30137478 - Permit - Laserfiche WebLink

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APPROVALS DATE ID/SIG. UNDER GROUND Wast e & Vent Water-Under floor Gas-Underfloor Building Sewer Area/Storm Drain - Interceptor/ Clarifier TOP OUT Waste & Vent Water Piping Gas Pipinq Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipinq 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 IIUILllER DF:LCARATION I hereby affirm under penalty of pe1ju1y that I run exem pt from the Contrnctors· Li cense Law for the followi ng rl!nson (Sec. 7031.5 * Business and Profession Code): Any City or Cou111y which requires a permit to constmct. alter. improve. demoli sh N repair any s tructure. prior to its issuance. also requires the applicalll for such permit to file a signed statcmenl that he o r she is licc11scd pursuant lo the provis ions of the C'ontrnctor's Licensed Lnw (Chapter 9. Commencing with Sectio n 7000 of Div ision _, o f the Business and Professions Code) or tha1 he or she is exempt 1herefrom and the basis for the nllcgc<l exemption. Any violatio n of Section 70] 1.5 by any ~ applicmu for a penn it subjects the applicant to a civil penahyof not more than ri ve huncll'ed dollrin; ($500). _I, as owner of the propc1t y. or my employees with wages n~ their sole compensation. will do the work and the strm:turc is not intended or offered for s.-1.lc (Sec.7044, Business and Professions C'ode: The C'ontrnctor·s License Law docs no t .ipply 10 .in owner of the pmpeity who builds or improves thereon. and who docs such work himself or herself or th rough his or her own employees. provided that such improvements are nol intended orofft..,-t..'U for s.-1le. If. however. the buikling or im1}rovement is sold with itl one year of completion. the Owner Builder will have the burden of pro\'ing tlmt he or she did not build or irn pr·o,·e the propc11y for the purvose of sale). _I. as O\vnt::rofthe propctty. am exclusi,1ely contrnc1ing with licen!.ed contractors to conslruct the project (Sec. 70.M. rl11s iness .ind Profession Code: The Con1rnc1or's License Law does not apply 10 nn owner of properl y who builds or impnwr.:s th r.:rcon . .ind who contracts for such projects with a C'ontraclor(s) licen sed pursuant 10 the Con1 rn c1or·s Li cc11se Law). _I am exempt under Section ________ . B. & r .C. for this re:-isun U:llc : __________ Owner: _______________________ _ WOIU<ERS' CO,\I l'ENSATION DEC L ARATION I hereby affirm under pctmltyof pcrjury one of1l ,e fo llowi11g dcclarntinns: _I have and will maint ain a Ce11ilicnte of Consent to Self-Insure for workers· compens~11 io n. ns provided for by Sect inn .noo of the Labo r Code. for the perfonmmce of the work for which the permit is issued. _1 ha ve and wil l nrnin ta in workers· compensn ti on insura nce. ns required by Sect ion ., 700 of the Ln bor Code. for 1hc pt·rfon nance of th e work for which this pennit is issued. M y workers· compcnsntion ins urnnce caiTicr mid policy number are: Ca11icr: )j ....5",o:J:N,,( "-:J: /1..s. Po licy Number:~ 1:;-lJ_Q_~7 __ i _/_"7_7~~/ ________ Expires : _I ce1til)' 1ha1 in the pcrlOnnance of the work for which this permit is issued. I sh.ill no t employ ;rny person in nn y mmmcr so as 10 become subject to lhc workers' compensal ion lnws ofCnlifornia. a nd ag ree that if I should become subject tu the workers' eompcm.atio n provisions ofScc1ion 3700 o f the Lnbor ('ode. I shall. fm1 hwith comply with t hose pro\"isions .. WARNING: Fai lure to secure workers' compensation rnvcrng.c is un lnwful. an d shall subject an employer to '-,·i111 i11:1l 1ximhics and civil tines up to one hundred thousand dollars ($100.000). in addi 1ion 10 the cost of compensation, Ja1 11agcs as pm\'illed for the Section 3076 of the Labor Code. interest nnd attomcy·s fees. ~ ... ~ Date: ___________ A1>1>lic.1nt:i •~;/~= /?,~ --~cr.-~,-~-~=::=---------- LIC:El"Sn-·oNTR-v'TOR IV◄ 'I A (tA'.ffl)N I hereby affirm under penalt y of perjury th at I run licenselunder r><1'vlsion of Chapter 9 tcommcncing with Sect ion 7000) of Divis ion 3 of the Business and Professions Co<le. and my license is in full force and effect. License Ckiss: ______________ ,Liccnsc Nur::;nbc~·e."..---------------- Dalc: ___________ Co nlraclor:_}_P(~i.~:=_~_,A<'.'.'.':::::::_:~__..-;:;?:;;;::;~::..,,C:::::::==::::------ CONSTIIUC~~GENC\0 I hereby affi rm under pcnnlty of pe1juiy 11ml there is n constn1ct ion lending .ig.cncy for the pt.i·fonmmce oft he work fo r which I his pL·nnit i.-. issued (Sec. 3097. C'iv. C'.), Lcndcr·s Name: _________________________ _ Lender's Address: _________________________ _ A rrLICANT DECLARATION I herebyaffim1 under penalt y of perjury one of t he following dcclarnt ions: Demolition Pcrm it s~Asbcstos Not ification Federnl Regu lations (Title 40. Pm16) _Required Letter of Notification _I cet1ify 1lrn1 the fcdernl rcg ulnlions regarding asbcs1os rcmovnl nre 1101 .ipplicnble to this project. _I CL.11ify that I have read this application and state that the alxwc info rmatiun is co n-ect. 1 agJ cc to comply wi lh :-i ll Ci1y nml Counly 01dmanccs and Strite Lm\S 1clatrn g to bu 1ld 111g constrnctmn. mid he1eby <wthonze 1ep1ese111.i11,cs ofth1s C'1ty aml Coun ty lo e111 er upon the above men11011ed p1ope11y for mspect~oy"puq;,~ . Appl1 c,mt or Age nt Signnl u re: f'.!./' / ~~ Da te // ... / 6 · / 6 Pcrmilce name (IH'int): ~ er~ ~L/ Lrl.LLt;,· "f---'''-'·,_,rc.._ __________________ _ / / J