20174111 - Permit - Laserfiche WebLink

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INSPECTOR RECORD a SITE-WORK DATE ID/S!G.COMMENTS OWNER BUILDER DTLC {RATION I herehy afTinn under penalty of periury that I am exempt form the ('ontractors' l.icense Larv for the follorving reason (Sec.70.11 .5 J,usiness and Profession Code): Any City or County rvhich requires a Frrmit to corlstrucl. alter. improve. demolish or repair any structure. prior to its issuance. also requires the applicanl for such perrnit to file a signed slataxent that he or she is licensed pursuant to the provisions of the Contractor's I.icensed l-au,(Chapter9. Commencing with Section 7000 of Division .1 of the Business and Professions Code) or that he or she is exempt therefrorn and the basis for the alleged exonption Any violation of Section 701I .5 by any applicant for a pcrmit subiects the applicant to a civil penalty of not more than fir,e hundred dollars ($500). [1. r. owner of the proFrcrty. or my employecs u,ith wages as their sole compensation. rvill do the rvork and the structurc is nor inrended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's l-icense [.aw does not apply lo an owner of the propcrty rvho builds or improves thereon. and rvho does strch rvork himself or herself or through his or her orvn cmployees. providcd that such improvements atr not intendecl or offered fior sale. lf. horvever. the building or improvcrrâ‚¬nt is sold within orrc year of complaion. the Orvner Ruilder s'ill have the burden of proving that he or she did not build or improve tlre properil fcr the ptrpcre of sale). 19 t. ,r owner of the propea)'. am exclusively contracting rvith licensed conractors to construct the project (Sec. 7044, Business and Profession Code: The Contractor's l-icense I-arv does not apply to an owner of property rvho builds or improves thereon. and s'ho contracts for such projects u'ith a Contracto(s) licensed pursuanl to the Contractor's l.iccnse Lau'). No I arn exempt under Section B. & P.C. for rhis reason. l+'ORKFR.S' COMPTNS{TION NFCI T RATION I hereby affirm under pcnalty of perjury one of the following declarations: ! I nr*. and will maintain a Certificare of Consent to Self-lnsure for s'orkers' compensation. as provided for by Section 1700 of the labor Code. for the per-formance of the u'ork for s'hich the permit is issued. YES __ I have and s'ill maintain rvorkers' compâ‚¬nsation insurance. as required by Section .1700 of the [:bor Code. for the pcrformancc of the rvort for rvhich this permit is issued. My workers' compensation insurance carrier and policy numher are: rtate fundcarrier:- -e22e222 1ttm2021 Policy Number:_ _Expires: NO I cerrifr'that in the perfonnance of the rvort for u'hich this grrnrit is issued. I shall not employ any person in any manner so as to bet-ome subiect to the u'orkers'compensation larvs of Califomia. and agree that if I should become sub.iect to the workers' compensation prcr,isions of Section -17()0 of the [.ahor Code. I shall. forthwith comply u'ith those provisions.. WARNING: Failure to secure rvorters'conrprensation coverage is unlarvful. and shall subiect an employer to criminal pnalties and civil fines up lo one hundred thousand dollars ($100.000). in addition to the cost of compensalion. damages as provided for the Section 3076 of the Labor Code. interesl and attornev's fees. LI('FNSF'n ('ON'r'RA("rOR nE('l AR,t'rroN I hereby affirm under penalty of periury llrat I arn licensed under provision of Chapter g (comnrencing with Section 7000) of Division .1 of the Business and Professions ('ode. and mv license is in full force and effect. cl0 l-iccnse ('lass:1032529 l.icense Nurnher (.ONS'[RTI(:TION I ]'NDING AGEN('Y I hereby affirm uncler penalty of periury that there is a construction lending agency for the perfonnance of the work for u,hich this perrnit is issued (Sec. -10t)7. Cir,. C.). I-ender's Narne: l.ender's Address: APPI I(' AN']' NT('LARA'TION I herebv allinn under penalty of'per iury one of the follorvrrrg dc'claralrons Derttol rtron Perrnrts-Asbestos Notrlicatron Federal Regulalrons (Trtle 40. Part6) No Required l-etter of Notific:ation ttl t certiS/ thar the federal regulations regarding asbestos removal are not applicahle to this pro.iect. YES_ I certifu that I have read this application and state that the above information is corre.ct. I agree to comply rvith all City and County ordinances and State l^arvs relating to building construction. and hereby authorize representatives of this City and County to enter upon the above mentioned propâ‚¬rty for inspet'tion purposes. Reroof Roof (Diaphragm Sheathing/Frame) Structural Final Plumbing Under FIoor I Under Slab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final Electrica! Service (Meter I Panel)b-.|-Lt \) Grounding / Bonding /o-,1 -Zt ) Rough /ra4t A-.{t tlz- Electrical Final lo4-zt ,-a tl r- Mechanica!\ Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc. t