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APPROVALS DATE ID/S!G.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <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 SIab / Floor <br />Bonding I Grounding IUFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Wa!!s (Conduit) <br />Walls (Roush) <br />Ceilings (Hard & Soffit Roush <br />Ceilings (T-Bar Rough) <br />N/eter Release <br />Rough iYarr- <br />Service Meter r! .rf E U <br />FINAL lt ll i,. <br />Remarks Etc. <br />I hcrchy uffirm under pcnrhy of pcrjury that I um erempt frcm lhc Contracton' Liccnre ljw for the following rcaon (Se.7031.5 <br />Busincss md Profession C.tic): Any City or Counly which rcquitcs a Jumit to construct. ahcr. improvc. dcmlish or rcpdr any <br />structure. prior lo its issuancc. also requircs the applicant for such pcrmit to filc a signcd statcrrcnt that hc or she is lien*d pursumt <br />lo lhc pmvisions of lhc Contracto,'s Liccn*{l law (Chaptcr 9. Commcrcing with Scction 7000 of Division 3 of thc Busincss ond <br />PrcfcssionsCodc)orthBlhcorshciscrctrrptthcrcfromondthcbasisforlhcallcgcdcxcmption. AnyviolationofsstionTO3l.5bysny <br />applicanl for a pcrmit subjcrts thc applicant to e civil pcnalty of nol mrc lhan five hundrcd doll[s (S500). <br />-1. <br />as owncr of the property. or my ctnployees with wages as their solc conrpensation. will do thc work and thc stnrcturc is n<tt <br />inlcrrdcd or ollcrcd for salc (Scc.7()ll4. Business and hofessions Codc: Thc Contractor's License [.aw docs not apply lo an <lwner of <br />the propcrty who builds or improves thcrcon. ard who dcrcs such work himsclf or hcrsclf or through his or hcr own cmployccs. <br />provided that such intprovenrcnts are not intendcd oroffcrcd for sah. If. howcver. thc building or improvcrnent is sold within onc ycar <br />of cornplction. thc Owncr Builder will havc thc burdcn of proving that hc or shc did not build or improvc the propcrty for the purprscof <br />salc). <br />-1. <br />as owncr of thc propcrly. arncxclusively contracting with liccnsed contractors to construct thc pr<rjcct 1Scc. 7044. Business <br />and Pmfcssion Code: Thc Contractor's Licensc [,aw does not apply t(! an owner of propcrty who huilds or inrproves thcrcon. <br />and who conlracls for such projccts with a Corrtractor(s) liccnscd pursuanl to thc Contractor's l-iccnsc Law). <br />-l <br />anr cxcnrpl undcr Scction_. B. & P.C. for this reason. <br />Dale:_ <br />WO RKERS' CO[}I PENSATION <br />lhcrebyatfirmundcrpcnattyofperjuryoneofthcftlllowi,*ffi <br />-l <br />have and will maintain a Certificate of Conscnt to Self-lnsure for workers' comJrcnsation. as provided for by Seclion .j700 of the <br />Labor Code. lbr the pcrfornunce of thc work for which thc pcrrnit is issucd. <br />;!l trave and will maintain workcrs'compensation insurancc. as rcquirc<l by Section 3700 of the l^abor Codc. for the performance o[ <br />ih'e work for which this Jrcrmit is issucd. My workers' comlrcnsation insurancc carrier and plicy number arc: <br />coni",, Sfa*t, fiLAA h' €L/(t-$cdrnnA <br />it I v-leovg <br />,r,,",4Tt2( 2..r* <br />Policy <br />-l <br />ccrtity that in thc pcrlbrrnancc of thc work lbr which this pcrrnit is issucd. I shall not employ any pcrson in any manncr <br />so as to bccorrrc subject to thc workers' compensalion laws of California. and agrcc that if I should bcconrc subject to thc <br />workcrs' contJrcnsation provisions of .Scction -3700 of thc l-atnr Codc. I shall. forthwith conrply with thosc provisions.. <br />WARNING: Failurc to sccurc workcrs' compcnsation covcragc is unlawl'ul. and shall subjcct arr cnrploycr to crinrinal prraltics and <br />civil fines up lo onc hundrcd thousand dollars (S1ffi.fiX)1. in addition to the cost of compcnsalion. darnagcs as providcd for thc <br />Scclion 3076 of thc Lahrr Codc. intcrcst and <br />( )s rrer. <br />[rnder's Addrcss: <br />I hcrcby affirrn under pnalty of perjury that I am licenscd undcr provision of Chapn 9 (commencing with Sectbn 7000) of Division 3 <br />of thc Busincss and Profcssions Codc, and my license is in full force and cffect./. <br />[-iccrrsc Nulnbc'r:lo? gbo?- <br />Date:_ <br />CONSTRTJCTION LENDING AGENCY <br />I hcrcby aflirrn undcr lrcnalty of lErjury lhat therc is s construction lcnding agcncy for thc pcrformncc ofthc work for which this lErmit is <br />issucd (Sa. 3097. Civ. C.). <br />[rndcr's Nantc: <br />APPLICANT DECLAITATION <br />I hcrcby aftirm undcr penalty of perjury onc of thc l'ollowing dcclarations: <br />Dcmolition Pcrmits-Asbcstos Notificalion Fcdcral Rcgulations (Title 40. Part6) <br />-Rcquircd <br />lrttcr of Notification <br />-l <br />certify that thc fcdcral rcgulations rcgarding asbcstos rcnrcvalarc not applicable to this projcct. <br />-l <br />certify that I have rcad this application and statc that thc atrrvc information is correct. I agrcc to cornply <br />rlrclinances and State Laws rclating conslruclion. and hcrcby authorizc reprcscnlatives of'this City and County to cnlcr upon thc <br />atxlvc rrrcntioncd propcny for <br />t <br />lD <br />with all City arxl County <br />Applicant or Agenl ,,,",411t1 t%tg <br />Permitee name QnnO, ?-' <br />n'7 nn <br />ELECTRICAL.I NSPECTOR R ECOR D