30142315 - Permit - Laserfiche WebLink

Home Browse Search

PLUMBING.INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OWNER BUILI'ER DELCARATION I hcrcby affrm undcr pmlty of ;rrjury that I m cxcmpt frcm thc Contracton' Licenr Law for thc ftrllowing rc&$n (Sd.7031.5 Businss ard Profession Codc): Atry City or County which rcquircs a pcmit to @trdruct, alta, impmvq dcmlish or rqnir any slructure, prk r to its issecc, al$ rcquircs thc applicant hr such pcmit to filc a signcd rtatcmml that hc or 3hc ii liccnsd pumant to thc pmvisioos of thc Contractor's Liccnsd Law (Chaptcr 9, Commercing with Sction 7000 of Divisioo 3 of thc Business and Pmfcssions Codc) or that hc or she is excmpt thcrefrcm 8nd t]rc b6iir for thc allcgc{ cxcmption. Any violation of Section 703 | .5 by 8ny applicant for a pemil sbjcts thc applic.nt to a civil pemhyof mt mE th6n fivc hundrcd dollars ($500). -1, as owner of the property, or my employees with wages as their sole compensation, will do the work ard the structure is mt intended or olferd for sale (Sec.7(X4, Busirrcss and Professions Code: 'l'he Contractor's License Law does not apply to an owner of the progrerty wtn builds or impmves therqrn, ard wtn does ruch work himself or herself or thmugh his or her own employees, provided that such improvernents arc rnt interded oroffeled for sale. l[, however, the building or irTrrovement is sold withinon€ ]tar of completion, th€ Owner Builder will lrave the burden of proving that h€ or she did mt build or impmve the propcrry for the purynse of sale). -1, as owner of the property, am exclusively contracting with licensed conlraclors to construct the pmject (Sec. 7M4, Business ald Profrsskln Code: The Contractor's License Law does not apply to an owner of property who builds or improves thercon, pursuant to thc Clonlractor's License Law).and who contracts for such projects with a -I I hereby allirm under penalty of perjury one of thc -l have ard will maintain a Certilicate of Consent to Self-lnsure for workers' conrpensolion, as pmvided for by Section 3700 of the Labor Code, for the performance of ttle work for which the permit is issued. -l have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the perfonnance of the work for which this permit is issred. My workers' compersation insurance carrier and policy number are: Carrier: Policy Number: Expires: a -l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner a so as to become subject to the workers' compensation laws of Califomia, and agree lhat if I stnuld become subject to thc workers' compensation provisions of Section 3700 of the Latnr Code, I shall, forthwith comply with tlnse provi.sions. . WARNING: I;ailure to secure workers' compensation is and shall subject an employer to criminal penahies and civil fines up to one hundred thousand dollars ($100,000),to the cost of compensation, damages as provided for the Section 3076 of the interest and h I hereby aflirm under penalty of perjury that I am licensed 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class: License Number: Contractor: W I hcrcby alfm under peultyof pcrjury that therc ir I onstruction lcnding agf,cy for thc pcftrmncc of thc work for uhich lhis trmil i$ Civ. C.). Lender's Address: APPLICANT DTCI ARA'TION I lrerebyaflimrunder penalty of perjury one of the following declarations: Denrolition Permits-Asbestos Notification l;ederal Regulat ions ('l'itle 40, Part6) -Required Letter of Notification r -l certi&that the federalregulations regarding asbestos removalare not applicable to this project. _l ceaify that I have read this all City and County ordinances and State Laws above mentioned property Applicant or Agent Pernritee nanle the , lrt tulxrn llrc UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Building Sewer Area/Storm Drain I nterceptor/ CIa rifier TOP OUT Waste & Vent Water Piping Gas Piping Roof Drain Tub/Shower Test Rough Water Heater POOUSPA P-trap/Drain Line Main Drain/Pool Piping Fill Line/Back Flow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back FIow Device Rough Plumbins Final Gas Test Meter Release t FINAL tl IltoYl,,t Dkrks,,I ,Notes, Remarks, Etc. l)ate: Name: