30143265 - Permit - Laserfiche WebLink

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PLU M BI NG.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER IIEI.CARATION I hacby aIfim undr poulty of pajuy thrt I m qdpt 6om drc CoiilreloB' LicqE Lrw for thc following twn (Sc.7031.5 Bwins aod Profeioo Codc): Any City or Couty which rcquis a psmit to srlsruct, ahq, imprcvq dolish or rpair uy sEuclw, prior to its ismcq also rcquic thc pplicet for such pamit to filc a ligtrcd statmat tha hc or slrc b licoscd pwan to thc Fovisiom of thc Contretor's Licoscd kw (Chaptc 9, Comcncing with Sstiotr 7000 of Division 3 of thc Bwins ud PrcfesiomCodc)utharbGorstEbq@ptth6c&omrndthcbosisforthcallcacdaoptio!. AtryviolrtionofscrbnT03l.5byey applimt for a pamit subjcr thc applicmt to a civil pcnalty of rot mrc thff five hundrcd dollffi ($500). -1. as owner of thc property. or my employees with wages as their sole compensation. will do the worft and thc sructure is not intended or offerd for sale (Scc.7044, Business and hofessions Code: The Contractor's Licâ‚¬nsc [-aw does not ryply to an owner of the propcrty who builds or improves thcron, and who does such work himself or hersclf or through his or her own employees. provided that such improvanants are not intended or offcred for sale. If, hows/er. the buildhg or improverncnt is sold within one )air of complctiorL thc Ournâ‚¬r Buildcr will havc the hrdcn of proving thd he or shc did not build or improve the propcrty for thc purposeof sale). -1, as owner of the propaty. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Business and Proftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Contraoo(s) licosed pursuant to the Contractor's License l-aw). -l arn exempt undcr Section-. B. & P.C. for this reason. l)o t o' WORKERS' COMPENSATION DECLARATION I hereby affrm under pendty of perjury one of the following declarations: _l have and will maintain a Certificatc of Consent to Self-lnsure for worketrs' compensation, as provided for by Section 3700 of the I-abor Code, for the perfonnance of the work for which the perrnit is issued. a 7hW*rra*il^aintainwo*c'ompcratiooiMGc,a rcquircdbysâ‚¬lionsTOoofthckborCodc.forthcpsfomof\ thc wrk for wNch this pamit is iscd My wcl6' ompcnsation irumcc mic and policy nmbc rc: f9 _l certi& that in the performance of the work for which this permit is issuo( I shall not qnploy any pcrsoo in any mann6 so as to become subject to the workcrs' compensation lsws of California, and agrec thd if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with those provisions.. WARNING: Failure to sccure workâ‚¬rs' compensation coverage is unlawful, and shall subject an snploycr to criminal pcoalties and civil tines up to one hundred thousand dollars ($100,000), in addition to the cost of compcnsation, damagcs as provided for the 3076 of the Labor Code, interest and attorney's fees. I I I hereby affrm under penalty of perjury 3 of the Business and Professions Code, and my licerse is in full force ard effect. ct."r' '.1 ---: ' â‚¬ LicenseNumbcr:zkzru 17"./z I 7 W I, I hclbyaffimurd6 padtyofpajurythrt th@is8@trsfudbo lodilgrgcyforthcpqforc ofthcmft forwldchthispmit b isucd (Se. 3097, Civ. C.). lrnder's Name: lcndcr's Address: APPLICANT DECI.AR,ATION t hcrcbyaffirmunder penalty of pcrjury onc of the following dcclarations: Dcmolition Pernrits-Asbcstos Notification Federal Regulatioru (Title 40, Part6) -Requhed lrtter of Notificaion I , -l ccrti$, that the federal regulations rcgarding asbestos rernoval are not applicable to this projcct. -,.J certily that I have read this application and state that the above infonnation is correc't. I agree to conrply ordinanccs and Statc Laws relating to building construction. and hcreby authorize represcntatives of this City abovc rncntioned property for inspection purposes. r--- with all City and County and County to entcr upon the rdpplicant or Agent ,// 7rZ/ I'ermitee treme UNDER GROUND Waste & Vent Water-Under floor Gas-Underfloor Buildinq Sewer Area/Storm Drain I nterceptor/ Cla rifier TOP OUT Waste & Vent Water Piping Gas Piping Roof Drain Tub/Shower Test x Rough Water Heater POOL/SPA P-trap/Drain Line lvlain Drain/Pool Piping Fill Line/Back FIow Pool Heater/Gas Line Miscellaneous Gas Service Water Service Lawn Sprinkler Sanitary SewerlCap Back FIow Device Rough Plumbing Final Gas Test Meter Release I FINAL 7l lil 2-t tx*p 7 , Owner:_ ( ,rt t tt t .l't,lrrr \rrntlrr't l'rpir cs: (;; _L_ Notes, Remarks, Etc.