40133321 - Permit (2) - Laserfiche WebLink

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I hreby affm undc pdalty of pqjury thd I m cxcmpt ftom thc Contrclo6' Liccnr [:w for thc following rcen (Sa.7031.5 Buinss ud Profeion Codc): Aly City or County which rcquis a pomit to onsruct, altq. improvg &rndish or rcpair my strucluc, Fior to ils issuocc, also rcquirc thc qplicet for such pemit to 6lc a signcd statmt thar hc or slE is li@sed pwari to the provisions of thc Contractor's Licensed l-aw (Chapter 9. Commencing rvith Section 70@ of Division 3 of the Business Professions Code) or that he or she is exempt therefrom and the basis for the alleged exanpion. Any violation of Secrion 7031.5 by applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001. -1. ds owner of the property. or my employees with wages as their sole compensation. will do the work md the sructtne b not intended or offered for sale (Sec.7M4, Business and hofessions Code: The Contraclor's License Law does uot apply to an owncr of the propcrty who builds or improves theroru and who does such wort himself or herself or through his or her own employees. provided that such improverrcnts are not int€nded oroffered for sale. I[, however. thc building or improvanent is sold within one ]€ar of complaion, the Orvner Buildo will have the hrden of proving thd he or she did not build or improvc the property for the purposcof sale). -1. as owner of the prop€rty. am exclusively contracting with licensed contractors to comtruct the project (Sec. 7U4, Brsiness and hoftssion Code: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Licerse Law). -l arn exempt under Section-. B. & P.C. for this reason. WORKERS' COMPENSATION DECLARATION I hereby affirm undcr paralty of pcrjury one of the following declarations: -l have and will maintain a Ccrrificate of Conscnt to Sclf-lnsure for workers' conrpensation, as pnovided for by Section 3700 of the Labor Code. for the pcrformance of the work for which the pcrrnit is issued. -l have and will maintain workers' compensation insurance. as required by Section 3700 of the labor Code, for the performance of the work for which this permit is issued. My workers' compcnsation insurance carrier and policy numbcr are: Policy o -l certi& that in the pcrformance 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 3700 of the Labor Code. I shall. forthwith comply with thosc provisions.. WARNING: Failure to secure workers' compcnsation coverage is and Dste: I hereby aflirm under pcnalty of perjury that I am licensod under provision of Chapter 9 (commorcing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License civil fines up to one hundred thousand dollars ($100,000), in Section 3076 of the l-abor Code. interest and attorney's fees. 4 lTtlt r Date:Ul4tl t17tI the lending agercy for the performance of the work for which this pennil b with all City and County and County to erter upon the L I hereby affrm undcr peoalty of pcrjury tha there issued (Sec. 3097, Civ. C.). a Lender's Name: Lender's Address: ,rr tc' Nr ""ct RAT I herdry affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Pafl6) -Required Letter of Notification certi$/ that the lederal regulations rcgarding asbestos rernoval are not applicable to this project. -l certify that I have read this application ordinances and State laws relating to building above mentioned property for Applicant or Agent Pennitee name APPROVALS DATE ID/SIG.COMMENTS Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer t.-6-11 Q-cZ'-) Residential Ranqe Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release rl - ??- FINAL IQ\U1D J KIYI tll_'.Y07 Notes, RernarXs, Etc.,1 I rt ) tS /odZ+-' N,rfA,'A4{ e 4 AltD- ^fO /loriwtYl./1n r/* /v/ M ECHANICAL.I NSPECTOR RECORD c.,a*, SRTE fi/-nJF (Exoires: \r l ContrectobZ