40133473 - Permit - Laserfiche WebLink

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M ECHANICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION I hmby affm undc pcaalty of pcrjury that I m qcmpr fiom thc Contractorc' Licene Lrw for the following wn (Scl7o3lii Buincs sd Profsion Codc): Any City or Coutrty which rcquirc a pcmh to corutruct. akq. improvc, damlisl or rtpoir aS structur, prbr to ias issumcc. also rcquirs thc applicot for such pcrmit to filc a signcd statoot that hc or slE b licccd ptNut to thc provisioE of thc Contractor'! Liccnrcd t:w (Chapta 9. Comcncing with Sction 7000 of Division 3 of thc Busins ud Prcfsiom Codc) or that hc or she is qcmpt thqâ‚¬from md thc basis for thc allcged emptiotr. ADy violation of Sclion 7031.5 by ey applictrt for 8 pcrmit subjcts thc applicmt to a civil pmlty of not morc the livc hun&ed dollus (5500). -1. as owner of the property. or my employees with wages as their sole compensation, will do the work and the stnrfirc is not intcnded or offered for sale (Sc.7044. Business and hofessions Code: The Contraclor's Liccnsc [-aw does not apply to an owner of the propcrty who builds or improves theron" and who does such work himself or herself or through his or her own employees. provided that such funprovanents are not intended or offerrod for sale. l[, howwer. the building or improvcmcnt is sold within one ]Ezr of complction, the Orvner Buildcr will have thc hudo of proving tha he or she did not build or imp,rove the propoty for thc purposc of sale). -1, Bn owner ofthe propcrty, 8rl cxclusively contracting with ticeosod contracton to construct the project (Sec. 7044, Business and Proftssion Code: The Contractor's License Law does not apply to an owncr of property who builds or improvcs thereon, and who contmcB for such projects with a Contracto(s) ticenscd punuart to the Contractor's Liceosc l-aw). -l am exempt under Scction-, B. & P.C. for this reason. l)ul c: WORKERS' CONTPENSATION DECLA]TATION I hereby affirm under penalty of pojury one of the following declarations: -I have and will maintain a Certificate of Conscnt to Self:lnsure for workers' compensation, as provided for by Section 3700 of the Labor Code. for the performance of the work for which the permit b issued. -l have and will maintain workers' compensation insurancer as required by Section 3700 of the Labor Code, for the pcrfornrance of the work for rvhich this permit is issuod. My workers' compensation insurance carrier and policy number are: -ll a 0-T [)n "\4(.-,;at \r-e-s T PS-C o Policy \r-J E ,7 I a lo'JG - Zc, l9 _l cerri& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers'compansation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the t-abor Code I shall. forthwith comply with thosc provisions.. WARNING: Failure to sccure workers' compensation coverage is unlawful. and subject an crinrinal penalties and civil fines up to one hundred thousand dollars ($100,000). Section 3076 of thc Labor Code interest and anorney's fees. the as provided for the t DECI ^ RATION I hereby aflirm under penalty of pcrjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. b jw License , F 2 5 1 CONSTRUCTION I T'NDING AGENCY that there is a construction lending agency for the performance of the work for which this pennit is Lender's Address: ,rr tcANr "".LARATI hereb,, affrnn under penalty of perjury one of the follorving declarations: Demolition Permils-Asbestos Notification Fedcral Regulations (Title 40. Part6) -Required Lrtter of Notification -l certi& that the federalregulations rcgarding asbestos removal are not applicable to this projed. I agree to comply with all City and County of this City and County to crter upon the above mentioned property for Applicant or Agent 1 Pennitee nzune v\ and state that infonnation is g-- I Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation Insulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings Installation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release ltr FINAL Q-L,12 t/l (LC tc.vsllg -Lrl Notes, Remarks, Etc. -> a L ,lr,.- Contractor:$-!.-\ il o6Y(a U Lb