20273456 - Permit - Laserfiche WebLink

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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) lVleter Release Rough Service lMeter l-_rl ^-FINAL '(&19 vEtctS2 '(, z;r/) Notes, Remarks, Etc. OWNER BUILDER DELCARA'I'ION I hereby affirm under penalty of perjury that I am exempl from the Contractors' License Law ftrr the folkrwing reason (Sec.7031.5 Business and Profession Cule): Any City or County which requires a permit to construct. alter, improve. dennlish or repair any structure. prirr to its issuance, also requires the applicant frrr such permit to file a signed staternent that he or she is licensed pursuant to the pnrvisions of the Contractor's Licensed Law (Chapter 9. Commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by any applicant frrr a permit subjects the applicant to a civil penalty of not rnore than five hundred dollars ($5tttt). _1. as owner of the pnlpeny. or my empkryees with wages as their soh compensation, will drl the work and the stnrclure ls not intentled rlr offered for sale (Sec.7044, Business and Professions Code: The G)ntractor's License Law does not apply to an owner of the property who builds or improves thercon. and who does such work himself or herself or through his or her own employees. providecl that such improvernents are not intendetl or offercd for sah. lf, tmwever, the builtting or improvenrnt is rcld within one )rear of completion. the Owner BuiUer will have the burden of pnrving tha he or she dil n9t buikl or improve the property for the puryrse of sale). _1, as owner of the property, am exclusively contracting with licensed b(construct the project (Sec. 7044, Business and Pnrfession Code: The Contractt)r's License Law tloes not of prrlperty who builds rlr irnprrlves thereon. and who contracts frrr such projects with a Contracto(s)to the Contractor's License Law). -l am exempt untler rc'ilson. o*",- (o [7[!J I hereby affinn under pnalty of perjury one of the -l have nntl will maintain a Certihcate of Consent to for workers' compensation. as provided firr by Section 37(X) of the Labor Code, for the performance of the work firr which the perrnit is issued. -l have and will maintain workers'comgrcnsation insurance, as required by.Section37fi)of thc LaborCode, forthe perfonnanceof the work for which this permit is issuerl. My workers' compensation insurance carrier and plicy number are: Policy Number: Expires: -l certify that in the perfrrrmance of the work for which this permit is issued, I shall qot employ any person in any manner so asto beconrc subject to the workers'compensation laws of Califrlrnia, antl agrce that if I stmuld become subject tothe workers' cornpensation provisiuns of Section 3700 of the Latxrr Code, I shall,comply with thorc pnrvisions.. WARNTN(i: Failure to secure workers' compensation and shall subject an employer to criminal penalties and civil fines up to one hundred thousand the cost of comJrensation. damages as provitl.tl firr the Section 3076 of the Labor Code, interest antl """,rb IzlA\ I hereby affirnr under penalty ofperjury that I am of Chapter 9 (commencing with Section 7000) of Division 3 of the Business ancl hofessions Code, and my in and effect. License Class: License Number: Contractor: CONSTRUCTION LENDING AGENCY I hercby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issuetl (Sec. 3097. Civ. C.). Lender's Name: Lrnder's Adclress: A PPLI CAN'I' DECLARA'I'ION I hereby affirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Ferleral Regulations (Title 40, Part6) -Requ iretl Letter of Not il-rcation -l certify that the federal regulations are not applicable to this project. the ahlve infornration is correct. I agree to comply with all City and County aml hereby authrriz.e representatives of this City antl County to enter ugxrn the above nrentionetl property for Applicant or Agent l'crnritee nanre trl 0B-07-2015