30141260 - Permit - Laserfiche WebLink

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APPROVALS DATE ID/SIG.COMMENTS UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Buildinq Sewer Area/Storm Drain I nterceptor/ Clarifier TOP OUT Waste & Vent I w{/ Water Pipinq tltqlxl f>A4rD6 Gas Piping tt J Roof Drain Tub/Shower Test Rough Water Heater POOUSPA P-trap/Drain Line Main Drain/Pool Piping Fil! Line/Back Flow Pool Heate/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary Sewer/Cap Back Flow Device Roush Plumbinq Final Gas Test Meter Release 1 trfl FINAL Sl r,W)I)INTVY .+{ D -4 Noteq Remarks, Etc.\\r\IZI I ,7 1n C (r> kr{tdA-W 7 u-I OWNER BUILDER I'ELCARATION I hcrcby allirm under p€nalty of psjury that I m excmpt frem th. ContracloB' Licmse Law for thc f<rllowing @eo (Sc.?031.5 Busin6s ard Prcf6sion Codc): Any City or County shich rcquim a pcmit to @[drucl, aho. impmrc, dcmlish or rcpair any struclurc, ttrior to itr irsancc, als rcquiH the qrplicant for sch pcmit to ,ile a sigrcd statemil that hc or slE h liccnred pumanl to the pmvisions of th€ Conlractd's Liccn*d Law (Chsptcr 9, Commcncing with Sstion 7fi)0 of Divi8ion 3 of thc Busincss ana Pmfcssions Codc) or that hc or shc is exempt thmfmm snd thc horis for thc allcgcd cxcmption. Any violation of Scction ?031.5 hy any applicant for a Jxmit sbjcts th€ applicail to I civil pcnalty of mt mrc than firc hundrc<l dollars (15fi)). -1. as owner of the property, or my employees with wages as their sole compensalion, will do ttre r/r,rt and the structure is rrtt intended or offered for sale (Sec.7M4, Business and Pmfessions Code: '[he Contractor's License Law does not apilfy to an owner of lhe prop€rty wtn builds or inqrmves thermq and who does such wnrk himself or herself or through his or her own employees, provided that such improvcrrrnls are rnt intcnded or oflered for sah. l[, however. the btrilding or improvernent is sold within one ytar of comphtion, the Owner Builder will have the burden of pmving that he or she did rnt build or improve the proprty for the pur;nse of sale). _1, as owner of the propcrty, am exclusively contracting with licensed conlractors to construct thc project (Sec. 7M4, Business and Proftssion Code: 'l'he Contractor's License Law does not apply to an owner of property who builds or improves lhereon, and who contracts for such pmjects with a Contracto(s) licensed pursuant to the Contractor's License Law). -lamexemplurrderSection-,B.&P.C.forthisreason. I ):rl r. ( )rr rrcr' WORKERS' CONT PENSA'I'ION DECLARA'I'ION I hereby affirm under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' conrpensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which the permit ls issued. -l have and will maintain workers' compensation insurance. as required by Section 37fi) of the Labor Code, for the Frerfonnance of the work for which this permit is issued. My workers' compensation insurance carrier and plicy number are: Policv Number: Exnires: _l certify that in the performance of the work for which this permit is issued, I shall not employ any person in any nlanner so as to become subject to the workers' compensation laws of California, and agrce that if I stnuld trcome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith cornply with ttnse provisions.. WARNING: l;ailure to secure workers' compensation coveraEie is unlawful, and shall subjecl an employer to criminal pnalties and civil fines up to one hundred thousand dclllars (S100,000), in addition to the cost of compensation, damages as provided for the Section 3076 the Code, interest ll'cs 4r\Rc I hereby aflirm under penalty of perjury lam 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full ltrrce and effect. l.rcense I hereby allirm under penalty of perjury issued (Sec. 3097, Civ. C.). agency for the perfonnance of the work for which this permit is Lender's Name: APPI ICANI' DE,CLARA'I'I()N I lrc-rebyaflinnunder penalty of perjury one of the follor+'ing declarations: Dernolition Permits-Asbestos Notification l;ederal Regulations ('l'itle 40. Part(r) -Required l.elter of Notification PLUM BING-INSPECTOR RECORD ( 81 S q Date: 4 LZ .zo\3 Lender's Address: