20168544 - Permit - Laserfiche WebLink

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I hqcby affrrn undc pcralty of pajury that f m excmpt from thc ContractoB' License taw for thc folbhqg rcn (Sx.ru-,,.. B$in6s ild Profasion Codc): Any City or County which rcquire a pomit to @strud, altc. improvg &molGh'or rcpeir mi structue. prior to its issmcc, also rcquirG thc applicut for such perrnit to filâ‚¬ a signcd $atm@t that hc or shc b licetcd plmq[ . to the prcvisioN of thc Contr.ctor's Liccnscd Law (Chaptq 9. Comcncing with Setion 7000 of Division 3 of thc Buins ud Prcfsions Codc) or that hc or shc is cxmpt thqcfrom ed thc basis for thc allcgcd cxmBion. Any violstion of SE{bo 7031.5 by any applicut for a po'mh subjets thc spplicut to a civil poalty of not morc tho fivc hun&cd dollus (1500). -1. as owner of the property. or my employees with wages as their sole compcnsation. rvill do the work and thc stnrture b not intendod or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who builds or improvcs theron and who does such work himself or herself or through his or her own employees. provided that such irnprovonents are not intendcd or offered for sale. If. howwer. the building or improverncnt is sold within one )Ear of complaion, the Orvner Buildcr will have the h.rden of proving tha hc or she did not build or improve the propoty for the purpose of sale). _1. as owner of the property. am exclusively contracting with licenscd contractors to construct the project (Sec. 7044. Brsiness and Prroftssion Codc: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a Contraclo(s) licorsed pursuant to the Contractor's License law). -l am exempt under Section-. B. & P.C. for this reason. Owner: WORI(ERS' CODIPEN SATION DECLARATION I hereby affrrm under pcnalty of perjury one of the following declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the l-abor Codc, ficr the performance of the work for which the perrnit is issucd. -l have and will maintain workers' compensation insurance. as required by Section 3700 of thc l-abor Codc, for the po'formance of the work for which this permit is is$cd My workers' compensation insurancc carrier and policy numbcr are: l)it t e Policy Number: Expires: _l certify that in the performance of the work for which this perrnit is issued. I shall not etnploy any person in any manner so as to become subject to the workers'compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Lahlr Code. I shall. forthwilh cornply with those provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful.subject an to crirninal penalties and civil fines up to one hundred thousand dollars ($100.000).the of compensation.as provided for the Section 3076 of the Labor Code, interest and attorney's '2S-Zot I hereby aflinn under penalty of perjury that I arn licensed undcr provision of Chapter 9 (comrnencing with Section 7000) of Division 3 of the Business and Professions Code. and rny license is in full force and effect. License L l-z l) I hereby affrrm under penalty of per-jury that issued (Sec. -j097. Civ. C.). of the work for rvhich this perrnit is Lender's Ad&ess: APPI ICANT DECL T RATION I hereby affrnn under poralty of perjury one of the following declarations: Demolition Permits-Asbcstos Notification Federal Regulations (Titlc 40. PaI16) -Required l-,etter of Notification -l certify that the fderalregulations regarding asbestos removal are not this project. infonnation is I agree to comply with all City and ('ounty of this City and County to enter upon the Dnte:,)- 2S - Zr:r -l cefli& that I have read this application and state that ordinanccs and State Laws relating to above mentioned property for Applicant or Agent I'crrttilec nil nle (prirrt ): iurd 1 APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm I Dampers Communications Cable Buildins Under Slab / Floor Bondinq I Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Rouqh) Meter Release Rough Service Meter FINAL ?4-ctzt lL Ot<,/c.us -27 Notes, Remarks, Etc. no n7 )n -t r:, ELECTRICAL.I NSPECTOR RECORD