20173395 - Permit - Laserfiche WebLink

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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltase Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding / Groundins / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh)Q1oat r{Lc Z ) Meter Release Rouoh Service Meter FINAL 128 z\ZOI:>Jeian-'Zl'| Notes, Remarks, Etc. I hereby affirm under penalty of perjury that I arn exempt from the Contractors' License Law frlr the following reason (Sec.7031.5 Business arxl Profession Ccxle): Any City or County which requires a permit to construct, alter. improve. dennlish or repair any structure. prior to its issuance. also requires the applicant ftrr such grrmit to file a signed statement that he or she is licenscd pursuant to the pnrvisions of the Contractor's Licensed Law (Chapter 9, Commencing with .Section 7fiX) 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 T03l .5 by any applicant for a grcrmit subjects the applicant to a civil penalty of not nxrre than five huntlred dollars ($5m). _[, as owner of the prcperty, or my employees with wages as their soh comlrcnsation, will do the work and thc structure is rnt intended or offered for sale (Sec.70l4. Business and Professions Ccxle: The Contractor's License Law does not apply to an owner of the property who builds or improves thercon" and whcr does such work himself or herself or through his or her own empkryees, provided that such improvernents are not intended rlr offercd filr sah. I[ lxrwever, the building or inqtrovenrcnt is sold wilhin one year of completion, the Owner Buikler will have the burden of pnlving tturt he or she dil not build or improve the pruperty for thc purynse of sah). _1. as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7(X4. Business arxl Prufesskrn Code: The Contractor's License Law does not apply to an owner of property who builds or improves thcreon, and who contracts for such projects with a Contracto(s) licensetl pursuant to the Contractor's License Law). -l am exempt under B. & P.C. for this reason. WORK ERS' COM I'ENSA'I'ION DECLARATION I hereby affirm under penalty of perjury one of the following tleclarations: _l have and will maintain a Certifrcate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of thc Labor Code, frrr thc performance of the work for which the permil is issued. _l have and will maintain workers'compensation insurance, as required bySection3T(Dof the laborCode, forthe perfirrmanceof the work ftrr which this permit is issued. My workers' compensation insurance carrier arxl grlicy number are: Canier: Policy Numtrcr: Expires: that in the perfrrrmance of the work for which this permit is issued, I shall not empk)y any person in any manner so as to becorne subject to the workers'compensation laws of California. and agrce that if I slxluld become suhict to the workers' compensation provisions of ,Section 3700 of the Lahrr Code, I shall, firrthwith comply with those pnrvisions.. WARNTNG: Failure to secure workers'compensation coverage is unlawful. and shall subject an employer to criminal Jrenaltics and civil fines up to one hundred thousand dollars ($100,fiD), in atldition to the cost of compensation, damages as provide<l for the Section 3076 of the Lahrr Code, interest and attorney's fees. ",",5 / 26 /teu( I hercby affirm under penalty of prjury that I am licensed under provision of Chapter 9 (comrnencing with Section 70m) of Division 3 of the Business and hofesskrns Code, and my license is in full frrrce and effect. License Number: CONSTRUC'I'ION LTNDING AGENCY I hercby affirm under penalty of pe rjury that thcrc is a construction hnding agency for the performance of the work for which this permit is issuetl (Sec. 3097, Civ. C.). Lender's Name: Lentler's Address: APPLICANT DECLARATION I hereby affrm under penalty of perjury one of thc following declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Requ ired lrtter of Notifrcation furnify thu the federalregutations regarding asbestos rernvalare not applicabte to this project. -l certify that I have read this application arxl state that the above informathn is corrcct. I agree to comply with all City and County ordinances and State Laws relating to building construction. and hereby authorizr representatives of this City and County to enter upon the *-,3 /26 lzot 1 l'ermitt'e name 0B-07-2015 Conlractor:., above nrcntioned property for inspectro| puryoses. r AppricanrorAgent ,ru rrr"", ) | TeA Ttlg,all