Laserfiche WebLink
ELECTRIGAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Owner-Buil der Declaration <br />I hereby aflirm undcr penalty of perjury that I am exempt form the Contractorst uicensi <br />, <br />Law for the following reason (sec.703l.5 Buiness <br />md Profffiion Codc): Any City or County which rcquire a pcmit to construct, altcr, improva, drmolish or rcp8ir ay strudm. priq !o its <br />issume, also rcquir* thc applicut fq such pcrmit to lilc a signcd statmet that hc or shc is limscd pumuot to thc provisions of thc <br />Cmtrrcror's Licoscd Law (Chrptcr 9, cmmdng with Scction 7000 of Division 3 of the Buinqs od Profqsions Codc) or thd hc or <br />shc is cxmpt thcrcfrcm od thc bsis fo thc allcgcd cxoptior .Any violatio of Sction 7031.5 by ey appli@t ftr 8 pcmir subj@ts thc <br />applicer to a civil pcnalty ofnor mm rhu fivc hundrcd dollm (9500). <br />}(-1, o owno of thc propcrty, or my cmployc with waga o thcir solc @mpc[satiff, will do thc work od thc structuc is not intcndcd <br />d, ofrscd fq salc ( Se.7044, Buins ud Prcfssions Cod€: Thc Cmlractor'3 Licmsc Law dc not apply to e omq of $e prcpqty <br />who builds o impov6 th@, ud who dc srch wqk himclf or hmclf u thrcugh his or hcr wn mploycs, prcvidcd that such <br />improvmots uc not inh&d ff offacd fff salc. lf, howwr, thc building or improvomt is sold within onc ycr of cmplctio, thc <br />Owncr-Buildq will havc thc burdm of proving that hc or shc not build or improvc fo tho purpsc ofsalc). <br />-1, <br />6 owncr of thc prcperty, m cxcluivcly @nrrcdtr8 with licoscd conracbrs to consruct thc proj@r ( Scc. 7044, Buin6s md <br />Profssion Codc: Thc Cmtrelor's Licffic Laq do€ not apply to o oma of popaty who builds s improvc thmn , md who <br />cotrrcts for such projcts with a Cotreto(s) limscd purswt to thc Contsetor's Licm€ Law.). <br />Iam under Section <br />I <br />I hereby affirm under penalry of perjury one <br />-IhavcmdwillmsintaitrsCatificstcofCoosottoSclf-lnsurcfoworkcrc'compqrsation.d <br />prcvi&dfqbySetim3T00ofthc <br />Labor Codc, for thc pcrfme of thc work for which thc pqmit is issucd. <br />-I <br />havc ild will maintain wsk6' compcrsdion insmcc, 6 rcquircd by S@tion 3700 of thc Labor Codc, fq thc pcrfmue of thc <br />work for which this pcrmit is isucd. My wsk6' mpctration insurue mis ad policy numba rcr <br />Policy <br />(This section need not bc completed if the permit is for One dollars {$100} or less) <br />\y ccnify that in the pcrformance of the work for which this is issucd, I shall not employ any person in any manner so as to <br />agree that if I should become subject to the workers'became subject to the workers ' compcnsation laws of <br />compensation provisions of Section 3700 of the Labor <br />and <br />shall, forthwith <br />It <br />WARNING: Failurc to sccure workers' compensation coverage is unlawful, <br />fines up to one hun&ed thousand dollars ($100,000),in addition to thc cost of <br />the Labor Code, interest and attorney's fecs. <br />pcnaltics and civil <br />compcnsation, damages as 3076 of <br />LICENSED CONTRACTORS DECLARATION <br />I hocby affim unda poalty of pcrjury that I m licoscd undq prcvisim of Chaprq 9 (comocing wirh Sstion 7000) of Division 3 of <br />thc Buin6s od PrcfBsims Codc, ud my limsc is in full fmc ud cffcct. <br />Liccnse Class: Licensc Number <br />Date:Contractor: <br />CONSTRUCTION LEIYDING AGENCY <br />I hmby afrim uda pcnslty of pctjury rhat th6c is I @osbuctio lmding agacy fc thc pcrfme of thc wsk ftr which this pcmil is <br />isucd (Sc. 3097, Civ. C,). <br />Lada's Nmc: <br />Lender's Address: <br />APPLICAIYT'S DECLARATION <br />Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part 6) <br />_ Required Lettsr of Notification <br />€ccrtify that the fcdcral regulations regarding asbcstos removal are not appticable to this project. <br />Hcerti$ that I have read this application and stste that the above information is correct. I agree to comply with all City and County <br />ordinances and Statc Laws relating to representatives of this City and County to enter upon the <br />above mentioned <br />npprll-o, <br />tPermittee <br />sig It <br />Site-Work -A..j <br />Underground p uA t7:, <br />Pole Bases <br />ay'?b/'re h <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm I Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough I /^,.A. <br />Service Meter qlz lzt W \27 <br />FINAL 6X7lt@ 'fu{Tc TINE I <br />Notes, Remarks, Etc. <br />It).l .' <br />.thie+Cegon___ <br />purPoses.