30141197 - Permit - Laserfiche WebLink

Home Browse Search

PLU M BING.I NSPECTOR RECORD APPROVALS DATE !D/SIG.COMMENTS OWNER BUI I.DER DELCARATION I hcEby afiim undcr pcmlty ofperjury that I m crcmpt from lhc Contraclors' Licmrc lrw for thc following rcasn (Scc.7031, Businc$ ard Profasion Codc): Any City or County which rcquiH r pcrmit to @nstrucl, alt6, imprcvc, dcmlish or rtpair any structurc, prior to its iismcq aLs rcquirca thc applicmt f(,r sch pcrmit to filc a signcd statcrcnt thst hc or shc is lienscd pumant to thc provkiom of thc Contrsctor's Liccns(d tas (Chaptcr 9, Comrcing wilh Sation 70fi) of Divishn 3 of thc Busine*r and Pmfcsions Code) or th.t hc or ihc is qcrlpt ttmfrcm ud thc b6sis for thc allcgcd cxmption. Any violatioo of Ss{hn 7031.5 by any applicantforapcmitsubj@tsthc applicsnttoscivilpcmltyofnotmrclhanfivchundrcddollam($500). _1, as owner of the pmperly, or my employees with wages as their sole compensation, willdo the work and ttre stnrcture is not intended or ofFered for sale (Sec.7M4, Business and Professions Code: 'l'he Conlractor's License Law does not apply to an owner of the proprty who builds or improves thermr\ and wtn does nrch work himself or herselfor through his or her own employees. providd that such improverncnts are mt intended or offerod for sah. l[, tnwever. thc huildtng or inprovement is sold within one ]car of conryrletion, the C)ryner Builder will have the burdcn of proving that he or she did rnt build or improve the property for the purynse of sale). _1, as owner of the property, am exclusively contracting with licensed conlraclors to construcl lhe project (Sec. 7044, Business and Profession Code: 'l'he Contractor's License Law does not apply to an owner of property who huilds or improves thereon, and who contracts for such pmjects with a licensed pursuant Contractor's License Law). -l am exempt under B. & P.C llris l)t,:('t.ARA I'loN I hereby alllrm under penalty of ffiury one of the fullowing declarations: _l have ard will maintain a Certificate of Consent to Self-lnsure for workers' conlpensation, &s provided for by Section 3700 of the Labor Code, for the perfonnance of the work for which the permit ls issued. _t have and will maintain wo*ers' compensation insurance, a.s required by Section 3700 of the Labor Code, for the performance of the work for which this permit is isnred. My workers' compensation insurance carrier and policy number are: -l cenify that in the performance of the work for which this permit is issued, I shall not employ any person in anyrnun*t so as to become subject to the workers'compensation laws of California, and agrce that if I stnuld become subject to the workers' compensation provisions of Section 37fi) of the Latnr Code. I shall. forthwith conrply with ttnse provisions.. WARNTNG: I;ailure to secure workers' compensation coverage is unlawfuL and shall a an employer to criminal penalties and civil fines up to one hundred thousand dollars ($addition to of darnages as the Section 3076 of the Latnr Code, interest and afiorney's ltd 16. (>{l{nq r)!.('t,Att^'t'loN I hereby affirm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force arxl effect. License Clas.s: License Number: Date:_('ottlr:tctor: c()NS t'Rtr(-t'toN t.[.NDIN(; A(;LNCY I hcby.fiirm under tEmltyof pcrjury th.t therc is I @[struciion hnding agcncy for thc pafommc of the mrk ft,r which this tHmit is issued (Sec. 3097, Civ. C.). Lender's Address: APPI ICANT DECI AITATION I hcrEbyaffirmunder penalty of perjury orrc of thc following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Requ ired Letter of Notilhatbn _l certify that the federal regulations regarding asbestos removalare not applicable to this project. -l certify that I have read this application and lhat the atnve information is correct. I agree to comply with all City and Counly ordinances and State Laws relating to hereby authorize representatives of this City and County to enter uPon the ah<lve mentioned property for ,rrr, O'C' 11Applicant or Agent Pernritee nanre UNDER GROUND Waste & Vent cllo rq ca*d,to Water-Under floor til,s-t re 949.* 7a: Gas-Underfloor Buildinq Sewer ArealStorm Drain I nterceptor/ Clarifier TOP OUT Waste & Vent Water Piping Gas Piping Roof Drain Tub/Shower Test Rough Water Heater POOL/SPA P-trap/Drain Line Main Drain/Pool Pipinq Fill Line/Back FIow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCap Back Flow Device I Rouqh Plumbinq .ol frNA{ Final Gas Test -l t \, Meter Release --1 FINAL \LT4 tlt (,[^f-r" earh I /.o>) Notes, Remarks, Etc.ur \-/ ,*", -8l1s ll{ Policy Number: ExPires: