20169345 - Permit (3) - Laserfiche WebLink

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ELECTR!CAL.I NSPECTOR RECORD APPROVALS DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION I hqeby aflim und6 poalty of ptrjury that I m cxcmpt from lhe Contracton' Licruc Lsrv for the following rcon (56.703115 Busines od Profwion Codc): Any City or County which requira a pennit to construct, altq. improve. dcmolish or rcpair my structuq prior lo its isuoce. also rcquire the applicmr for such lmit to lilc a signed statqtrol that he or slE b licmscd plNait to the frovisions of thc Contractor's Liccnscd tarv (Chaptcr 9. Commencing rvith Sation 7000 of Division 3 of thc Busins md Prof6sions Codc) or that hc or she is cxcmpt thqcfrom and thc bsis for thc allcgcd cxmption. Any violation of Scclion 7031.5 by any applicant tor a permit subjcts the applicsnt lo a civil pcnalty of not morc thm fivc hun&cd dollss ($500). _1. as owner of the property. or my employees with rvages as their sole compensation. sill do the u'ork and the structure is not intended or offered for sate (Sec.7M4. Business and Professions Code: The Contractor's l,icense Larv does not apply to an orvner of the progrerty who builds or improves thersrn. and who does such s'ork himself or herself or through his or her own employees. provided that such improvonents are not intended or offered lirr sale. l[, however. the building or improvement is sold within one year of complaion. the Ormer Builder witl have the burden of proving tha he or she did not build or irnprove the propoty for the purpose of sale). _1. as o\t'ner of the property. am exclusively contracting rvith licensed contractors lo construct the projecf (Sec. 7044. Business and ttofession Code : The Contractor's License Larv does not apply to an orvner of property rvho builds or irnproves thereon. and s'ho contracts for such projeos rvith a licensed pursuant to the License Law). _-l am exempt under Section- ,n -7- -. B. & P.C. for this reason. DECLARA'TION I hereby alTirrn under penalty of pojury one of the follorving declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for rvorkers' compensation. as provided for by Section -3700 of the Labor Code. for the performance of the rvorft fior rvhich the permit is issued. _l have and will maintain rvorkers' compensation insurance. as required by Section 3700 of the tabor Code. for the performance of the work for which this pennit is issued. My workers' compensation insurance carrier and policy number are: Carrier':-- Policy Number: ExPires: _l ccrtify that in the performancc of the rvork for which this perrnit is issued. I shall not cmploy any pemon in any manner so as to become subject to the workers'compensation laws of California, and agree that if I should become subject to the worters' .o,np*.iion provisions of Sertion 3700 of the Labor Code. I shall. forthwith comply rvith thosc p.oritio*.. I WARNING: Failure lo secure rvorkers' conrpensation coverage is unlarvful. and shall an onployer to and civil fines up to one hundred thousand dollars in addition to the for the Section 3076 of the Labor Code. interest and attorney's g A I hereby affirm under penalty of perjury that I arn licensed under provision of Chapter 9 (commencing with Section 7000) of Division -1 of the Business and Professions Code. and rny license is in full force and effect. License Class:-- -License Number: l)nte:(lonlrnclor: CONSTRUC'TION LENDING AGENCY I hmby affum unds pcnalty of pdjury that thrc is a mrotruc-tion lmding agocy for thc pffomscc of thc rcrk for which this pqmh b issucd (Se. 3097. Civ. C.). Lender's Narne: - Lender's Address: - APPLICANT DECLARATION I hffiby affirm under penalty of perjury one of the follorving declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Pat16) -Required Later of Notilication _l certify that the federal regulations regarding asbestos rernoval are nol applicable to this project. I cerrify that I have read this application and state that the akrve infonnation is correct. I agree to comply rrepresentatives of this City rvith all City and County and County to enter uSnn theordinances and State Larvs relating constnrction. and hereby authoriz.c above rnentioned propfiy for Applicnnl or Agent Pernrilee nAnre (print):?+ra, oate:O-â‚¬'11 Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Buildins Under Slab / Floor Bondins I Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinss (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release Rough q v4 ui Fzn,r.qc"rpn; Service Meter u\ FINAL tt t 14 -1 W {2u Notes, Remarks, Etc.UI