20470917 - Permit - Laserfiche WebLink

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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding I Grounding I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinss (Hard & Soffit Rouqh Ceilinss (T-Bar Rouqh) N/eter Release Rouqh 9,/r,/z t,R<-ts,V' =' /"t' Service Meter , 7/*/e)FINAL ruS,;te4.eS Af) 7aNotes, Remarks, Etc., OWNIiR BUILDER DEI,CARATION I hereby affirnt under penalty of perjury that I am exempt from the Contractors' License law for the following rcason (Sec.7031.5 Business and Profcssion Codc): Any City or County which requircs a pcrmit to construcl, alter, irnprovc, dennlish or repair any strucrure, prior to its issuance. also requires the applicant for such perntt to file a signed staternenl that hc or she is liccnscd pursuant to the pmvisions of thc Contractor's l,icenscd Law (Chapter 9. Commencing with Section 700O of Division 3 of the Business and Professions Code) or that lle or she is exempt therefrom and tlre basis for tlre alleged exenrption. Any violation of Seclion 7031.5 by any applicant for a pennit subjects thc applicant to o civil penalty of not morc than live hundrcd dollars ($5tttt). _1. a.s owner ol'the propcrty, or my clnployccs with wages as their sole compensalion, will do thc work and thc structure is not intenlal or offercd for sale (Sec'.704+. Busircss and hofessions Cqlc: The Contractor's Licensc l-aw docs not apPly to an owner of the properry who builds or improves tlrreon" and wlp does .suclr work himself or lrerself or through his or her own employees, provided that such irnprovenrcnts arc rnt intcndcd oroffered for sale. Il. howcver, tlrc building or irprovcrmnt is sold within one )aar of complctiorL thc Owncr BuiIJer will havc thc burden of pnoving ttrat hc or shc did mt buill or inrpmvc thc propaty for thc purposc of K8-:'ff Tii"JJ;?lffi ]il"Jl,:"ffr':x,;:iff [*;Tff :"J:ffiilfr lff If,,';::i'tr;lHl,[tril and who contracts for such projccts with a Contractor(s) licenscd pursuant to the Conuactor's License [.aw). _l anr exempt f I hcrcby affirnr undcr pcnalty of pcrjury onc of the tbllowing _l have and will nraintain a Certilicate of C<lnsent to Self-lnsure for workers'conqrcnsation, as provided fior by Section 3700 of thc Lahor Code, for the performarrcc of thc work for which the Srrmit is issued. _l have and will nraintain workers' conrpen.sation insurarr:e, as required by thc work for which this pcrmit is issucd. My workcrs' comlrcnsation insurancc Seclion 3700 of thc l-abor Code, for the perfornunce of carricr uxl policy number arc: Policy _l ccrtify that in thc prtbrnuncc of thc work for which this grcrmit is issucd, I shall not enrploy eny pcrson in any manncr so as to bccorne subjcct to thc workcrs' conrpcnsation laws of Califomia, and agrec that if I should beconrc subjcct to the workers' com;rnsation provisiorrs of Section 3700 of the Labor Code, I shall, forrhwith comply with those provisi<lns.. WARNING: Failure to secure workers'compensation coverdge i.s unlawful, and shatl subject an employer to criminul penalriesrand civil fines to oue hundred lhousand dollars (S in addition to the cost of comSrcnsation, danrages as provided for thc Scction Codc, intercst and >o I hereby affinn under ;rcnalty of perjury tlrat I ant licensed 9 (corunrencing with Section 7m0) of Division 3 of the Business and Professions Code. arxl my license is in full forcc arxl elTect. Licensc Numbcr: Contrector: CONSTRUCTION LE}IDING AGENCY I hcreby al'lirm undcr pcnalty of pcrjury that thcre is a conslruction hnding agerrcy for the Jrcrformance of the work for which this permit is issued (Sec. 3097. Civ. C.). [.cnder's Name: A PPI,ICANT DECLARATION I hrcby aflirnr undcr pcnalty of perjury one of thc folklwing declarations: Dcnxrlition Pernrits-Ashestos Notification Fedcral Rcgulations (Titlc 40, Pan6) -Rcquired lrtter of Notifrcation ,Z certity that rhc fcdcral rcgularions regarding asbcstos rcmoval ile not applicable to this prolxt. {rcertify tlrat I luve rcad this appticarion arl state rlrat thc ahrve informalion is corrcct. I agree to conrply with all City an<l County ordinances and Statc Laws rclating to construction.auttnrize reprcsentatives of this City and eotcr upoll ure ahrve rrrcntioned property for Applicant or Agent Pcrnritec nonrc u) -201 I t