50101196 - Permit - Laserfiche WebLink

Home Browse Search

G RADI NG.I NSPECTOR RECORD 1, I APPROVALS DATE ID/SIG.COMMENTS Ow-Buildq Delsmtion I hcrcby affrrm undo pcmlty of pcrjury that I m qcmpt fom thc Contrscton' Liccns Law for lhc followitrg tlmn (s.7031.5 Businds ard Prcfcssion Codc): Any City or Couty which rcquim a 6mit to orutrucr, sk6, imprcrc, &mlish or rcpot my structw. prior to ts isrumc, alm rcquim thc spplicail for $ch pcmir to filc a sigmd stalmnt fiat hc or shc ii liccffid pumut to thc prcvisions of thc CootEctor'r LiccNrd Lsw (Chlptcr 9, Commcrcing with Sction 7000 ofDiviik n 3 ofthc Bwincas atd Prcftslioro Codc) or lhal hc or shc ii ilcmpt tlrefom and thc borir for thc allcgcd cxcmption .Aoy vhlstion of Sction 7031.5 by my rppli@rt for r pcmit $bjltB thc applicsnt to I civil pcmltyof ma mrc than live hundrcd dollan (t5fl)). _1, &i owEr of thc pmpdly, or my cmployc with w.86 a. thcL $lc @mpcnlatiott vill do rhc work atd fic atrucluE h ml htcnded or offaed for olc ( Se.7044, Bu.iBr .nd Pmfcaeioni Codq Thc Contrelor'r Licc[r Law doe mt apply to m owr of thc pmpcny who builds or imprcrcr therclt and who do6 srch work himrlf or hre|f or thrcugh his or hcr om cmplorrcs, pmvidcd thst swh impmrcmcnts re mt intcndcd or olfcrcd for slc. tf. howcq. thc building or imprcrcmcnt is sld within orc ya of omplaion, thc Owrcr-Buildr will harc thc burdcn of pmving lhlt lrc or lhc mr build or impmrc for thc purporc of ulc). _1, &i owrcr of thc ,rrcpcrly, sm qclurivcly coilreling with lice[sd @ntmctoE lo @N]rucr thc projct ( Se. 70,14, Busines ard Prcfcsri<rn Codc: Thc Contmctor'r Liccre lre doa mt apply to u orc of prcpcry wtn builds or imprcB thcrcn , and wtn contracts for such projects with a licensed pursuant to the Contractor's License Law.). _l am exempt & P.C. for this Date: I hereby affirm under penalty perjury one the _l hsvc ard will mhtrin a Ccrtificatc of Coffint to Sclf-Itrflrc for mrtcrr' mmpenstion, as prcvidcd for by S6tion 3700 of thc Labor Codc, for thc pcrfomre of thc wort for which thc Fmit is issed. _l hrvc and will maintEin work6' mmpcnstion in$Bre, ar rcquircd by Scction 3700 of thc Lsbor Co&, for thc pcrfomancc of thc work for which thi! pmil is iscd. My workm' compcnsalion insnre c.rier ard policy numbcr rc: Policy ('[his section need not tc completd if the permit is for One hundred dollars t$1001 or less), in any mann? so as to the workers' 5 performance work for u'hich this is issued, I shall not employ laws and agree if I should compensation of the \ WARNING:to workers' compensation is and an employer to criminal fines up to one hundred thousand dollars ($100,000),in the Labor Code, interest and attomey's fees. the cost of compensation, damages as provided for the Section 3076 of @ I hcrcby allirm unda pcElty of pcrjury thrt I m lienrcd undcr pmvision of Chaptq 9 (@lmncirg with Sction 7000) of Divirion 3 of thc Buircs lnd Prcftlriou Codc, Erd my liccw is in frll forcc and cfIct. License License Numher Date: Contractor: W I hâ‚¬rcby affirm urdq pcmlty of [Erjury lhot thcrc is a mnstrucrion lcnding EEcrcy for thc Frfomncc of th. uork for which this ,rcrmit is isscd (56. 3097, Civ. C.). l:ndcr's Namc: Lender's Address: APPLICAIIT'S DECLARATION Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part 6) _ Required lrtter of Notification asbestos removal are not applicable to this project. state that the above information is correct. I agree to comply City and County above mentioned Applicant or agent Permittee name and hereby authorize re?resentatives of this City uJr'on the Preliminary Soil Report Excavation Fills Sub Drains Buttresses Soils/Geology Report Statement of Compaction Compaction Report Flood Elevation Cert Paving Sub Grade Aggregate Base Water Test & Seal Coat Asphalt Concrete Soils Eng. Cert. Rough Grading Release Final Civil Cert. tl FINAL ro /r LD TDhF6) Notes, Remarks, Etc., ytCA + HrSStroL tvtlkal il tul \aap *ril trlI T I t3 D Date:0_13 civil br+teI16{*-l()W,