Form Var-1 - Application For Permanent Variance
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1
2CALIFORNIA OCCUPATIONAL SAFETY AND HEALTH STANDARDS BOARD
2520 VENTURE OAKS WAY, SUITE 350
SACRAMENTO, CA 95833
(916) 274-5721
APPLICATION FOR PERMANENT VARIANCE
Please type or print legibly
1. APPLICANT (List Employer/Elevator Owner - Do not list representative)
(Name)
(Address)
(City, State, Zip)
(
)
(
)
(Telephone)
(Fax)
DOCKET NO.
2.
Applicant requests a permanent variance from Title 8, California Code of Regulations, Section(s):
(Do not list ANSI, ASME, NFPA, API or other section nos.)
3.
State the location or address where the variance will be in effect:
Applicant certifies that it informed its employees of this application by (applicant must do at least one of the following):
4.
Applicant's employees are represented and applicant gave a copy of this completed application to the employees'
a.
authorized representative.
Applicant posted a copy of this application, or a summary of it, including a statement indicating where a copy
b.
of the application may be examined, at the place(s) where employee notices are normally posted.
Applicant's employees must be informed of: 1) this application; 2) their right to full party status, including
5.
the right to participate in the hearing; 3) the availability of all pleadings for inspection and copying
at a reasonable time; and 4) their right to petition the Standards Board for a hearing. Indicate how
applicant has fulfilled this obligation:
a.
By posting this application at the place(s) where notices to employees are normally posted; or
b.
By posting a summary of the application and a statement of these rights at the place(s) where employee notices
are normally posted.
6.
What means, methods, practices or conditions does the applicant plan to use to provide safety and health that is equal or
superior to the level of safety and health provided by the Title 8 section(s) the applicant wants a variance from (e.g., provide head
protection, post warning signs, provide training)? (If more space is needed, attach an additional sheet as Attahcment 6).
VAR-1 (REV. 08-00)
(Continued on reverse side)
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