30141973 - Permit - Laserfiche WebLink

Home Browse Search

PLUMBI NG.INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OlVNF,R IIUILDER DEL(:ARATION I hercby affirrn undo penalty of perjury thal I iln exempt from the ContractoE' l,icose l-as' for the follo|ing reasn (Se.703 1.5 Businqs and Profcsion Codc): Any CiIy or County rvhich re<pirs a ponil to conslrucl. altq. improve. dmolish or repair any structure. pior to its issuance. also rcquirs lhc applicill for such ponit to filc a signed staternot that hc or sh. is licilsed pursuanl lo lhc prclisioE of the Contractor's Licensed larv (Chapts 9. Comnrencing lvilh S(tion 700O of Division 3 of the Businss ud ProfcsionsCode)orthath€orsheisexemptlhqcfromandthebasisforthcallegcdcremplion. Anyviolalionofsction?03l.5hyan! applicant for a pmtrit subjels thc applicant to a civil penaltyofnot morethan live hundred dollars ($500). rLY ,-I. as osnq o[lhe proply. or my employe rvith rvags as lhcir relc corrpcmalion. lrill do lhe wo* ild the $ru1w is not intmdcd or ollsed for slc (56.7044. BrBins and hoF6sions Codq The Contractor's l-icose Larv doo not apply to an ownq of - lhe [roIE ty who buil<h or imJrorc th6an. ild vho do6 such \ort himselfor heEelfor threugh his or her osn cmployeB. providedlhatsuch imrol,mfllsilcmlintodedorolltrqlfor*le. lf.hoNc\a,thehuildingorimSrcr,mtissldrvilhinonc,@ ofcornplc,tion. Ihe Orvner Builda will havc the hrds ofprovinS thd he or she did not lilild or improvc thc pmpdy for thc purlns of ele). -1. as owner of the prop€rty. am exclusively contracting with licensed contractoni to construct the project (Sec. 7M4. Business and hofession Code: The Contractor's License Law does not apply to an orvner of propcrty who builds or improves thereon. and who contracts for such projects with a Contracto(s) liccnsed punruant to the Contractor's License l-arv). _l am under B. & P.C this b I hereby affirm under penalty of perjury one of the follorving -l have and will maintain a Cettificate of Conscnt to Self-lnsure for workers' compersation. as provided for by Section 3700 of the Labor Code, for the performance of the 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 pcrformance of the rvork for which this permit is issued. My workers' compensalion insurance carrier and policy number are: Policy Number:_Irrllircs: Kt certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workcrs' compaxation laws of California. and agrce that if I should become subjcct to the workers' compqsation provisions of Section 3700 of the labor Code. I shall. forthwilh comply with those provisions.. WARNING: Failure to secure rvorkers' compensation coverage is unlawful. and and civil lines up lo one hundred thousand dollars ($100.000). in Section 3076 of the labor Code. interest and attorney"s fees. to the the \ I hereby affirm under pcnahy 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 and effect. License Class:- _-License Number: l)irle: ('oltlr:rclrlr. CONS'TRUCTION LENDING ACENCT' I hqeby affinn undd penaly offsjury lhat thqe is a constuclion hnding agcncy for lhe pofonlance ofthe rvork for s'hich this pstnit b issued (Ss. -1097. Civ. C.). Lender's Name: Lender's Address: A PPLICANT DECI,ARAI'ION I hereby affrrm under penalty of perjury one of the follos'ing declaralions: Dernolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Parl6) _ _Required I.etter of Notification - _l ccrtify that the federal regulations regarding asbestos rernoval are not applicable to this project. t?AJ cerlify that I have read this application and statc that the atxrve infonnation is con'ect. I agree to cornply rvith all City and County ordinances and State Laws relating to construction. and hereby authorize represextatives of this City and County to enter ugxln the above mentioned property for insgrection n" otl ,tJf utaApplicrrrt or Agent Perrrrilce nRme (print): 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 POOL/SPA P-trap/Drain Line Main Drain/Poo! Pipinq Fill Line/Back FIow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCap Back Flow Device Rough Plumbing Final Gas Test Meter Release tl ,tl r') FINAL Notes Re Etc. ( )rvrrer: Carrier:- on", oL I e.b (Lp >o _ Applicant:_ Va\)