20173229 - Permit - Laserfiche WebLink

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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDE,R DELCARATION I hereby affirm under penatty of perjury that I am exempt frcm the Contractors' License Law for the following reason (Sec.7031.5 ' Business arul Profession Code): Any City or County which requires a permit to construct. alter, improve, rlennlish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed staterEnt that he or she is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9. Commencing with Section 7fi)0 of Division 3 of the Business and Pnrfessions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 703 L5 by any applicant for a permit subjects the applicant to a civil penalty of not nx)re than five hundred rlollars ($stttl). _1, as owner of the property. or my employees with wages as their mle compensation, willdo thc work and the gnrcturc ls not intenled or offered for sale (Sec.7044. Business and Professions Crxle: The Contractor's License [-aw does not apply lo an owner of the pnrprty who builtls or impnrves thereon, aml wlrl does such wurk himself or lrerself or through his or her own employees, provided that such improvenrnts are not intended or offerctl filr sale. I(, however, thc buikling or inrytrovenrnt is sokl within one )â‚¬ar of completion, the Owner Buikler will have the burden of pmving that he or she <Iil not buiU or impnrve the pmperty for the purpose of sale). _1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 704a. Business arxl hofessirn Corle: The Contractor's License Law does not apply to an owner of proJrcrty who builds or improves thereon. and who contracts for such projects with a Contracto(s) licenserl pursuant to thâ‚¬ Contractor's License Law). -l arn exempt under Section-, B. & P,C. firr this reason. Date: WORKE,RS' COM I'ENSATION DHCLARA'TION I hereby affirnr untler penalty of perjury one of the following declarations: _l have and will maintain a Certifrcate of Consent to Self-lnsure frrr workers' compensation. as pnrvided for by Section 3700 of the labor Crxle, for the performance of the work for which the permit is issued. _l have and by Section 3700 of thc [-abor Code, for the grrformance of the work for carrier arxl Jxrlicy number are: Policy _l certify that in the perfirrmance of the work which this permit is issued, I shall not empkry any person in any so as to becorne subject to the workers' compensation laws of California, and agree that if I shtuld become subject to the workers' compensation provisions of Section 37fi) of thc latxrr Ctxle. I shall. forthwith comply with those provisions.. WARNTNG: Failure to sâ‚¬cure workers'compensation coverage is unlawful, and shalt subject an employer to criminat ptfies ana civil fines up to one hundred thousand dollars ($100.0110). in addition to the cost of compensation, damages as provided for the "*""':u{:nu:';l'''".'.'' T_ I hcrcby affirm under penalty of perjury that I am licensed under provlsion of Chapter 9 (comnrncing with Sectbn 7U[) of Division 3 of the Business and Professions Code, and my license is in full force and effect. c ?13LicenseNulnber: oru, S -1 - Z( CONSTRUC'TION I TNDING AGENCY I herchy affirm under penalty of Jrcrjury that there is a construction hnrling agency for the perfirrmance of the work for which this prmit ls issued (Sec. 3097, Civ. C.). [.cnder's Name: lrnder's Address: APPLICANT DE,CLARATTON I lrcrchy affirm uncler penalty of perjury one of the following declarations: Derrxrlition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) _Required Letter of Notification _l certify that the federalregulations rcgarding asbestos renxlvalare not applicable to this project. _l certify that I have reatl this application :rnd state that the ahrve inftrrmation is correct. I agree to comply with all City and County ordinances and State Laws rclating to building construction, and hereby auth)rize representa{es of this City and County to enter ufnn the above mentioned property for Applicant or Agent l'enrriter .L Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor /t //.a Bondinq I Groundino I UFERT,/?/rv &(ztrz,tct{CZ, Transformers Torqueincr Sub-Panels Air Conditioners Roof Top Equiprnent Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinos (Hard & Soffit Rouqh Ceilinos (T-Bar Rouqh) Meter Release Rough Service N/eter Itt ^t )/u_/ -^-E FINAL Dil 1TAl,r ryF./W T A4q) Notes, Remarks, Etc. & -.q 7 Rev. 08-07-2015