101107919 - Permit - Laserfiche WebLink

Home Browse Search

INSPECTOR RECORD SITE-WORK DATE ID/S!G.COMMENTS OWNER BUILDFR DEI CARATION I hereby affinn under penalty of periury that I am exempt form the Contractors' License Larv for the following re:$on (Sec.7031.5 Business and Profession Code): Any ('ity or County rvhich requires a permit to construct. alter. improve. demolish or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed stateflrâ‚¬nt that he or she is licensed pursuant to the p,rovisions of tte Contractor's Licensed Larv (Chapter 9. Commencing rvith Section 7000 of Division -1 of the Business and Professions Code) or that he or sheisexempttherefi'omandthebasisfortheallegedexemption. AnyviolationofSectionT03l.5byanyapplicantforapcrmitsubjectsthe applicant to a civil penalty of not more than five hundred dollars ($500). *1f . ". owner of the property. or my onployees with rvages as their sole compensation. rvill do the work and the structurâ‚¬ is not intendod or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Larv does not apply to an owner of the propâ‚¬rty who builds or improves thereon. and rvho does such rvork himself or herself or through his or her orvn employees. provided that such irnprovements are not intended or offered for sale. If. hou,o,er. the building or impovement is sold within onc year of complaion. the Orvner Builder s,ill have the burden of p,roving that he or she did not build or improve the properW fcn ttre purpose of sale). Y!st. as owner of the proFrcrty.am exclusively contraoing rvith license<l contractors to construcr the project (Sec. 7044. Business and Profession Code: The Contractor's l.icense Larv does not apply to an owner of property who builds or improves thereon. and s'ho contracts for such projects u,ith a Contracto(s) licensed pumuant to the Conffactcn's [-icense Law). !!1 ., exempt under Seoion 703r.5 _. B. & P.C. for this reason. WORKFRS' COM PF'NS ATION NFCLARATION I hereby alTirm under penalty of perjury one of the following declaratiors: *a I tlru. and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the l.abor Code. for the performance of the work for rvhich the pennit is issued. YES -_lhaveandrvill maintainu'orkers'compensationinsurance.as requiredbySection-1700ofthel.aborCode.forthepcrformanceofthe work for rvhich this perrnit is issued. My workers' compensation insurance carier and policy number are: Statc Compcnratlon lnrurancc Fund('amier: 1211212021 l'}olicy' Nurnber: ilo _Expires: _l cerri$'that in the grcrformance of the rvork for u,hich this permit is issued. I shall not employ any person in any manner so as to become suhject to the u'orkers' compensation lau's of Califomia. and agree that if I should become subiect to the workers' compensation provisions of Section .1700 of the Lahor Code. I shall. forthrvith comply with those provisions.. WARNIN(i: Failure to secure rvorters'compensation coverage is unlau,ful, and shall subiect an employer to criminal penalties and civil fines up 16 onâ‚¬ hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section.1076 of the [.abor Code. interest and attomel"s fecs. LI('FNSFN ('ONTRACTOR NFCI AR ^TIONI hereby alTirm uncler penalty of perjury that I am licensed under provision of Chapter g (commencing rvith Section 7000) of Division -1 of the Business and Professions Code. and my license is in frrll force and effect. c39 License Class: 98/t203 l.icense Number CONSTRUCTION I FNNING AGFNCY I hereby affirm under penalty of periury that there is a construction lending agerrcy for the perfornunce of the wort for which this permit is issued (Sec. -1097. ('iv. C.). Lender's Name: l,ender's Address: APPI IC^NT NFCI ^RATION I heretrv aflimr undel penalty of perluw one of the followrng declarations: Denrolrtion Perrrrits-Asbestos Notrlicatron Federal Regulatrons (Trtle 40. Part6) !o Required l-etterof Notification t-t1 t certiS/ that the federal regulations regarding asbestos removal are not applicable to this prqect. at YEg I cerriI that I have read this application and state that the above information is correct. I agree to comply'rvith all City and County ordinances and State l-as's relating to building construction. and hereby authorize representatives of this City and County to enter upontre above mentioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame)la s.-- Ztl Structural Final /6-(*z-t L-rnil' {r.G Plumbing Under Floor I Under Slab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final Electrical Service (Meter I Panel) Grounding / Bonding Rough Electrical Final Mechanical Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc. *rJ.nL frp; t**