40335113 - Permit - Laserfiche WebLink

Home Browse Search

M ECHANICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG,COMMENTS OWNER BUILI'ER DELCARATION I haeby affm undq paulty of pCjury thd I m qcmpt from tlE ContnctoB' Licms kw for thc followitrg ren (Se.7031.5 Buine ard Profcssioo Codc): Any City or Coutrty which rcquie a pcrnit to corutruct. alt6, imprcvq &rnolish or npah my structuq prior to its ismc also requirc thc appticet for such pcrmit to tilc a signcd ststmat tha hc or slrc i: licosc{ pwam to thc prcviEioN of thc Contrstor's Licnscd L:w (ChaptE 9, Commcing with Setion 7000 of Division 3 of thc BusiB ud Prcfeioro Codc) or that h€ or shc is qmpt thqcfrom ad thc b6sis for thc allcgcd qmption. Any violation of Sction 703 1.5 by my applicant for a pcrnit subj*ts thc applicant to a civil pcmlty of mt morc thm five hundrtd dollm (5500). -1. as owner of the property, or my employe$ with wages as their sole compensation. will do the rvork and the struciure is not intended or offcred for sale (Sec.70l4, Business and Professions Code: The Contractor's License Law does not apply to an owncr of the pnoperty who builds or improves thereon and who does such work himself or herself or through his or her own employec. provided that such improvancnts are not intcndcd orofferod for sah. I(, hower/er. thc hrilding or improvernent is sold within one )car of complaion, the Orrner Buikder will have thc burdcn of proving thd he or she did not build or improve the property for thc purpose of sale). h* as owner of the property. am exclusively contracting with licenscd contractors to construcl the project (Sec. 7044. Busincss Profession Code: The Contractor's License Law does not apply to an own€r of property who builds or improves thereon, who contracts for such projects with a Contracto(s) licersed pursuant to the Contraclor's License Law). _l am & P.C. for this reason. ?O owner: )- il'o n[gBctx r pr:rr snr I o n_F_ // pECLARATION t'uttnrfi nf -.-lo*ti.*r, I hereby allirm under penalty of perjury one of the -l have and will maintain a Cerrificate of Consent to Self:lnsurc for workers' contpensation, as provided for by Section 3700 of the tabor Code for the pa'formance of the work for rvhich the perrnit is issued. -l 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 permit is issued. My workers' compcosation insurance carricr and policy number are: Policy Number: E.tpires:I ftl ceniry that in the pcrformance of the work for rvhich this permit is issued. I shall not ernploy any person in any manner $ as to become subjcct to the workers'compensation laws of California, and agree that if I should become subject to the llorkers' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvith cornply with those provisions..I WARNTNG: Failurc to serure workers' compensation coverage is and civil fines up to one hundred thousand dollars ($100.000). in to the Section.3076 Code. interest and attorney's fe'cs. 2)? I hereby alTirm undcr penalty of perjury that I arn licensed 9 (commencing rvith Section 7000) of Division -3 of the Business and Profissions Code. and my license is in full force and effect. License Class: License Number: W I hmby alfim unds penalty of pqjury that th6c is a construction landing agorcy for the pqfomercc of thc sprk for Nhich this FHrnit is issued (s6. 3097. civ. c.). Lender's Name. Lender's Address: ,r,.rc Nr rr"ct RAr-tnn I herfuffirnunder penalty of perjury one of the follorving declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notilication all City and County above mentioned prop€rty for inspection Applicant or Agent Pennitee name upon the Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation Insulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer Residentia! Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test n Meter Release FINAL la-\+ 410 R \S.,it ) Notes, Remarks, Etc V \\) oate: [l I Carrier: Date:_(lontractor:_ ln\ \