20272887 - Permit - Laserfiche WebLink

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ELECTRICAL-I NSPECTOR RECORD APPROVALS DATE COMMENTSID/S!G Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltase Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bondinq I Groundins I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Wails (Rouqh) Ceilings (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) N/eter Release Rouqh Service JMeter FINAL câ‚¬LE Etc. ( I I IUC odN4_ - Jl tlhcrcby aftirm undcr Jrcnahy of perjury that I m excmpt fmm thc Contractos' Liccns hw for thc following rcasn (Ss.7031.5 Busincss and Profcssion Codc): Any City or Counly which requircs a Jrcrmit lo conslruct, altcr, improvc, dermlish or rcJuir'any struclurc, prk r to iIs issuamc. alm rcquires the applicant for such lrcrmit to filc a sigrcd statemnt that he or she is licenscd pusant to thc pmvisions of thc Contractor's Licen*d law (Chaplcr 9. Comrrcncing with S6tion 7000 of Division 3 of thc Business and Pn)fcssions Codc) or lhat hc or shc is cxempt lhcrcfrcm and thc basis for thc nllcgcd cxemption. Any violalion of S6tion 70.1 I.5 by lny applicant for a Fmit subjccts thc applicant to a civil pcnaly of not mrc lhan fivc hundrcd dollus (5500). _1, as owncr of the propcrty. or my cmployces with wagcs as thcir vrlc comyrcnsali<ln. will do the work and thc structurc is ff)t intendcd or offcrcd for salc (Scc.7044, Busincss and Profcssions Codc: Thc Contraclor's Liccnsc l-aw does not apply to an owncr of thc p()pcrty who builds or inrprovcs thercon. and who docs such work himsclf or hcrsclf or through his or hcr own cmployccs. providcd that such intprovcnrcnts arc not intcndcd orotlcrcd for salc. lf. howcvcr. thc building or irnprovcmcnt is sold withinonc year of corrrplction. the Owncr Buildcr will have thc burden of proving that hc or shc did not build or improve thc propcrty for thc purpsc of salc). __1, as owncr of thc propcrty. am cxclusivcly contracting with liccnscd conlractors to construct thc projcct (Scc. 7(X4, Busincss and l'rofbssion Codc: Thc Contraclor's Liccnsc Law docs not apply lo an owncr of property who builds or intproves thcrcon. and who conlracls for such projccts with a Contractor(s) liccnscd pursuanl lo lhc Contractor's Liccnsc Law). _l anr exctnpt undcr B.&.C. l'or this reason. I hercby aflirm undcr penalty of pcrjury one of the following dcclarations: _l havc ard will maintain a Ccrtificate of Consent to Self-lnsurc for workers' compensation, as providcd for by Scction 3700 of the labor Codc. for thc ;lcrformance of thc work for which thc permit is issucd. -l havc and will maintain workers' compensation insurancc, as rcquircd by Section 3700 of the labor Codc, for the ;rcrformancc of thc work for which this permit is issucd. My workers' compensation insurancc carrier and plicy number are: Policy Numbcr: Expires: _l ccrtity that in thc pcrlbrmancc of thc work for which this pcrnrit is issucd. I shall not employ any pcrson in any tnatlncr so asto bcconrc subjcct to the workers'compensation lawsof California. and agrcc lhat if I should bccomc subjcct tothc workers' cornpcnsalion provisions of Scction 3700 of the l-atnr Codc, I shall. forthwith conrply with those provisions.. WARNING: Failure to sccurc workers'comJrcnsalion covcragc is unlawful. and shall subjcct an employcr to crinrinal pcnaltics and civil fincs up to one hundred thousand dollars in addition to lhc cost of compensation. damagcs as providcd for thc Scction 3076 of thc Lrkrr Codc, intercst and I hcrcby affirnr undcr pcnalty of pcrjury that I arn liccnscd Chaptcr 9 (commencing with Section 7000) of Division 3 of the Busincss and Professions Codc, and nry liccnsc is in full forcc and effcct. Licensc Class: Liccnsc Numbcr: Date:Contraclor: W I hcrcby aflirm undcr pcnalry of Frjury that thm is a construction lcnding 8gercy for the pcrformrce of thc work for which this lrmit is issucd (Scc. 3097. Civ. C.). l-crttlcr's Narttc: [-cnder's Addrcss: APPLIC^NT NECI ARATION I trrcby atlirm undcr pnalty of pcrjury onc of the following dcclarations: Dernolition Pcrmits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40, Part6) _Requircd Lcttcr of Notification _l certify that thc fedcralregulations rcgarding asbcstos rcntovalurc not applicablc to this projcct. _l ccltily that I huvc rcad this application and statc that thc atxlvc int'orrnation is corcct. I agrce to comply with all City and County ordinanccs and Statc Luws rclating and hcrcby authorizc rcprcscntatives of this City and County lo cnlcr upon thc atxlvc nrcntioncd propcrty lbr Applicant or Agent Pernritee nttme nr, nO n7 Onltr , Carrier: o2 ,rr"W