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APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (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 />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factorv Wired Unit <br />Walls (Conduit) <br />Wails (Rouqh) <br />Ceilinos (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar Rouqh) <br />N/eter Release <br />,l I tl <br />Rouqh ruLlLl J)f{Ytr,7 <br />Service [Vleter <br />FINAL lD.S -tt tr ^{'4t <br />Notes, Remarks, Etc. <br />(l <br />DITI.CARA'tlON <br />I hcrcby aflirm undcr pcnalty of perjury that I er excmpt frcm lhc Contracton' Licens lrw for thc following re&sn (Ss.70.31.5 <br />Business and Profcssion Codc): Any City or County shich rcquircs a pcrmit to construcl. trlts, imprcvc, dcrtlish or rcpair any <br />strucrm, prior lo its issuarce, als rcquircs thc applicant for such Frmit to filc a sigred stotercnt that hc or slE is licenrd luiuant <br />to thc prcvisioN of thc Contmctor's Licenrcd taw (Chaptcr 9. Commercing with Scction 70OO of Division 3 of lhc Busircss ed <br />Profcssions Code) or Ihat hc or shc is cxcmpt thcrcfrcm and thc basi\ for thc allcgcd cxcmplion. Any violation of Setion 703 1.5 by .ny <br />applicant for a fErmit subjccts thc applic.nt to a civil pcmlty of not mrc tha five hundrcd dollus ($500). <br />-1. <br />as owncr of thc prclrc ty, or my cmplores vith wsgcs as thcir slc omlrcnstion, will do thc wo]k and thc stnElw is rct <br />inlcndcd or offered for $lc (Se.7044, Busircss and Profcssions Codc: The Contretor's Liccns kw docs not spply to an owncr of <br />thcprcIEny whobuildsorinpreuthc@[ondwhodesochmrkhimsclforhcrslforlhrcughhisorhcrowncmployccs, <br />providcd that such impmwmnts rc rct intcndcd or offcrcd for sh. lf, howcwf, thc buiHing or impmrcmnt is sH within onc )t4 <br />of or{,htion, thc Owrcr Buikhr will haw the burdcn of prcving thar hc or shc dil rct buiH or itrprcw thc prolEty for thc purporc of <br />strlc). <br />-1, <br />as owncr of thc popcrty, am cxclusivcly contrrcting with liccnscd contracloE to construct thc Fojccl (Ss. 7044, Busincss <br />and PmfcsionCodc:TheContretor'sLiccnscLavdcsnotapplytosowncrofpropertywhobuildsorimptovesthcrcon, <br />and who conrrcts for such prciEts with o Contrcto(s) liccnsd puNunt to thc Contractor's Licensc l:w). <br />-Iamcxcm],tundcrscclion-'B.&P.c.forthisrcason.Date:--*r**"ro' a,rMPExsA'rION <br />DECLARATION <br />I hcrcby affirm undcr pnalty of perjury onc o[ thc following dcclaratbns: <br />_l havc and will maintain a Ccrtificatc of Consent to Sclf-lnsure for workers' comJrcnsation. &s providcd for by Section 3700 of thc <br />Labxrr Code, for thc performancc of thc work for which thc pcrrnit is issucd. <br />_l havc and will maintain workcrs' compensation insurance, &s rcquircd by Section 3700 of thc Labor Codc, for the pcrformance of <br />thc work lbr which this pcrmit is issucd. My workcrs' compensation insurancc carrier and plicy numbcr are: <br />Carricr: 't <br />Policv Number: Exnires:iD <br />-l <br />certily that in thc grcrlbrmance of the work lbr which this is issucd. I shall not cnlploy any pcrson in any manncr <br />so as lo bcconrc subject to the workers'cornpcnsalion laws and agrce that if I should bccomc subject to lhc <br />workcrs' conrpcnsation provisions of Secti<ln 3700 of thc l-:bor I shall. forthwith comply with thosc provisions.. <br />WARNING: Failurc to sccurc workcrs' comlrcnsation IS and shall subjcct an cmploycr to penaltics and <br />civil fincs up lo onc hundrcd thousand dollars ($100.000).cosl conrpensation. damagcs as [<rr thc <br />Scction J076 [:bor Ccxlc.attorney's fces. <br />a <br />I hcrcby aflirnr undcr pcnalty of pcrjury that I am liccnsed undcr provision of Chapter 9 (comtnencing with Scction 7000) <br />of thc Busincss and Profcssions Codc. and my liccnse is in futl forcc and effect. <br />Liccnsc t .l <br />a, <br />I hcrcby afnrm undcr lEnalty of lErjury that therc is a construction hnding agercy for thc lErforlrc ofthe work for which this Frmit is <br />issucd (Scc. 3097, Civ. C.). <br />Lcndcr's Narnc: <br />[.cnder's Addrcss: <br />APPLICANT DECLARATION <br />I hcreby all-um under pnalty of prjury one of the following dcclarations: <br />Dcmolition Pcrrnits-Asbcstos Notification Fcderal Regulations (Titlc 40, Part6) <br />_Required [rttcr of Notifrcation <br />I <br />-, <br />certify that the fcderal rcgulations't=asbcstos renroval are not applicable to this projcct. <br />_l certity that I havc rcad this application statc that thc atxrve int'ormation is corrcct. I with all City and County <br />ordinanccs and Statc Laws rclating lo and <br />abovc mcntioncd propcrty ltrr <br />Applicant or Agenl <br />I'ernritee name <br />and hcrcby authorize <br />- <br />to cnlcr uJxrn lhc <br />ELECTRICAL.INSPECTOR RECORD <br />Dn.r na n7 On'l tr <br />Owner:_ <br />L <br />,l