40135487 - Permit - Laserfiche WebLink

Home Browse Search

M ECHAN ICAL.I NSPECTOR RECORD APPROVALS DATE !D/S!G.COMMENTS OWNER BUILDER DEITARATION I hmby aflm uodq poalty of pqjury thar I m cxmpt 6om thc ContradoE Licre kw for thc following rcen (Ss.7031.5 Busincs ud Profasion Codc): Any City or Couty which rcquic'a pqmit to orstruct. altq, improvc. doolish or rcpair uy structuc. prior to its isswcc, also requiG thc applicar for such pqnit to filc a signrd ndmt thst hc or slE b licc[scd plruad to thc prcvisioN of thc Contrsctor's Liccnscd Lrw (Ch8ptq 9, Comocing with Sction 7000 of Divisioo 3 of thc BEirc ud Prcfc$ioE Co&) or that he or shc is dcmpt th@from and thc bais for thc allcXcd amption. Ary violation of S6tbn 7031.5 by my applimtforapamitsubjcsrhc applicuttoacivilpcultyofootmorcthafivchundrcddollm(t500). -1, as owner of the propertyt or my employecs with wagcs as their sole compcnsation, will do the wort and the structure b not intendod or offered for sale (Sec.7044, Business and hofcssions Code: The Contraclor's Licensc l-aw 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 improvanrents arc not intendcd oroffcnod for sale. l[ howcvcr. the building or improvement is sold within one ]qr of complaion. the Orner Builder will have the hrdcn of proving dra he or she did not build or improve the propcrty for the purposc of sale). -1. as owner of thc propeny. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Buiness and hofission Code: The Contractor's License Law does not apply to an ownef, of propcrty who builds or improves thereon, and who contracts for such projects with a Contracto(s) licerscd pursuant to the Contractor's Licersc l-aw). -I am under B. & P.C. for this reason.rOrnnunf of the follorving declarations:I hercby affrm under pcnalty of perjury one _l have and will maintain a Certificate of Consent to Self-lnsure for workcrs' compmsatio[ as providcd for by Section 3700 of the I-abor Codc for the pcrformance of the wor* for which the pcrrnit b issued. -l havc and will maintain workers' compeosation insurance, as required by Section 3700 of the labor Code, for the performance of the work for which this pernrit is issuod. My workers' compensation irsurance carrier and policy number are: Carricr: Policy _l cetifr that in thc performance of the work for which this permit is issued, I shall not onploy any person in any manncr so ils to bccome subject to thc workers' compensation laws of California, and agrce that if I should become subject to thc workers' compensation provisions of Section 3700 of the Labor Code. I shall, forthwilh cornply wilh those provisions.. WARNING: Failure to sccure workers' compensation coverage is unlawful, and shall subject an ernploycr to criminal ponlties and civil fines up to onc hundred thousand dollars ($100.000). in addition to the cost of compensation, damages as provided for the Section 3076 of the Labor Codc, interest and attorney's fees. o,,", Ll(a P)a- LTCENSED CONTRACTOR DECIAITATION I hcreby afnrm under paralty of pcrjury tha I am licâ‚¬rucd under povision of Ctraptcr 9 (comnrcocrng with Soctbn 7000) of Division 3 of thc Business and Profcssions Code, and my licensc is in full forcc and effect. License Class: License Number: ('oltl raclor'. W I hcby alfm udc paultyof pojurytha th@ ir 8 @nnrudbn larding agocy forthcpcfomc of thc worl br wlrich thir pmit b issucd (Sc. 3097, Civ. C.). Lcndcr's Name: Lender's Address: APPLICANT DECLARATION I hei.,*y affirm under peaalty of perjury one of the fotlowing declarations: Demolition Permits-Asbcstos Notification Federal Regulations (Title 40, Part6) -Required Lrtter o f Notifi cation _l cdiry thd thc fcdqal rr?ulatioB rrgadin8 Bbâ‚¬to3 mov.l sc mt applic.blc to thb Fojct. -l cdiry that t havc Gd ftis spplicarion ard stalc that thc abovc irfomation is cotrE1. I agr to comply with all City ed County ordimcc and Statc l,w rchirg to hrilding condruclio& ad hTcby &{horia rcprffitdivB of this City and Couty to mtq upon thc above mentioned property for Applicant or Agent Perrnitee name (print): purposes. I Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rouqh Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test n Meter Release \\ FINAL g-k-Z)v,yt Notes, Remarks, Etc. h{ Exoires: ,^,", l lot ful - - V