20170427 - Permit - Laserfiche WebLink

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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Building Under Slab / Floor Bondinq I Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit L Walls (Conduit))Jtz/za --7&?-/) AWalls (Rough)I I \{ \t f t bill/ilACeilinqs (Hard & Soffit Rouqh t Fthbl,){fx)ru Ceilings (T-Bar Roush) Meter Release lt Rough Service Meter i ,u FINAL 7'lo'?ot)l)Attwr',',) Notes, Remarks, Etc. OWNER BUTLDER DET,CARATION I hocby affm undr pcrulty of pcrjury that I m excmpt from the Contractos' Licoc law for thc folldrring rasr (56.7031.5 Busincs md Profsion Codc): Any City or County which rcquiE I pqmit to conslruct. ahc. improvc, doolish or rcpair uy structuq prior to its isumcc, also rcquiG the applicilt for such pcmit to file a signad statmmt tha hc or she b licenrd pwut to thc provisioru of the Contractor's Liccnscd taw (Chapto 9, Commencing with Setion 7000 of Division 3 of thc Busins mC ProfsionsCodc)orthatheorshciscrcmptthqcfromedthcbosisforthcallcgcdcroFion. AtryviolationofSctionT03l.5byuy applicmtforapcmitsubjatsthc applicanttoacivilpcmltyofnotmorcthillivehun&eddollus($500). _1, dS owner of the properly. or my employees with wages as their sole compensation, will do the work and the structure is not intcnded or offered for sale (Sec.7044, Business and hofessions Code: The Contraclor's License law does not apply to an owner of the property who builds or improves theron. and who does such work himself or herself or through his or hcr own employces. provided that such improvanents are not intendod or oflered for sale. l[, howwer, the building or improvement is sold within one year of complaion" the Orvner Buildcr will have the hrden of proving dra he or she did not build or improve the propoty for the purpose of sale). _1, os owner of the propoty. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Business and Pnoftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Contracto(s) licenscd pursuant to the Contraclor's License l-aw). -IarnexemptunderSection-,B.&P.C.forthisreason. Date: YA8tsEES.COMPINSAIION DECT.ABAIIAN I hecby alfm undo panalty ofpo'jury onc ofthc following dcluatiom: -l havc and will mintain a Catifrcatc of CoMt to SclflBure for workc' ompensation, u providcd for by SEtion 3700 of tha labor Codc, for thc pGfomce of thc wort for which thc p6nit is isued. Ml111c ma witt maintain workm' compcmation iruurmcc, a rcquircd by S*rion 37OO of thc libor Codc, for thc poforec of the work for which this pennit is issuocl.My workers' compâ‚¬nsation insurance carrier and polby number are: ,ACJ\ZuY, .L A /11 ?- {\( fA tnq,)ha Policy ?/t / a.o _l certi& that in the performance of the work for rvhich this permit is issued. I shall not onploy any person in any manner so as to become subject to the work6s'compensation larvs of California, and agree that if I should become subject to the workers' compcnsation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with those provisions..t WARNTNG: Failure to secure rvorkers' compensation is unlawful. and shall and civil fines up to one hundred thousand dollars addition to the the Section 3076 Code, interest and a I hereby affrm under penalty of perjury that I arn under provision of Chapter 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code. and my t q License I hereby affrm under penalty of perjury that there is issued (Sec. 3097. Civ. C.). lending agency performance of the work for which this pennit is Lender's Narnc: Lender's Address: APPLICANT DECLARATION I herdry affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Par16) -Required l-rtter of Notification all City and County above rnentioned property for Applicant or Agent Pernrilce nnme (print): \upon the Rev. 08-07 -201 5 i6B to