20169103 - Permit (2) - Laserfiche WebLink

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ELECTR!CAL.I NSPECTOR RECORD I hereby aflirrn under penalty of perjury that I am exempt frorn the Contractors' License [.au' for the follorving reason Business and Profession Code): Any City or County rvhich requires a pennit lo construct. alter. improve. dernolish or structure. prior to its issuancc. also requires the applicant for such pennit to hle a signed statement that he or she is licensed to the provisions of the Contractor's Licensed [,au' (Chapter 9. Conunencing rvith Section 7000 of Division 3 of the Business Profe$ionsCodelorthathcorshcisexcmptthscfromandthebasisforthcallcgedcrmpiof,. AnyviolalionofSctionT0-1l.5byany applicant for s pemit subjets the applicant to I civil pru[y of not morc than five hundrcd dolles ($500). _1. as owner of the property. or my employees rvith rvages as their sole cornpensation. s'ill do the rvork and the structure is not intendetl or offered for sale (Sec.7044. Business and Professions Code: I'he Contraclor's License Larv does not apply to an orvner of the property rvho truilds or improves thereon. and rvho does such rvort himself or herself or through his or her orvn employees. provided that such improvonents are not intended or offered for sah. l[, hos'ever. the building or improvement is sold rvithin one year of cornplaion. the Ou'ner Builder rvill have the burden of proving that he or she did not build or irnprove the property for the purpose of sale). as owner of the propeay. arn exclusively contracting rvith licensed conlractors lo conslruct the project (Sec. 7M4. Business and Code: 'l'he Contractor's [,icense Larv does not apply lo an orvner of property rvho builds or improves thereon. Contractor's l,icense Law).and rvho contracts ftrr such projects rvith a Contractor(s) licensed pursuanl to the _l zun exempt under Section_t]. & P.C. ftrr this so as WORKERS' (]Oi\I PENSA'TION DT:(:LARA'I'ION I hereby alTirm under pcnalty of perjury one of the follou'ing declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for u'orkers' compensation. as provided for by Section 3700 of the Labor Code. for the perfonnance of the work for u,hich the pennit is issued. _l have and rvill maintain workers' compensation insurance. as required by Section -1700 of the Labor Code, for the performance of the rvork for which this permit is issued. My rvorkers' compensation insurance carrier and policy number are: Carrier:_\ Policy Number:l:xpircs: certify that in the perforrnance of the w'ork for s'hich this pcrmit is issued. I shall not etnploy any person in any manner to become subject to the rvorkers'cornpensation larvs of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the labor Code. I shall. forthwith comply wilh thosc provisions.. WARNING: Failure to secure rvorkers' cornpensation coverage is unlarvful. and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. darnages as provided for the Section 3076 of the Labor Code. interest and attorney's fees. ?-5- (1 l.t('ENst,.D ('oN'tRA(' I OR DECI"ARATION I hereby affirrn under penalty of perjury that I arn licensed under provision of Chapter 9 (commencing rvith Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and cffect. [.icense Class:_ - -License Number: ('ortlr:rclor: CONSTRUCTION LENDING ACENCY I hcrcby aflirm undo pcnahy of pqjury rhat th6c is a construdion lf,din8 agscy for the pqfomilcc of the work for \r'hich lhis pcnrit b issued (Se. 3097. Civ. C.). [.ender's Narne: Lendcr's Address: APPLICANT DEC LARA"T'ION I hâ‚¬rdry afErm under penalty of perjury one of the follorving declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notification __l certify that the federal regulations regarding asbestos rernoval are not applicable to this proiect. rvith all City and County and County to entâ‚¬r upon lhe above rnentioned property for W e2 *-I reason.av,* aYApplicnnt or Agent APPROVALS DATE ID/SIG,COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm lDampers Communications Cable Buildinq Under Slab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Roush) Meter Release Rough l0'-IJ Y'l't-{5i) Service Meter I \J _l A ,ilttrulstFINAL #>7 Notes, Remarks, Etc.tJ Permiteennme ,oXr&qM â‚¬K5 \-U;l; - ^-s--/f l)ale: and I