30137524 - Permit - Laserfiche WebLink

Home Browse Search

APPROVALS DATE ID/SIG. UNDER GROUND Waste & Vent ~, z, 1,7 Water-Under floor I i Gas-Underfloor Building Sewer Area/Storm Drain Interceptor/ Clarifier TOP OUT Waste & Vent Water PipinQ Gas PipinQ Roof Drain I I Tub/Shower Test Rouah Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipina Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back Flow Device Rough Plumbing Final Gas Test Meter Release FINAL Notes, Remarks, Etc. PLUMBING-INSPECTOR RECORD COMMENTS OWNER BUILDER DllLCARATION ., I hereby :1flir111 un der penall y of perjury 11ml I am exempt from 1hc Con1rac1ors · License Law for the foll owing r~:1so11 {Scc.7031.5 Business and Pro!Cssiu n Code): Any Ci ty or Count y wh ich requi res .i per mit to cnns!nH:I. allc r. im prn Yc. dcmoJi·;h or rcpaii any structure. prior to ils issuance. a lso require s the applic.1111 for such permit lo tile ;.1 s ig.ncd st:11i.:mcn1 tlmt he or she is li L·cnst:d ,pur:!uant to the rrovisio ns o r 1hc Con1rnctor's Licensed Law (C hap!cr 9. Commencing with Scc1 i o11 7(IOO of Divi sio n 3 o f the Husincst and Profe ssions CodcJ or 1ha1 he or she is exempt l herefrom a nd 1hc ha si.s for the :1 lleged exempt io n. Any vio lat ion of Section 703 1.5 by any "11""' tor a pe rmi t subjects the applica11t to a civil pe11alty u f 1101 mor e tha11 live hu11dred dullars (5500), \ I. us owner of1hc prope rt y. or 111ycmployccs wi1h wages as 1hc ir so le compcnsut ion. will do the work atKI the strncturc is not i111cndcd or ortC red fn r sa le (Sec. 7044. Bu siness .1 11d Prufossions Code: The Crn 11ractnr's License Law docs 1101 apply tn ,111 owner of lhe property who builds or impro\'CS thereon. and who docs such work him se lf or he rself o r 1hrough his or her own emp loyees. provided thal such improvcme111s .ire not in tended or offered for sa le . If. ho\\'cvcr.1hc hu ild ing or irnpro\'cme111 is sold within one year of comp lei in n. the Owner llui ldcr will h;.1 ve lhe burden of prm1ing lh:it he or she did 1101 build or improve the pmpe11y ro r the purpose of s:Lle). _I. as owner of the prope rly. :un exclusively cnn!rnct ing with li censed crn1 trac1ors lu conslrncl the proj ect (Sec . 7044. Business a1Kl Pmfes~ion Code: The Conlrn ctor's License L.1w docs 11nl apply to an o\\111er nf properl y who huilds or i111 p rn,·es thcn:on. and who cont racts for suc h projects wi1h a Contrn c1or(s> llcc11se d pursu,.1111 to the Contractor"s Lic en~e La w). _I amcxcmpl under Sec li on, ________ . D. &~P-1/JYJlhis reaso n. IJnlc: • \) -\ -/ (,,., Owner:_:i.., ~ _ _,,_,___~~~---WO~l-lK-E-,R-,+A(d'(~)~~,1~P-E_N_S_A_T_l(-IN _____________ _ DECLAl!ATION I hereby affirm under pen:1l1y of perjury one of rhc following declara tions: _I h:.1\'C and w ill ma intai11 a Ce rt ificalc nfCnnscnt In Self-Insu re for workers· t..·0111pcnsatirn1. as pro\'ided for hy Sect inn .HOO of1hc L:1b<)r Cnde. for the pcrform:.uK"C oflhe wnrk for which the permit is issucll . _I luwe and will mailllain workers' cot11pc nsa1 io n in sur;mcc. a.!I re<1ui red by See l io n 3700 of the Labor Code. for !he perfor mance of the wmk fo r which I hi s pe rmi t is issued. My wo rker s· compcnsa rio11 insurnnce c;.1 rrier a nd po licy nu111 hc r arc: C:1rr ie r: ___________________________ _ Po licy Numbcr: _____________________ Exp ires: __________ _ ,di ccr1ify th,11 in the performan ce of the work for whic h I his permi l is issued . l shall not employ any person in :my 1m111 11cr so as to become subject 10 th e wnrkcrs' cnm pcns,11inn laws o r Californ ia. ~md agree that if I slum Id hcrnmc suhjc:ct lo the workers' compe nsation provisio ns of Sc:c1iun ]700 of the lahor Code. 1 shal l. for thwi th comply with those p nwisions .. WAR NING: f-'a ilure to sec ure wor ke rs' compen s.i1ion covera~e•~1s unl:n f1 I. and shall suhject ai1 c111 plnycr lo crimi nal penalties ;md civil lines up 10 one hundred lhousand do1\ars (SIOO.Uot)J. in addil i t e cos! n f co mpe11s.1l ion. damages as pmvich:cl for 1he Seel inn 3076 o flhe Lahor Code. intercsl and al\orne y"s fees. Date: • \'.L,-\ -l >? A1>1>lic:m1 :'1'-~---~~---------------- LI C EN SEI> CO NTRACTOR lJECL ARATHlN I here by aflirm under penalty of perjury I hat I am lice nsed under provision of Chapter 9 (co mme ncing with Sect io n 70UU) nf Di,,ision 3 of lh c Bu siness and Professions Code. and my license is in fu ll force and crtCe1. License Class: ______________ License Num ber: _______________ _ 0.-ite: ____________ Conlrnclor : _____________________ _ CONSTRUCTION LENDING AGENCY I hereby affirm unde r pem1\t y o f perjury that I here is a co11s1111c1ion lending agency for the pe rformance of 1he wnrk for whic h this permit is issued (Sec. ~097. Ci\'. C.). l ender's Name: _________________________ _ l cnd er"s Add ress: _________________________ _ APPLICANT DECLARATION I hcf'cby aninn under pc11ulty of perjury one of the follo wing declara tions: Dcnmlition Permits-As bes tos Not ification Federal Rc gula1io ns (Title 40. Par1 6) _Req uired Le11crof Notitica1 ion _I ce11ify 1ha1 the federal regulations regardin g ashcslos remn\'al arc 1101 applicable 10 this projccl. ordm.mce~ and St.tic Ll1ws rdttmg to hl1 ild1 n stn1c1 1on and hc1 ehy authom:c 1cp1e~cnra t1vcs of tlus C11 y a nd Counl) In en ter upon the 4 ~ ce111ty th ,H I h,1vc 1c,u..l !111s ,tpphc,t:i~1un ,111 state th.11 the alx1vc 111lonn.1tm 11 1s crnTect I agree to comp ly w1tl1 alt Ci ty ,111d Count y t--------------------1-------+------l-------------------l ,tbovc mentioned p1o pe1ty lur 111,;pcctmn p I s 1--------------------11-------+------+------------------~ Ap plkanl or AJ.,:enl S 1J.,:11.1lure: \tl. Dute • I l.. -{ -{ h Permitce name tprint):.~~~~--'~H:::A-t:1~~-tt=c+--\J~~----------------------