20170729 - Permit - Laserfiche WebLink

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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I heeby affrm unda penalty of perjury that I m cxmpt 6om the Contriltots' Licere Law for thc followitg wn (56.7031.5 Businos ad Prcfesion Codc): Any City or County which rcquira a pornit to sngruct. alta, improvq danolish or rcfnir uy structue. prbr to its isswce. also rcquirs thc applicmt for such pcmit to filc I signcd stalflat that hc or slrc b licosed plNst to thc prcvbioN of the Contmctor's Licensed [:w (Chapt6 9. Comocing with Setion 7000 of Divigion ] of the Busine md Prcfesions Code) or that hc or shc is excmpt thrcfrom md the basis for thc allcged exmption. Any violation of Scrion 7031.5 by uy spplicot for I pcrmit subjets the applicant to I civil p@[ty of not morc thm fivc hundrcd dollm ($500). _1. as owner of the propcrty, or my employees with wages as their sole compensation, willdo the rvork and the struclure is not intended or offcred for sale (Sec.7044. Business and hofessions Code: The Contractor's LiceIEe Law does not apply to an owner of the property who builds or improves thereoru and who docs such wort himself or herself or through his or her own employees. providd that such improvcrnents are not intended or offered for sah. If. howevcr. the building or improvement is sold within one )€ar of complaion, the Orvner Builder will have the hrden of proving tha hc or she did not build or improve the property for the purposcof sale). _1. as owner of the prop€rty. am exclusivcly contracting with licensed contractors to construct the project (Sec. 7O14. Business and Proftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves ther@n, and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Law). -l arn exempt under Scction-, B. & P.C. for this reason. O*ner. WORKERS' COMPENSATIM DECLARATION I hereby affrm under penalty of perjury one of thc following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as providcd for by Section 3700 of thc Labor Codc for the performance of the work for which the perrnit is issued. _l have and will maintain worketrs' compensation insurance. as rcquired by Section 3700 of the L^abor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: r Ahert1en Tttrtcu tl / r/zcaiPoricyNubo,' \./C;OqbolS Expires:- _l certi$, that in the performance of the work for which this perrnit is issued. I shall not ernploy any person in any manner so as to becornc subject to the workers' compensation laws of California. and agrec that if I should becorne subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall, forrhwilh cornply with thosc provisions. WARNING: Failure to secure workers' compensation coverag,e is unlawful. and shall subject an onployer to criminal penaltics and civil fines up to one hundred thousand dollars ($100.000). in addition to thc cost of compensation. damages as provided for the Section 3076 of the Labor Code. interest and attorncy's fees. ,r,u, . l^ 2 -41 -?o/o ^--,r^^-..y'Y) a,n I e(Inq rcc 5 LTCENSED CONTRACTOR DECI.AITATION t hereby affrm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Codc, and my liccnse is in full force and effect. License6,urr', C(O LicenseNumbcr:a qf 37 r+ oarc, t 7 -7- 2 o? cs Contrector:* VfVrrrl. I So@r W I hmby affm undo pcoalty of pcrjury thst th6c is s con$ruction loding agocy for thc pqfomcc of thc work for which this pqmit is isucd (Sc. 3097, Civ. C.). knds's Nmc: kndcr's Address: I\ I'Pt,ICAN'I' I) EC L'\RA'I'ION I hffiby affinn under panalty of perjury one of the following declarations: Dcmolition Pcrmits-Asbcstos Notification Federal Regulations (Title 40, Part6) -Required [rtter of Notification _l certify that the federal regulations regarding asbcstos removal are not applicable to this project. Ilt cqtitythat I have read this application and state that the above information is conecl. I ordinances and State Laws relating to building construction. and lhe above mentioned properly for inspection purposes. Applicant or Agent Pernritee nflme '-2cs? - Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire AIarm I Dampers Communications Cable Buildins Under Slab / Floor tr lr I Bondinq I Groundinq / UFER { Transformers ll Torqueing Sub-Panels Air Conditioners I \t t\t t AI Roof Top EquipmenlU\fty Y(YLULU U,}\\H,k-rro Factory Wired Unit I Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) Meter Release Rough Service Meter I\\A FINAL W\l?tY7{ Notes, Remarks, Etc.I Y -) Rev. 08-07-2015 t( I Vqfqer> -t! 'mY)n'I>tr;ulopfi f,M