20172290 - Permit - Laserfiche WebLink

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APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards -() Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bondino / Groundino I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Wdls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release Rouqh Service N/eter I /Notes, Remarks, Etc. / I O}YNI.]R I hereby affirnr under penalty of prjury that I arn exempt fronr the Contractors' License I:w for the following reason (Sec.7031.5 Business and Prol'cssion Codc): Any City or County which rcquircs a pcrmil to construct, alter, itnprovc, demolish or rcpair any structure, prior to its issuance. afso requires tlre applicutt for such penrtt to file a sigrrcd staternent that lrc or she is licerrsed pursuant to thc pmvisions of thc Contractor's l,iccnscd law (Chaptcr 9. Commencing with Scction 7ffi of Division 3 of thc Busincss and Professions Code ) or that he or she is exenrpt therefrom and tlre basis for tlre alleged exemption. Any violation of Section 703 1.5 by any applicnnt for a permit subjects tlrc applicant to a civil pcnnlty of not more than five hundred dollars ($5tltl). a.s owncr ol'thc propcrty. or tny crnployccs with wagcs as thcir solc compcnsation, willdo thc work ard thc structure is rnt or offered for sale (Sec.7Ua. Business and Prcfessions Code: The Contraclor's License Law docs nol apply to an owner of wlro builds or inrproves therurn, and wlp does such work him.self or lrerself or ttuouglr his or her own entployees, providcd that such improvemcnts are not intendod orollcrcd for sale. Il. howevcr, thc building or improvenrcnt is sold within one ycar of complctiorL thc Owner Buikler will havc thc burden of pmving that hc or shc did not buikl or improve thc propoty for thc purpose of sale). _1. as owner of the properly, am exclusively contracting with liccnscd contractoni to conslrucl the project (Scc. 7044, Business aill Protessbn Code: The Contractor's License Law dms not apply to an owner of property who builds or intproves thereon and who contracts for such projccts with a Contracto(s) licensed pursuant to the Contractor's License taw). _l anr reason. \)p I hcrcby allirnr undcr pcnalty of pcrjury onc of thc tbllowing _l have and will nnintain a Certilicate of Con.sent to Self-lnsure for workers' comSrcnsation, as provided for by Section 3700 of the Labor Code, for the Jrerformarrcc of the work for which thc perrnit is issucd. _l have and will maintain workers' conryrcnsation insurarrce, as required by Seclion 3700 of thc Labor Codc, for the perfornunce of the work for which this permit is issued. My workers' compcnsation insurance carricr ud policy number are: in tlrc;rcrfornlancc of thc work for which tlris prnrit is issued, I shall not cntploy any pcrson in any manncr to thc workcrs'conrpensation laws of California,and agree that if should becomc subject to thc provisions of Section 3700 of the Labor C'rxle,slrall,forthwith conrply witlr those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil lirrcs up to one hundred tlxrusand dollars ($100.()001.to the cost of comperrsation, danuges as provided for the Scction of thc L:bor Codc, interest and attorncy's [ees. I hereby affirm under grcnalty of perjury that I ant licens,ed 9 (conrnrncing with Section 7000) of Division 3 of the Business and Professions Code. and rny license is in full forcc aM effect. Licen.sc Numbcr: CONSTRUCTION LENDING AGENCY I hcreby al'lirm undcr pcnalty of perjury that thcrc is a construction hnding agency for the perlbrmance of thc work for which this pcrmit is issued (Scc. 3097, Civ. C.). lrnder's Name: [rnder's Address: APPI,ICANT DECI,ARATION I Mry affrm undcr pcnalty of pcrjury onc o[ the following dcclarations: Denrclition Pernits-Asbcstos Notification Fcderal Rcgulations (Titlc 40, Part6) _Rcquircd lrttcr of Notifrcation _l ccrtily that thc federal rcgulations rcgarding asbcstos rcmoval arc not applicablc to this projcnct. all City antl County Statc laws relating to entcr upon thc It Pernrilec nanle properry for (-, arxl hereby authorize reprcscntatives of ?9 ELECTRICAL.INSPECTOR RECOR D t Rev. 08-07-2015 , I so tlrat I havc rcad this application arxl statc that lhc ahrvc infrrrnution is corrcct. I agrc.c to or