101107873 - Permit - Laserfiche WebLink

Home Browse Search

!NSPECTOR RECORD a SITE-WORK DATE ID/SIG COMMENTS OWNER BUII NFR NEI CARATION I hereby affrnn under penalty of perjury that I am excmpl form the Conmctors' Liccnse Law for the following reason (Sec.7031.5 Business and Profession Code): Any City or County which requires a permit to construct. alter. improve. demolish or repair any structure. prior to its issuance. also rcquires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisiom of the Contractor's Licensed larv (Chapter 9. Commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is excmpt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by any applicant for a perrnit sul{ects the applicant to a civil penalry of not more than five hundred dollars ($-s00). II-tf . .r owner of the property. or my ernployees with wages as their sole compensation. will do the work and the stnictune is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Larv does not apply to an ownâ‚¬r of the nropâ‚¬rty who builds or improves thereon. and s'ho dcres such wort himself or herself or through his or her own employees. provided that such improvonents are not intended or offered for sale. lf. horvever. the building or improvetncnt is sold rvithin one year of complaion, the Ou,ner Builder will have the burden of proving that he or she did not build or improve the properw for the purpose of sale). YE_st. a. owner of the properly. am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Profession Code: The Contractor's License Larv does not apply to an owner of properly who builds or improves thereon, and who contracts for such pro.jects with a Contracto(s) licensed pursuant to the Contractor's License Law). xo-t ., exempt under Se<tion . B. & P.C. for lhis reason. WORKF'R.S' ('O[IP['NS ^TION DF'CI ARATION I hereby affirm under penalty of periury one of the following declarations: fSt h"u. and will maintain a Certificate of Consent to Self-lnsure for workers' compens:rtion. as provided for by Secrion 1700 of the [,abor Code. for the perfonnance of the work for which the permit is issued. NO __l have and rr'ill rnaintain rvorkers' compensation insurance, as required by Section .i700 of the l,abor Code. for the performance of the rvork for which this pennit is issued. My u'orkers' compensation insurance carrier and policy number are: Carrier:__ Policy Nurnber:_ NO Expires: _ I cerri[y that in the perforrnance of the rvork for which this pennit is issued. I shall not employ any person in any manner so as lo bccome sub.iect to the workers' compensation laws of ('alifomia. and agree that if I should become subject to the workets' cornpensation provisions of Section 1700 of the [abor Code. I shall. forthu,ith comply with those provisions.. IVARNING: liailure to secure workers'compensation coverage is unlarvful. and shall subject an employer to criminal penaltie and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section 3076 of the l.abor Code. interest and attomey's fees. LICFNSF'N CON'TRA('TOR DECI T ITA'I'ION I hcreby'alTirnr under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Businers and Professions ('ode. and my license is in full force and effect. License Class:I-iccnse Number CONSTRIICTION I t'NNING AGT'NCV I hereby' alTirm under penalty of prjury' that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. .10t)7. Cir'. C.). l,ender's Name: l.cnrler's A<ldrcss: APPI I('ANT DF('I ^ RATION I herehv aftimr under penaltv of peryuw one of the followrng declaratrons Denxrlition Perrrrrts-Asbestos Notrticatron Federal Regulatrons (Trtle 40. Part6) Nl Required l.etterof Notification tt1 t certify that the federal regulations regarding asbestos removal are not applicable to this prqect. 1tl , ceflifo that I lrave read this application and state that rhe above informarion is correri. t agree ro comply with all City and Cotmty ordinances and State Larvs relating to building construction. and hereby authorize representatives of this City and County to entcr upon the above mentiond property for inspection puryoses. Reroof Roof (Diaphragm Sheathing/Frame)7 /t"/ tt r.., 6q) Structural Fina!n/n for \_,- Plumbing / Under Floor I Under Slab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final Electrica! Service (Meter I Panel) Grounding / Bonding Rough Electrical Final Mechanica! Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc.