30143417 - Permit - Laserfiche WebLink

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INSPECTOR RECORD SITE.WORK DATE !D/SIG.COMMENTS OWNER BUILDER DELCARATION I hereby affirm under penalty of pojury that I am exempt form the Contractors' License Law for the following reason (Sec.7031.5 Business and Profession Code): Any City or County which requires a pcrmit to construct. alter. improve. demolish or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the ('ontractor's Licensed Law (Chapter 9. Cornrnencing 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 70-l I .5 by any applicant for a penmit subjects the applicant to a civil pnalty of not more than five hundred dollars ($500). *9 t. * owner of rhe propâ‚¬tty. or m)'employees rvith rvages as their sole compensation. rvill do the wort and the surrcnre is not intendod oroffered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the property rvho builds or improves thereon. and who do,es such wort himself or herself or through his or her orvn employees. provided that such improvernents ane not intended or offered for sale. lf. however. the building or improvfirent is sold u'ithin one year of complaion. the Owner Builder rvill have the burden of proving that he or she did not build or improve tre propertv for the purpose of sale). Ni l. ,. owner of the propâ‚¬rt),. am exclusively contracting rvith licensed contractors to constnrct the project (Sec. 7044. Business and Profession Code: '[he Contractor's l,icense l-aw does not apply to an owner of property who builds or improves thereon. and rvho conh'acts for such prr{ects rvith a Conh'actor(s) licensed pursuant to the Contractor's License Law). No I .rn exempt under Secrion - ---. B. & P.C. for this reason. WoRKFRS' COMPENS ATION DFCL ^ [tATlON I hereby' alTirm under penalt"v of periurv one of the following declarations: !o I nu". and rvill rnaintain a Certificate of ('onsent to Self-tnsure for rvorkers' compensation. as provided for by Section 1700 of the I-abor ('ode. for the performance of the work for which the pennit is issued. YES I har.e and u,ill rnaintain rvorkem' compensation insurance. as requited by Section .1700 of the [.abor Code. for the performance of the work for which this pennit is issued. My'workers' compensation insurance carrier and policy number are: . lnlurance Company Of Thc Wert('arrier': wsos05257101 l)olicr Nrrrttber. 01to1,2022 Expires: __ NO I cerrify that in the performance of the rvork for rvhich this permit is issued. I shall not employ any person in any mann6 so as to become subiect to the rvorkerc' cornpensation laws of California. and agree that if I should become subiect to the workers' compensation provLsions of Section -1700 of the Labor Code. I shall. forthrvilh comply with those provisions.. WARNIN(i: Failure to secure rvorters' compensation coverage is unlawful. and shall subiect an employer to criminal pendti* and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compâ‚¬nsation. damages as provided for the Section 3076 of the l-abor Ccxle. interest and attomey's fees. LICENSTn ('ON'I'RrAC'[OR nF('l { RJA'[!ON I hereby affirm under penalty of grcr.iury that I am licensed under provision of ('hapter g (commencing rvith Section 7000) of Division J of the Business and Professions Code. and m1' license is in full force and effect. c-36 Liccnsc'('lass: 7C5430_ l,icense Number CONS-I'R[ICTION I FNNIN(: AGFNCY I hercby alfinn under penalty of per.iury that there is a construction lending agcncy for the perfonnance of the work for which this permit is issued (Sec. .1097. Civ. C'.). I-ender's Name: l.cnder's Address: APPI I('ANT NFCI AR.ATION I heretry affinrr undel penalty of per1ury one of the followrng declarations: I)enxrlrtron Pernrrts-Asbestos Notrfication Federal Regulatrons (Trtle 40. Pad6) !o Required Letterof Notification tt1 I certib/ that the federal regulations regarding asbestos removal are not applicable to rhis project. tlt t cefliS' that t have read this application and state rhat the above informarion is correct. I agree to comply with all City and County ordinances and State Larvs relating to building construction. and hereby authorizc represenlatives of this City and County to erter upon thc ahove mentioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame) Structural Final Plumbing Under Floor I Under SIab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plurnbing Fina!â‚¬<t-Lt 1- -Dd^- Electrical Service (Meter I Panel) Grounding / Bonding Rough Electrical Final Mechanical Gas Air Pressure Test Rough Piping (HW,CW, etc.) Exhaust Ducts lVlechanical Final Notes, Remarks, Etc.