20171496 - Permit - Laserfiche WebLink

Home Browse Search

ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE !D/S!G.GOMMENTS OWNER BUTLDER DELCARATION I hereby affm unds poalty of pejury that I m excmpt from thc Contraclor' Licre law for the following rwn,(Sc.7031.5 Buines md Profeion Codc): Any City or County which rcquirs a pomh to coNtruct, altq. improvc, donolish or repair ay structuc. prior to it$ issuilce, also requirB thc spplicet for such pcrmit to filc I signcd stalo@t thd hc or sltc is licm!€d pwant to the prcvisioE of thc Contractor's Licm*d l"aw (Chaptq 9, Commcncing with Setion ?000 of Division 3 of the Buines ud Prcfsions Code) or that he or shc is qmpt thqcfrom ed thc basis for thc allegcd cxmption. Any violation of Setion 7031.5 by dny applicantforspennitsubjctsthc applicmttoacivilpmltyofnotmorcthmfivchundrrcddollm($500). _1. &s owner of the property, or my employe'es with wages as their sole compensation, will do the work and the structure is not intcnded or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License l-aw does not apply to an owner of the progrerty who builds or improves thereon and who does such work himself or herself or through his or her own employces, providd that such improvernents are not intended or offered for sale. I(, however. the b,uilding or improvement is sold within onc year of complaion. the Owner Builder will have the burden of proving that he or she did not build or improvc the property for thc purposeof salc). _1, 3s owner of the prop€rty. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Business and Professbn 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) licorsed pursuant to the Contractor's Licensc Larv). _l am Section-, B. & o I hereby affrnn under penalty of perjury one of the following _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the perfonnance of the work for which the permit is issued. _l have and will maintain workers' compcnsation insurance. as required by Scction 3700 of the Labor Code, for the performance of the work for which this perrnit is issued. My workers' compensation insurance carricr and policy number are: Policy Number: Expires: _l certify that in the perforrnance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'compcnsation laws of California. and agree that if I should becorne subject to the workers' compensation provisions of Seaion -1700 of the t^abor Code. I shall. forthrvith comply with those provisions.. I WARNING: Failure to secure workers'compcnsation coverage is arrd civil fines up to one hundred thousand dollars ($100.000). in the attorney's fees. DECI.ARATTON I hereby affrrm under penalty of perjury that I am licensed under provision of Chapter 9 (commancing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Contractor: CONSTRUCTION LENDING AGENCY I hrcby allim undc pcnalty of pcrjury that thrc is a construabn lcnding agocy for thc po forec of thc work for which this pqrnit b issucd (Se. 3097, Civ. C.). lrnder's Name: Landcr's Addrcss: APPLICANT DECLARATION I horby affinn under poralty of perjury one of the following declarations: Demolition Permits-Asbcstos Notification Federal Regulations (Title 40, Par16) _Required Lrtter of Notification _l ccrti& that the fedc'ral regulations regarding asbestos ronoval ile not applicable to this project. _l certi& that I have read this application the above information is correct. I agree to comply with all City and County ordinances and State Laws relating to building upon the above mentioned property for Applicant or Agent Permitee nRme and hereby authorize representatives of Ze> Site-Work )a Underground c(h z -\ 7,t b Mrn. Pole Bases t\\\ Liqht Standards Spas, Pool, Fountains qvlrvt)\m Siqns (monument)lr lr Life Safety /Low Voltage Fire Alarm lDampers Communications Cable Buildinq Under SIab / Floor Bonding I Grounding / UFER 3^b Transformers \ Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Wails (Roush) Ceilings (Hard & Soffit Roush Ceilinqs (T-Bar Rouqh) Meter Release Rouqh Service Meter tl lr I I FINAL \LlLll'lf DWK' Etc. Rev. 08-07-2015 0wner:_4 ('lrrlicr':- Date:_ \