30141407 - Permit - Laserfiche WebLink

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PLUMBING.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hacby aIfirm undo pcnalty of pcrjury that I m cxcmpt ftom thc Conlnc{oB' Liccffi t w for thc following rcmn (Sc.703 1.5 BusinB and Prcfsion Codc): Any City or County which requirc a pcrnit to mnslruct, alta, impovq rlrnolish or rcpair my structuq prior to it3 bsuucc, also rcquiro thc applicut for such Fmit to filc a signrd stdmat th8t hc or slE b licascd pwusil to the prcvisioN of thc Contmctor's Limscd Law (Chapts 9, Comocing with Sction 7000 of Division 3 of thc Buins md Profmions Codc) or that hc or shc is exmpt thccfrom md thc bssis for thc allcged cxmption. Any violation of Scrion 703 I .5 by my applicaot for 8 psmit subj(ts lhe applicaot lo a civil pcnally of rct morc lhe live hundrcd dollm ($500). -1. as owner of the property, or my employees with wages as their sole compensation. will do the work and the struoure b not intqrded or offoed for sale (Sc.7O44. Business and hofessions Code: The Contractor's License Law does not ryply to an owner of the property who builds or improves theron. and who docs such work himself or herself or through his or her own employees. provided that such imprrovoncnts are not intended or offercd for sale. lf, however. the building or improvanrcnt is sold within one )€ar of complaion, the Orvner Buildcr will have thc burda of proving ilra he or she did not build or inprove the propcrty for the purposcof sale). -1. as owner of the propcrty. am exclusively contracting with licensed contractors to construct the projecl (Sec. 7044. Business and hofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Contracto(s) licerued pursuant to the Contractor's Licerse l-aw). -l am exempt und6 Section-. B. & P.C. for this reason. ()rvncr: \1'ORK Elts' ('()1\t I'tiNSA',il()N t)1:('l.AIL\ l'l()N onc oIthc [ollos irrg rlcclarations:I hercby affirm under penalty of perjury -l have and will maintain a Certifrcate of Consent to Self-lrulure for workers' compensation. as provided for by Section 3700 of the Labor Code, for the pcrformance of the work for which the pcrmit is issued. _l have and rvill maintain u'orkers' compensation insurance. as required by Section 3700 of the Labor Code. for the pctformance of the work for is issued.rvorkers'insurance carrier and policy numbcr are: Policy Exoires: __l certify that in the performance of the work for which this permit is issued. I shall not onploy any person in any manner so as to become subject to the workers' compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section -1700 of the labor Code. I shall. forthwilh cornply with those provisions.. WARNING: Failure to secure workers' cornpersation covemge civil fines up to one hundred thousand dollars ($100.000). in is unlarvful. and shall subject an anployer to crirninal penalties and addition to of firyded forthe Iattorney's fees. I hereby affrrm under penalty of perjury that I am licensed ( 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and rny license is in full force and effect. License C 0c3 Number: zs3 ('onlrRclor: W I heby alfm unda Fulty of pcrjury thrt thqc is 8 @nstruction lcnding agacy for thc pcfomacc of thc work 6r wNch lhis p6mit b issued (Sec. 3097. Civ. C.). Lender's Name: APPLI('ANI' DEC LARA'TION I hoeby affrnn under penalty of perjury one of thc follos'ing declarations: I)ernolition Pcrrnits-Asbeslos Notification [:erleral Regulations ('l'itle 40. l'art6) _Required I.etter of Notification -l certify that the federal regulations regarding asbestos rernoval are nol applicable to this project. -l certify that I have read this application and state that the above information is correct. I agree to cornply with all City and County ordinances and State [-arvs relating lo building City and Countylo cnter above mentioned prop€rty for inspection Applicnnt or Agent hereby aurho@ihis lhe UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Building Sewer Area/Storm Drain I nterceptor/ Cla 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/Pool Piping Fill Line/Back FIow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCap Back FIow Device Rough Plumbing Fina! Gas Test ?-ltl- ?^o A---l I rr'r Meter Release FINAL Notes Remarks Etc. ln >r"'{ n) ?t, i Section 3076 /o Lender's Address: uPon Dnle:b/il 7