20170093 - Permit - Laserfiche WebLink

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ELECTRICAL.I NSPECTOR RECORD t\Q n7 '>^a r; APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltase Fire AIarm I Dampers Communications Cable Building Under Slab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Wails (Roush) Ceilings (Hard & Soffit Rouqh Ceilings (T-Bar Rough) Meter Release /\ Rough -F-11 Vr,t#% Service Meter U \J FINAL \,*tMx Notes Remarks Etc. -+ I hseby affirm undo penalty of pcrjury that I m cxempt from thc Contractos' Licme taw for thc following re$n (Sc.70-t1.5 Businos and Profsion Code): Any City or County which requirs a ponit to construct. alta. improve. donolish or rcpair uy structurq prior to its isuucc. also requiB the applicilt for such pemit to lile a signed statmot th.t lE or shc b licased plNilt to thc provisioc of thc Contractor's l,iccnsed larv (Chaptq 9. Commcrcing rvith Setion ?00O of Division J of thc Bsins dd Prcfc$ions Codc) or that hc or shc is excmpt thoefrom and thc basis for thc alle8ed ermption. Any violation of Sation 7031.5 by 8ny applicantforapennitsubjetsthc applicanttoacivilpenaltyofnotmorelhilfivehundrcddollm($500). -.1. as owner of the property. or my employees with wages as their sole compensation. rvill do the work and the structure is not intended or offered for sale (Sec.7044. Business and hofcssions Code: The Contractor's License l-arv does not apply to an orvner of the property rvho builds or inrproves theron. and who does such w'ork himself or herself or through his or her own employees. provided that such improvonents are not intended or offered for sale. l[, horvever. the building or improvement is sold within one year of cornplaion. the Orvner Builder rvill have the burden of proving tha he or she did not build or irnprove the propo'ty for the purpose of sale). _1. as owner of the propeity. am exclusively contracting with licensed contractors to construcx the project (Sec. 7044. Business and Pnoftssion Code: The Contractor's License Larv does not apply lo an o$,ner of propcrty who builds or improves thereon. and rvho contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Law). _l arn exempt under Section_. B. & P.C. for this reason. Date:_Owner:_ }VORKERS' CONT PENSATION DT,CLARATION I hcreby affirm under penalty of perjury one of the follorving declarations: -l have and rvill rnaintain a Certificate of Consent to Self-lnsure for rvorkers' compensation. as provided for by Section -3700 of the Labor Code. for the pa'formancc of the work for rvhich the permit is issued. _l have and will maintain rvorkers'insurance. as by Section 3700 of the Labor Code. for the performance of ,carrier and policy number are:the rvork for which this pennit is issued. Carrier: ' Policy Number: ' a _Expires: -l certify that in the perforrnance of the work fur which this perrnit is issued. I shall not ernploy any person in any manner so as to becorne subject to the rvorkers' compensation larvs of California. and agree that if I should become subject to the rvorkers' cornpensation provisions of Section -3700 of the Labor Code. I shall. forrhrvith comply rvith thosc provisions.. WARNING: Failure to secure s'orkers' compensation coverage is unlarvful. and subject an onployer to crirninal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the of comlrcnsation. damages as provided for the Section 3076 of the Labor Code. interest and attorney's fees. l)1,.('1.,\ll.\ l'loN I hereby affrnn under penalty 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. License Class: '_l-icense a [c, zs I orrr,- ll 44 Contractor,(-- CONSTRUCTION LENDING ACENCY I hmby alfim undo penalty of pcjury that thqe is a orotruaion bnding agocy for thc pcrfommcc of thc wrk for which this pâ‚¬nnit b isued (Sa. 3097, Civ. C.). l.crrrlcr 's Niurrc. Lender's Address: _ APPLICANT DECLARATTON I herelry aflinn under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Titlc 40. Part6) _Required Letter of Notification rernovalare not applicable to this project. above infonnation w'ith all City and County and above rnentioned property for inspection Applicant or Agent Signature: >L l)ate: - qPernritee nRnre (print): LT hereby County to enter upon the t;, aa ,