hcrcby aflirm undcr fEnahy of pcrjury that I m cxcmpt fmm thc ConlmctoB' Liccns tjw for thc following rcamn (Scc.7O.3 r. <br />Busincss and Profcssion Codc): Any City or County which rcquircs a ;rcrmit to construct. altcr, improvc. dcmlish or rcJnir any <br />structurc. prior lo ils issuancc, also rcquircs lhc applicant for such FrmiI Io filc a sigrcd stalcrcnt that hc or slrc is liccnsd pumuant <br />lo thc prcvisions of thc Contractor's Liccnscd ljw (Chuptcr 9, Commcrcing with Scction 7000 of Division 3 of thc Business and <br />PmfcssionsCodc)orlhathcorshciscxcmptthcrcfrom.ndthclxlsisforlhcallc8cdexcmption. AnyviolationofscclionT03l.5byany <br />applicant for a pcrnrit subjets thc applicant to a civil pcnalty of not rmrc lhm fivc hundrcd dollars (S50O). <br />-1. <br />as owncr of the propcrty. or nly employees with wagcs as thcir solc cornpensation, willdo thc work and thc strudure is not <br />intcndcd or oftbred fbr salc (Scc.7044. Busincss and Profcssions Codc: Thc Contractor's Liccnsc Law docs not apply to an owncr of <br />thc property who builds or improves ttrcrcon. and who does such work himsclf or hcrself or through his or hcr own employccs. <br />providcd that such improvenrcnts arc not intended or offcrcd for salc. lf, howcver. thc building or improvemcnt is sold within one ycar <br />of cornplction. lhc Owncr Buildcr will have thc burden of proving that hc or shc did not build or improvc thc propcrty for thc purynsc of <br />sah). <br />-1. <br />as owncr of the property. am cxclusively contracting with liccnscd contractors to conslruct thc project (Scc. 7W, Business <br />and Profcssion Codc: Thc Contraclor's Liccnsc Law docs not apply lo an owner of propcrty who builds or improvcs thereon, <br />and who conlracts for such projccts with a Contractor(s) licenscd pursuant to the Conlractor's Licensc kw). <br />_l arrr section-. B.lbr this rcason. <br />a <br />DECLARATION <br />I hcrcby affirrn undcr pnalty of pcrjury onc of thc following dcclarations: <br />-l <br />havc and will mainlain a Certificatc of Conscnt lo Scll'-lnsurc for workcrs' comlrcnsation, as providcd for by Scction 3700 of thc <br />labor Code. lbr thc performancc of the work for which the pcrmit is issued. <br />-l <br />havc and will rnaintain workers' compensation insurancc. as required by Scct ion 3700 of the l,abor Code. for thc pcrformance of <br />thc work for which this pcrrnit is issucd. My workcrs' compcnsation insurance carricr and policy numbcr arc: <br />Policy <br />-l <br />ccrtify that in the pcrfornrancc of thc work for which this pcrmit is issucd. I shall not cnlploy any person in any manner <br />so as to bccome subjcct to thc workcrs'compcnsalion laws of California. and agrcc that if I should bcconrc subjcct to thc <br />workcrs' compensation provisions of Scction 3700 of the Labor Code, I shall, forthwith conrply with those provisions.. <br />WARNING: Failurc to sccurc workcrs' compcnsation covcragc is unlawlul. and shall subjcct an cmployer to criminal Jrcnaltics and <br />civil fincs up to one hundrcd lhousand dollars ($100.000), in addition to thc cost of compcnsation, damagcs as providcd for thc <br />Scction 3076 I-atnr Code. intcrest and attorney's fccs. <br />L <br />"/14 a <br />I hcrcby affirnt undcr pcnalty of perjury that I am licenscd under provision of Chaptcr 9 (comrrcncing with Scction 7000) of Divisirn 3 <br />of thc Busincss and Profcssions Code. and my liccnsc is in full forcc and cffcct. I <br />Licensc Class: Liccnsc Number: <br />W <br />I hcrcby affirm under lEnslty of pcrjury lhat thcrc is I construction bnding sgcrcy for thc pcrformtne of thc work for which this lErmit is <br />issucd (Se. 3097. Civ. C.). <br />[-ender's Name: <br />[.cnder's Address: <br />APPLICANT DECLARATION <br />I hcreby affrnr undcr penalty of prjury onc of thc following declarations: <br />Dcmolition Pcrmits-Asbcslos Notification Fedcral Rcgulations (Titlc 40. Pan6) <br />_Required lrttcr of Notification <br />-l <br />ccrtify that thc fcdcralrcgulations rcgarding asbcstos rcmovalarc not applicablc lo this projcct. <br />ccrtify that I havc read this application and statc that thc atnvc inforrnation is correct. I agrcc to comply with all City and County <br />ordinanccs and Statc Laws relating to building construction. and hcreby of this City and County to entcr upon thc <br />abovc nrcntioncd propcrty lbr inspcction <br />.l <br />Pernritee <br />Applicant or rtgenl lz <br />ELECTRICAL.INSPECTOR RECORD <br />/n <br />Dnle:Contraclor:_ <br />i,x.lft;