40133169 - Permit - Laserfiche WebLink

Home Browse Search

MECHANICAL.INSPECTOR REGORD a APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hreby allim undc paalty of pa'jury thal I m cxmpt ftom thc Conl]sclom' Licen$ kw for thc following rcmn (Ss.7031.5 Busines and Profeion Codc): Aoy City or County which rcquirc a pamit to comtruct, dt6. imprcvq &rnolish or rcpair my stuctue. prior to its isumcc. also rcquirG thc eplicilt for such pcmit to filc I signcd stalmot thst hc or shc b licoscd pwatrt to thc provisiom of thc Cont sc!or'! Liccnscd [:w (Ch8pt6 9, Commmcing wilh Sction ?000 of Division 3 of thc Busirc trd PrcfsiomCodc)orthathcorshcisexmptthccfromedthcbGsisforthcallegcdaoptior Anyviol8tionofSetbnT0Sl.5byuy applicmtforapcmitsubjststhc applicaottoacivilpcnahyofmtmorcthafivchuncircddollus($500). -1, BS owner ofthe property, or my employees with wages as thcir sole compemation. will do the work and the strwture b not intcnded or offcrd for sale (Sc.7044, Business and ho ssions Code: The Contractor's License law does not apply to an owner of the property who hilds or improves thcron and who does such work himself or herself or through his or her own employees. provided that such improvanents are not intended or offired for sale. If, horverrcr. the building or improvemcot is sold within one )â‚¬ar of comptaion, thâ‚¬ Or,nner Buildcr will have the hrden of proving th,a he or she did not build or improve the propoty for the purposc of sale). \ -1. 0s owner ofthe property. am exclusively contracting with licersed contractors to construct the project (Sec. 7M4. Business builds or improves thereon,and hoftssion Code: The Contractor's License Law'does not apply owner of property who and who contracls for such rvith to the Conlractor's Licanse Law). _l am this reason. I hereb! aflirm under penalty of perjury one of the following -l have and will maintain a Cqtificate of Consent to Self-tnsure for workers' compensation, as pnovidcd for by Section 3700 of the Labor Code, for the performance of the work for which the pcrrnit b issued. I have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code, for the performance of the work for which this pennit is issued. My workers' compensation insurance carier and policy number are: PolicyNumber: Expires: _l cerrify that in the perforrnance of the work for which this permit is issued, I shall not onploy any person in any manner so as to become subject to the workers' compensation laws of California. and agree that if I should become subject to lhe workers' conrpensation pmvisions of Section 3700 of the Labor Code. I shall. forthwith cornply rvith those provisions.. h WARNING: Failure to secure workers' compensation is unlawful. and shall subject an â‚¬mployer to oiminal penahies and civil fines up to one hundred thousand dollars ($ln cost of provided for the Section 3076 [:bor Code. interest and fees. <-.- DECLA]TATION I hereby aflirrn under penalty of perjury that I am licensed under provision of Chapter 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full forcc and effect. License Class: Licerue Number: lloln. W I hreby affirm under penalty of psjury thar thqc b a construction loding agmcy for Ihc pcfommce of the rvork for which this pcmit is issued (Str. 3097, Civ. C.). Lender's Name. Lender's Address: ^ rr, ,c N, ""cI RA, I hereby affinn under penalty of perjury one of the following declarations: Demolition Permits-Asbcstos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notification -l ceiri& that the federal regulations regarding asbestos removal are not applicable to this project. -l certi& that I have read this application and that the above information is correct. I with all City and County and County to enter upon theordinances and State [:ws relating to above mentioned property for Applicant or Agent Penniter name and hereby Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors Installed Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type Il Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar i / Rough Mech //1 , /a'n I Z'tZ/a / Final Test fl Meter Release tl lt i FINAL t0llK/'to audta rf4w Notes, Remarks, Etc. ? Contractor: *.", *-?l/