20171184 - Permit - Laserfiche WebLink

Home Browse Search

ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNE,R BUILDER DIiLCARATION I hereby affrnr urxler penalty of perjury that I arn exempt from the Cbntracton' License Law for the following reason (Scc.7031.5 Business and Profession Codc): Any City or County which requircs a pc.rmil to construct, altcr, itnprove. dcmolish or rcpair any strucrure, prior to its issuance. also requires the applicant for such Srernrit to file a signed staterEnt that hc or strc ls licenscd pursuant to thc provisions of thc Contractor's l,icenscd Law (Chapter 9. Commencing with Section 7fiX) of Division 3 of thc Busincss and Professions Code) or tlrat lr or she is exempt therefronr and tlre basis for tlre alleged exenption. Any violation of Section 7031.5 by any applicant for a perrnit subjects the applicant to a civil penalty of not rrore than five hundred dollars ($500t. _1. as owncr ol'thc propcrty. or my crnployccs with wagcs as their sole compcnsation, will do the work and the stnrcture is not interxletl or offered for sule (Sec.7U4. Business anrJ Profcssions Corlc: The Contractor's Liccnsc Law does nol apply to an owner of the ptoperty wlxr builds or improves thereon, and wlto rkns such work himself or Irerself or through his or hcr own entployees, provided that such imprrrvements are not intendcd orollcrcd for sah. Il, howevcr, thc building or inproverrcnt is sold within onc )aar of conrplctiorr, tlrc Owrcr Buikler will havc the burdcn of proving thal he or she dirJ not build or imprcve tlre propaty for the purpose of sale). _1. as owner of the property, am exclusively contracting with liccnscd contraclors to construct thc project (Sec. 7044. Business arxl krolisskm 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 Contractor(s) licenscd pursuant to thc Contractor's Liccnsc l-aw). -l anr exempt under Section-, B. & P.C. fbr tlils reasott. 11,. . ^. WORKERS' COMPENSATION DECLARATION I hercby affirm undcr pcnalty of Jrerjury onc of the tbllowing dcclarations: _l have and will nninlain a Certifrcate of Consent to Self-lnsure for workers' conrpensation, as provided for by Section 3700 of the [:bor Codc, for thc Jrcrfonnancc of thc work for which the permit is issued. _l have and will nuintain workers' conrpensalion insurance, as required by Section 3700 of the labor Code, for thc perfornrance of thc work for which this pcrmit is issued. My workers' compensation insurance carricr ard pnlicy number are: Policy Numtrer: Expires: _l ccrrify that in tlrc prftrrnuncc of tlrc work f<rr which this pcrmit is issued, I shall not employ any lrcrson in any manncr so as to become subjcct to thc workcrs' conrpensation laws of California. and agree that if I stnuld becornc subject to the workers' conrpensatir.ln pruvisions of Section 3700 of the Labor Code, I shall, forthwith comply wilh thosc provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penahics and civil fines up lo one lrurrdred tlxrusand dollars ($100.000). in addition to tlrc cost comSrcnsation, danuges as provided for lhe attorrrcy's l'ees. I hereby afl-rnr under penalty of pcrjury that I anr licensed 9 (conrnrcncing with Se,ction 7000) of Division 3 of the Business and Professions Code. arxl rny license is in full forcc arxl effect. License I 8z f-l,) It ?ts 1s1 CONSTRUCTION LENDING AGENCY I hcrcby allirm undc.r pcnalty of perjury that thcre is a construction lcnding agcncy for thc pcrlbrrnarrcc o[ thc work lbr which this pcrrnit is issued (Sec. 3097. Civ. C.). [-ender's Narrre: I-cnder's Addrcss: APPLICANT DECI,ARATION I ffiy aflirnr untlcr penalty of pcrjury one of the following dcclarations: Dcnrolition Pcrnrits-Asbcstos Notification Fcdcral Rcgulations (Title 40, Pan6) -Rcquired lrttcr of Ntxification _l ccrtily that thc l'cdcral rcgulations rcgarding asbcstos rcrmrval arc not applicablc to this projcct. stalc tlut lhc ahrvc information with all City antl County and County to entcr upon thc above rrrntioned pmpeny for Applicant or Agent Pcrnritcc C.- and nere: t/r/zc zo Site-Work Underoround Pole Bases Lisht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildins Under SIab / Floor Bondinq / Groundinq I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) lVleter Release Rough 1l Plaw Service Meter V\ A FINAL l'? 170 Dkv{5 7 Notes, Remarks, Etc.I Rev. 08-07-201 5