20169225 - Permit - Laserfiche WebLink

Home Browse Search

ELECTRICAL.!NSPECTOR RECORD na n7 '),i APPROVALS DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION I hac@ affm undc pemlty of pajury that I m â‚¬xmpt film the Contraclon' Licw law for thc following rcmtr (S6.7031J Busins md Profsion Codc): Any City or County which rcquira a Jumh to construct. altr. improva &rnolish or rcpair my structue. prior to its issuucc. also rcquirc the applicat for such JEnnit to file a signcd statmot thst hc or shc b licffcd plmilt Io thc provisioE of thc Contractor's Liccnscd larv (Chapt6 9. Commcncing rvith Selion 7000 of Division 3 of thc Busincs od Prcfc$iotrsCode)orthatheorshciscxcmptthGcfrommdthcb6sisfortheallcgcdexmption. AnyviolationofSetionT03l.5byany applicantforapermitsubjetsthc applicanttoacivilpenaltyofnotmorelhefivehundrcddollus($500). l. as orvner of the property. or rny employees with wages as their sole compensation. rvilldo the rvork and the structure is not intende<l or offered for sale (Sec.7044. Business and hofessions Code: "l'he Contractor's License Larv does not apply to an orvner of the properly who builds or funproves theron. and who does such work hirnself or herself or through his or her own employees. provided that such improvanents are not intended or offered for sale. lf. horvever. the building or imp,ro!'ement is sold rvilhin one year of cornpletion. the O*'ner Buildcr rvill have the hrrdetr of prol'ing thd he or she did not build or improve the propaty for the purpose of sale). _ - l. as owner of the property. iun exclusively contracling rvith licensed conlractors lo construct the project (Sec. 7014. Business and Ftofession Code: The Contractor's License Law does not apply to an owner of property rvho builds or improves thereon. and rvho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License Larv). -lamexemptunderSection-,B.&P.C.forthisreason. l)ale:Owner:_ WORKER,S' COMPENSATION DECLARATION I hereby affrrm under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Scction 3700 of the Labor Code. for the performance of the rvork for which the perrnit b issued. _l have and will maintain workers' compensation insurance. as required by Section -3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: WARNTNC: Failure to scrure rvorkers' compensation coverage is unlarvful. and shall subject an onployer to criminal penalties ald civil fines up to one hundred thousand dollars addition to the cost of compensation, damages as provided for the Sectiorr 3076 of the Labor Code. intercst and ,r,., /-9-JO */ I hereby affrnn under penalty of perjury that I arn licensed under provision 9 (commencing rvith Scction 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. Liccnse ,r^r", c' 3 D 8aoNurnber: -70 I heretry affrrm under penalty of perjury that there is a issued (Sec. 3097. Civ. C.). lending agency for perfonnance of the rvork for u'hich this permit is Lender's Address: APPLICANT DECLARATION I hâ‚¬reby affinn under penalty of perjury one of the follorving declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Par6) --Required Letter of Notification rvith all City and County and County to enter upon the above rnentiond property for . Applicnnt or Agent ['ernritee "6*l)alc:/-1- 0-O Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildins Under SIab / Floor Bonding / Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Roush) Meter Release Rough Service Meter //.F FINAL 6/lnllo TMr [21 , Notes, Remarks, Etc.I \--, C"rri"r, \ 4 (O , L'7#-ono, ,f / -Poricy""^a* .- CZo ) 7 /7 7'2 l*l-(3 that in the performance of the tt,ork for rvhich this pcrnrit ts issucd.shall not employ any pâ‚¬rson in any manner should becorne subject to theso as It'l the rvorkers'cornpensation law's of California.antl agree that forthu'ith ifr rvortcrs'provisions of Section 3700 ofthe Labor Code.shall.comply w'ith thosc provisions.. the federalregulations regarding asbestos rernovalare not applicable to this project. that have read this application and State [-arvs relating Itt