20170097 - Permit (3) - Laserfiche WebLink

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ELECTRICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire Alarm lDampers Communications Cable Building Under SIab / Floor Bondins / Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinss (Hard & Soffit Rouqh Ceilings (T-Bar Rough) [\4eter Release Rough Service Meter FINAL tf - g-/9 aam/a Notes, Remarks, Etc. OWNER BUTLDER DELCARATION I hecby a{Iim unda poalty of perjury that I m cx.mpt from the ContractoE' Licmsc lrw for thc following wn (Sc.70-t1.5 Busines and Prof6sion Codc): Any City or County which rcquira a pmit to coGtruct. altc. improvq &molish or repair any structuc, pdor to its issumce. also requirc the applicmt for such pcrmit to filc a signql statmBt that hc or shc b lic@sed pmuilt to thc provisio$ of thc Contractor's Licensâ‚¬d liw (Chaptq 9. Commencing with Sfftion 7000 of Division 3 of thc Buincs ud Prcfesions Code) or that hc or she is eimpl thsefrom od thc basis for the alleged eremption. Any violation of Serion 7031.5 by any applicantforapemitsubjctsthe spplicanttoacivilprnaltyofnotmorethilfive hundrcddollm($500). _ l. as owner of the propfiy. or my employees rvith wages as their sole compensation. u'illdo the work and the stnrcture is not intendecl or offered for sale (Sec.7044. Business and hofessions Code: The Contractor's License [^aw does not apply to an orvner of the properly who builds or improves thereon. and who does such rvork himself or herself or through his or her own ernployees. provided that such improvernents are not intendsJ or offered for sale. If. horvever. the building or improvement is sold rvithin one yâ‚¬ar of cornplaion. the Orvner Builder will have the burden of proving tha he or she did not build or improve the propoty for the ptrpose of sale). _ l. as owner of the propeily. am exclusively contracting s'ith licenscd contractors to construct the project (Sec. 7044. Business and hofcssion Code: The Contractor's License Larv does not apply to an o\r'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 Law). -l am exempt under Section- Date:_ I)E('1,ARA'I'ION I hereby affrrrn under poralty of perjury one of the follorving declarations: --l have and will maintain a Certificate of Consent to Self-lnsure for rvorkers' compcrsation. as p,rovided for by Section -1700 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 reauired by Section 3700 of the Labor Code. for the performance of the work for which this permit is issued. My workcrs' compensation insurance carrier and policy numbcr are: Carrier:_ Policy Number:_Exoires: __l cerrify that in the performance of the rvork for which this permit is issued. I shall not employ any person in any tnanner so as to become subject to the rvorkers' compensation lau's of California. and agree that if I should becorne subject to the workers' cornpensation provisions of Section 3700 of the Labor Code. I shall. forthrvith cornply rvith those provisions.. WARNING: Failure to secure s'orkers' cornpensation coverage is unlarvful. and shall subject an onployer to criminal 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 Labor Code. interest and fecs. I hereby affirm under penalty of perjury I arn under provision of Chapter 9 (cornnrencing rvith Section 7000) of Division 3 of the Business and Professions Code. and rny license is in full force and effec't. [,icense Dnte: -License Number: ('onlrnclor: CONSTRUCTION LENDING AGENCY I hffiby affm under pcnalty of perjury that th@ is a corelruction loding agocy for thc pqfomace of the work for which this pcnnh is issucd (Se. -1097. Civ. C.). Lentlcr's ALldress: APPLICANT DECLARATION I her*y affinn under penalty of perjury one of the following declarations: Dernolition Permits-Asbcstos Notification Federal Regulations ('title 40. Par16) _Required Letter of Notification l3-.', nQ fi'7 1n{fi __ lcertifythat asbestos removalare not applicable to this project. rvith all City and County and County to enter upon lhe r\gt ltt Larvs for inspection _ Date:_