20170211 - Permit - Laserfiche WebLink

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ELECTR!CAL.I NSPECTOR RECORD f)^', nA n7 1n{ fi, APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm lDarxpers Communications Cable Buildins .A Under Slab / Floor r{ Bonding I Groundinq / UFER (-ylil.J0, Transformers \-/ Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinss (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release /^\ Rough JoLn4 1"ru-z,o t) "uJxI Service Meter t,1-'w 'L^lLbYilFINALl-Zzja Notes Re Etc. 1-t, I OWNER BUILDER DELC,ffATION I hereby affirm undu poalty of pcrjury that I m exmpt ftom thc ContractoB' Licw kw for the following llen (Se.7031.5 llusines md PIofsioo Code): Any City or County which rcquira a pcrmit to construct. alto, imprcvc dqnolish or rcpoir'mf structue. prior to its issuocc. also require thc applicilt for such pernit to file I signed statmml that hâ‚¬ or shc is licccd pwuan to thc prcvisiore of thc Contmctor's Liccnscd lrw (Chapt6 9. Commocing rvith Setion 7000 of Division 3 of rhc Buine md hofsionsCodc)orthathcorshciseremptthqcfomedthcbâ‚¬sisforthcallcgcdcxopion. AnyviolationofScrionT03l.5byany applicantforaptrnitsubjctsthc applicanlioacivilpenaltyofnotmorethillivehundrcddollus($500). _1. as o\t'ner of the propaly. or my ernployees rvith wages as their sole compensation. willdo thc rvork and the structure is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License [.arv does not apply to an ouner of the property rvho btrilds or improves thereon. and rvho does such u'ork hirnself or herself or through his or her own employees. provided that such improvonents are not intended or offered for sale. I[, howe!'er. the building or improvement is sold rvithin one year of complaion. the Orvner Buildo rvill have thc burden of proving that he or she did not build or irnprove the propoly for the purpose of sale). __1. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Btsiness and Profcssion Code: The Contractor's Licensc Larv does not apply to an orvner of property who builds or improves thereon, and who contracts for such projects rvith a Contractor(s) licensed pursuant tcl the Contractor's License Law). -larnexemptunderSection--.B'&P.C.forthisreason.Date:_Owner:_ WORKERS' COMPENSATION DECLARATION I hereby affirm under panalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compersation. as provided for by Section 3700 of the Labor Code. for the performancc of the work for which the permit is issued. ,6""and will maintain workers' compensation insurance. as required by Section 3700 of rhe Labor Code, for the performance of the u,ork for which this is issued. My workers' compensation insurance carrier and policy number are: l)olicy Nt,rrr,cr 1io16313 17 lzct _l certify that in the perforrnance of the rvork for u'hich this rn any manner so as to become subject workers' compensation to the \r'orkers' cornpensation lau's of California. and agree that if I should become subject to the provisions of Section 3700 of the Labor Code. I shall. forthrvith comply rvith those provisions.. WARNING: I.'ailure to secure rvorkers' compensation coverage is unlarvful. and shall subiect an onployer to crirninal penalties and civil fines up to one hundred thousand dollars in addition to the cost of damagcs as provided for the Section 3076 of the tabor Code. I)L('t./t RA'I'l()N I hereby afTirm under penalty of perjury that I am licensed under provision of Chaptcr 9 (cornmencing rvith Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License - 41,c-b l, 18, (.ONS'I'RU(]'I'I()N I,IiNDIN(; A(; I,N('Y I hereby affrm under penalty issued (Se'c. .1097. Civ. C.). tlrat construction lending agency for the perfonnance of the rvork for rvhich this permit is Lender's Name: Lender's Address: APPLICANT DECLARATION I herâ‚¬by affinn under penalty of perjury one of the following declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) --Required Letter of Notifrcation _l certify that regulations regarding asbestos remot'alare not applicable to this project. that I read this application and state that the ahrve information is correct. I agree to comply rrepresentatives of this City with all City and County and County to enter u;xln theI-arvs relating to building construction, and hereby authorize above Applicant or llcrnrilee for '1*20 t fr?a" ,n,, L l' 1?' t1