20172180 - Permit - Laserfiche WebLink

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ELECTRICAL.! NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Liqht Standards Spas. Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm I Dampers Communications Cable Buildins Under Slab / Floor Bondinq I Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release Rough Service Meter I .\ /Z/,b/zaFINAL ,t/ / Notes, Rernarks, Etc./a OWNER BUILDER DEI,CARATION I hscby alfm undo pmalty of pcrjury that I m exmpt ftom thc Contmclon' Licme Law for rhc following Itmn (Sc.7031.5 Buines and Profsion Code): Any City or County which rcquirs a pomh to construcl, alto, improvc, dmolish or rcpair my strucluq prior to its isumcc, also rcquirc thc applicilt for such pcnnit to filc I signcd stslmmt that he or sltc is licoscd plllsmt to thc provisioru of thc Contractor's Licqscd ttw (Chapt6 9. Comacing with Sction 7000 of Division 3 of thc Buins ild Prcfsions Codc) or that hc or shc is umpt thscfrom ed thc basis for thc allcgcd qmBion. Any violation of Setion 7031.5 by my applicet for a pcrmit subjcts thc applicant to a civil pcmlty ofnot morc tha five hundrcd dollm ($500). _1, s om6 of the pIopsty. or my cmployG with wag6 6 their mlc compemation, will do thc work ad thc stnrctw is rot intodcd or oflqcd for ele (56.7(x4, Buitre ud Profsiom Code Thc Cootractor's Licffi tlw do6 not apply to u omo of thepropqty whotuildsorimpovctluoo.ddwhodo6swhwd(himsclforhmlforthrcughhisuh6omcmploycc, providcd that such imptomts rc rct intodcd or offsod for slc. lf. how6. thc buiHing or imprcmt is $H within onc )E of mmplction, ttr Owns Buiklr will harc thc btrda of proving thd lrc or shc did mt tuild or impovc rhc popcty for thc ptrpo* of sle). _1. as owner of the property. arn exclusively contracting with licensed contraclors to construct the project (Sec. 7M4. Business and hofcssion 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) licensed pursuant to the Contractor's License l,aw). -larnexcmptunderSection-'B.&P'C.forthisreason. Date: WO RKER.S' COMPEN SATION DF'CLARATION I hercby affrm under penalty of pojury one of thc following declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for workcrs' compensation. as provided for by Section 3700 of the I-abor Code for the performance of the work for which the pcrrnit b issued. have and will maintain workers' compensation insurancc, as required by Section 3700 of the Labor Code, for the performance of the work fq which this pennit is issued. rwYvlt(An My workers'insurance carrier and policy number are:?v luPolicy\\I \ Lf ."rti5, that in the performance of the work for which this permit is issued. I shall not emptoy any person in any manner so as to become subject to the workers' cornpensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall, forthwith comply with those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an to criminal penalties and civil fines up to one hundred thousand dollars in addition to the cost of as provided for the Section 307Q of the Labor Code. interest o 121 ILO and t I hereby affirm under penalty of perjury that I arn licensed provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and rny license is in full force and effect. License C\D Nurnber:1b151z oate' \D V ar W I h6cby amm und6 pcnalty of pcrjury thrr thqc is 8 @Ntruction landing agocy for thc pqfomucc of thc mrk for which this pqmil b issued (Sâ‚¬. 3097, Civ. C.). Lender's Name: Lender's Address: APPLTCANT DECLARATION I hereb,, affinn under penalty of perjury one of the following declarations: Demolition Permits-Asbcstos Notification Federal Regulations (Title 40. Pan6) -Requ ired Later of Notification cotify that the federal regulations regarding asbestos rernoval are not applicable to this project. certify that I have read this and state that the above information is correcl. I agrec to comply with all City and County ordinances and State laws relating to representatives of this City and above rnentioned property for Applicant or Agent Permitee name construction. and ^-.^. \t County to eptcr upon thc ir:. lzu Rev. 08-07-2015 Licerue