20169929 - Permit - Laserfiche WebLink

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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/S!G GOMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm lDampers Communications Cable Building Under SIab / Floor Bonding I Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release Rough Service Meter IlwzzOnr**FINAL t1,l tt q -^/gO I Notes, Remarks, Etc.U \ /// \-' OWNER BUILDER DELCARATION I hcreby allirm unds penally of perjury that I an excmpl from the Contrscto6' Licw hw for thc following rcen (Str.7031.5 Busincs md Profeion Code): Any City or Couniy which requirc a pmnit to costruct, alta. improva dcmolish or rcpair my structuc. prior to its issuancc. also rcquirc the applicill for such pcnnit to filc a signcd statmot that hc or she is lictrcd pmudt to thc provisions of thc Contractor's Liccnscd law (Chaptq 9. Commocing vilh S(tion 7000 of Division 3 of the Buins md ProfcsionsCodc)orthathcorshciscxcmptthqefromadthebasisfortheallcgcdcrmption, AnyviolationofSe{ion703l.5byany applicantforapmitsubjelsthe applicanlloacivilpenaltyofnotmorcthillivehundrcddollils($500). -1. as owner of the property. or my employees with wages as their sole cornpensation. will0o the tt'.rrk and the structure is not intended or offered for sale (Soc.7044. Business and hofessions Code: 'Ihe Contractor's License Law does not apply to an orvner of the property rvho builds or improves theron. and rvho does such rvork himself or herself or through his or her orvn employees. provided that such irnprovernents are not intended or offered for sale. If. ho*'ev'er. the building or improvemenl is sold rvithin one )â‚¬ar of conrplaion. the Ov..ner Builder will have the burden of gnoving that he or she did not build or irnprove the propoty for the purpose of sale). _1. as owner of the property. am exclusively contracting rvith licensed contractors to construct the project (Sec. 7M4. Business and Proftssion Code : The Contractor's License Law does not apply lo an orvner of propeity 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 under for this reason. l)alc: I hcreby affrrrn under penalty of pei'jury one of the _ I have and rvill maintain a (lertificate of Consent lo Self-lnsure for rvorkers' cornpensation. .rs provided for by Section 3700 of thc Labor Code. for the performance of the work for which the pennit is issued. _ -l have and will rnaintain workers' cornpensation insurance. as required by Seclion 3700 of the Labor Code. for the performance of the rvork for rvhich this permit is issued. My rvorkers' compensation insurance carrier and policy number are: ('lrr r icr . Policv Number:Expires: _-l ceflifu that in the performance of the u'ork for rvhich this perrnit is issued. I shall not ernploy 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 thc wcrrkcrs' compensation provisions of Section 3700 of the kbor Code. I shall. fonhwith comply u'ith those provisions.. WARNTNG: Failure to secure s'orkers' conrpensation coverage is unlarvful. and shall subject an anployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000).to the cost of comlrcnsation. damages as provided for the Section 3076 thc Code. interest and fees.tl I hereby afllnn under penalty of perjury that I liccrrscd provision of Chapler 9 (cornrncncing rvith Section 7000) of Division -3 of the Business and Profle.ssions Code, and my license is in full force and effect. I-icense Class:_ Date:-- License Nurnber: Contmctor:-- W I hwby aflim unda pcnalty of pqjury thst thqâ‚¬ is a @nstruclion loding agocy for the pafomcc of thc rcrk for which thk pqmit is isucd (Se. 3097. Civ. C.). Lqrda's Nmc: Lender's Address: APPLICANT DECLARAI'ION I hereb}, affinn under penalty of perjury one of the follorving declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40. Par16) __Required Letter of Notification ---l cqtifythat the fcdoalregulatioro rcgarding sbGlos rmovalarc not applicable to this prcjet. - I crtif*that t hry/raa rtis appticarion atd statc thar rhc above infomation is cortrt. I agr6 to omply $'ith all City and County ordinancG a\{Star/Laws relating to buildins(ons:truction. dd hseby authorize rcprGotalivs of this City md County to mlF upon lhc above rnention$fopeny for inspetion pu1reDr I I nrr,,""n,,./J*\*,**' h *r", lt 111 l11,*n**,i**Z ZWDz,il"*F---- _--Il ()..', flQ fl? ')n{fi, I ,t