20170097 - Permit - Laserfiche WebLink

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ELECTRICAL.I NSPECTOR RECORD DATE ID/SIG,COMMENTSAPPROVALS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire AIarm I Dampers Communications Cable Buildins Under SIab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) Meter Release Rough Service Meter FINAL tt -g-/ g t)*rJtn< Notes, Remarks, Etc. I hereby affm under pcnalty of pojury that I m exempt fiom the Contracto6' l-icme tarv for the following r@n (Sc.7031.5 Businss md Profssion Codc): Any City or County which requirc a po'rnit to construct. altc. improve. dmolish or repair tny structurc. fior to its issudcc. also rcquiE the applicut for such pennit to file a signed statomt tha he or she is licoscd pmumt to thc trovisiom of the Contractor's Liccnscd law (Chaptq 9. Commencing with Sstion 7000 of Division 3 of thc Busines md Profsions Code) or that he or she is excmpt thqefrom and the basis for the allcged exondion. Any violation ofsetion 703 I .5 by any applicantforapsrnitsubjststhc applicanttoacivilpcnaltyofnotmorethmfivehundreddollrs($500). _1. as owner of the properly. or my employees rvith wages as their sole compensation. will do the rvork and the structure is not intenderJ or offered for sale (Sec.7044. Business and hofessions Code: 'l'he Contractor's License Law does not apply to an olvner of the property who builds or improves thereon. and rvho does such rvort hirnself or herself or through his or her own ernployees. provided that such improvonerts are not intended or offered for sale. lf. hou'ever. the building or improvement is sold wilhin one )â‚¬ar of complaion. the Owner Builder will have the h.rden of proving tha he or she did not build or imp,rove the property for the purgnsc of sale). _1. irs owner of the propâ‚¬rty. an exclusively contracting rvith licensed contractors lo construct the project (Sec. 7044. Business and Profission Code: The Contractor's License Larv does not apply to an os'ner of property rvho builds or improves thereon. and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License [arv). -l am exempt under Section-. B. & P.C. for this reason. Date: Owner:_ WORKER,S' COMPENSATION DECLARATION I hereby affrm under penalty of perjury one of the follorving declarations: -l havc ard will msintain a Ccatificate of CoG6t to Sclf-lmurc for $orkm'compeNalion. o providcd for bySation 3700 of thc tabor Code for thc pqfomficc of thc wort for which thc pmit is issucd. -l havc and will maintain work6' compcmtion irourancc. re rcquircd by Setion 3700 of Ihc l.:bor Codc. for thc pqfonmcc of the work for which this pcfmit is iscd My workm' compqtsation irouruce wiq and policy numba re ! ('irr r icr : Policy Nurnber:__Expires: that in the perforrnance of the work for rvhich this perrnit is issued. I shall not ernploy any person in any manner so as to becorne subject to the n,orkers' compensation larvs of California, and agree that if I should becotne subjett to the workers' cornpensation provisions of Section -1700 of the Labor Code. I shall. fonhrvith comply with those provisions.. WARNING: Failure to secure workers' cornpensation coverag,e is unlawful. and shall subject an etnployer to crirninal penalties and civil l-rnes up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section -3076 of the l-abor Code. interest and attorney's fees. DECI,ARATION I hereby alTirm under pcnalty 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. x'/ License Number:sq\nz \\ --? - \q z\(rr,.r.,o,, SJCK V(r\a{â‚¬S, CONSTRUCTION LENDING AGENCY I h@by aflm und6 pcnslty of prjury thd th@ is a mnsrucrion hoding agmcy for thc pafommcc of thc wort 6r which this pcrnit b issucd (56. 3097, Civ. C.). Lender's Narne: lrnder's Adclress: APPLICANT DECLARATTON I hereby affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Fcderal Regulations (Title 40. Parr6) -Required Letter of Notification I cerrifu that the federal regulations regarding asbestos removalare nol applicable to this project. that I have read this application and state that the ahrve inforrnation is comect. I agree to cornply with all (.ity and County and State Larvs relating to building construction. and above nrentioned properly for inspection or Agenl representatives of this City and ('ounty lo enter upon the n{2 n', '}n-l tr, t A -7- /7