40135765 - Permit - Laserfiche WebLink

Home Browse Search

INSPECTOR RECORD t SITE-WORK DATE !D/SIG.COMMENTS OWNER BUILNER DEI CAR,ATION I hereby aflirm under penalty of perjury that I am exempt form the Contractors' Liccnse Law for the following rcason (Sâ‚¬c.70-l1.5 Busincss and Profession Code): Any City or County which requires a permit to conslrucl, alter, improve, demolish or repair any structure. pnior to its issuance. also rcquires the applicant for such permit to file a signcd statement that he or she is licensed pursuant to thc provisiors 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 for a pe'rmit subjects the applicant to a civil penalty of not more than five hundred dollars ($.500). Y-t, .r o\^,ner of rhe propcrty. or my employees with wages as their sole compensation, will do the wort and the stucture is not inrended or offererl for sale (Sec.7044. Business and Professiom Code: The Contractor's License Law does not ap,ply to an owner of the property who builds or improve thcreon. and rvho docs such wort himself or herself or through his or her own cmployees. provided that such improvements ane not intended or offerod for sale. If. howwer. the building or imp,roverrcnt is sold within one ycar of complaion. the Orvner Builder will have the burdcn of proving that he or she drd not build cr improve tre property for tlre ptrpcc of sale). 19 t. a. owner of rhe propâ‚¬rty. am exclusively contracting with licensed contractors to constnrct the project (Sec. 7044. Business and Profession Code: The Contractor's License Larv does not apply to an owner of property who builds or improves thereon. and rvho contracts for such projects with a Contractor(s) licensed pursuant to the Contracts's License Law). xo t arn exempt under Secrion B. & P.C. for this reason. WOR.KT'RS' COM PT'NS ATION NFCI ^ R.ATIOIT I hereby affirm under penalty of perjury one of the following declarations: !-t nur. and will rnaintain a Cenificate of Consenr to Self-lnsure for workers' compensation, as provided for by Section 3700 of the L:bor Code. for the performance of the work for which thc pcrmil is issued. YES _l have and will maintain workers' compensation insurance. as required by Section -1700 of the labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurancc carrier and policy numbcr are: . Fallr Lako Flrr t Carualty lnrurancc Carrier: FLAM4E2EO' Policy Nulnher': __Expires:o11o112022 NO __ I certifo that in the performance of the rvork for which this pcrmit is issued. I shall not employ any person in any mann6 so as to become subject to the workers'compensation laws of California. and agree that if I should become subject to the workcrs' compensation provisions of Section -1700 of the l-:bor Code. I shall. forthwilh comply with those provisions.. WARNTNG: Failure to secure workcrs' compensation coverage is unlawful. and shall subject an cmployer to criminal penalties lnd civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compâ‚¬nsation. damages as provided for the Section J076 of the Labor Code. interest and attomey's fees. LICENSFn CONTRACTOR nFCI ^ RATION I hereby affirm under penalty of perjury that I am licensed under provision of Chapler g (commencing with Section 7000) of Division -1 of the Business and Professions Code. and my license is in full force and effect. c-20 [,icense ('lass:oe3eeo Liccnse Number CONSTRTICTION I F'NNING AGF'NCY I hcreby affirm under penalty of perjury that there is a construction lending agercy for the pcrfornunce of the work for which this permit is issued 1ggg. .1097, Civ. C.). Lender's Nanrc: Lender's Address: APPI IC^NT NFCI ^R.ATION I heretry affinrr under penalty of per1ury one of the followrng declaratrons: Denrolition Pernrits-Asbestos Nolification Federal Regulatrons (Title 40. Part6) rc Required Letterof Notification YEs f cefliry that the federal regulations regarding asbestcrs rcmoval are not applicabte to this project. 5t t ccfliry that I have read rhis apptication and state that the above information is correcl. I agree to comply with all City and Cotmty ordinances and State Laws relating to building construction, and hereby authorize rcpresentatives of this City and County to enter upon the above mentiond 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 Plumbing Final Electrical ,l r)LD 3\A ltshr 50tsqANet- Grounding / Bonding I Rough Electrical Final Mechanical Gas Air Pressure Test Rough Piping (HW,CW, etc.) Exhaust Ducts It Mechanica! Final zd5 Zlts/2-tlt Notes, Remarks, Etc. lt I Lâ‚¬,NI CoS\Crt^L{71-t