101106765 - Permit - Laserfiche WebLink

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INSPECTOR RECORD ?SITE.WORK DATE ID/SIG.COMMENTS OWNER BTIII NER DELCARATION I hereby affirm under penalty of periury that I am exempt form the Conffaclors' License Law for the following reason (Sec.70-31..5 Business and Profession Code): Any City or County which requires a pennit to construct. alter. improve. demolish or repair any structure. prior to its issuance. also requires the applicant for such permit to file a signed statement that he or she is licersed pursuant to the provisions of the Contractor's Licensed [,aw (Chapter 9. Commencing with Se<tion 7000 of Division -1 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption Any violation of Se<tion 70-31 .5 by any applicant for a pcrmit subiects the applicant to a civil penalty of not more than five hundred dollars 1$-500). Y131. rr owner of the property. or my employees with wages a-s their sole compensation. will do the work and the structure is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an ownâ‚¬r of the propâ‚¬Tg' who huilds or improves thereon. and who does such wort himself or herself or through his or her own employees. provided that such imprrrvernents ilâ‚¬ not intended or offerod for sale. lf. however. the building or improvement is sold within one yeirr of complaion. the C)s'ner Builder will have the burden of proving that he or she did not build or irnprove tlre propertv for the purpose of sale), Ilt. * owner of rhe proFrerty, am exctusively conrraoing with licensect contractors to constnrct the proiect (Sec. 7044. Business and Profession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such pro.iects rvith a Contracto(s) licensed pursuant to the Contractor's License Law). No I a,r, exempt under Section B. & P.C. for this reason. WORKF'RS' COMPFNS ^ TION NT'CI ARATION I hereby affirm under penalty of perjury one of the following declarations: !o I n"r. and will rnaintain a Certificate of Consent to Self-lnsure for workers' compâ‚¬nsation. as provided for by Section -i700 of the labor Code. for the performance of the work for which the permit is issued. NO _l have and will maintain workers' compensation insurance. as required by Section -1700 of the Labor Code, for the performance of the rvork for rvhich this permit is issued. My workers' compensation insurance carrier and policy number are: STATE FUND('an'ier: 9012332-22 o5.t01t2022 l: r pircs:Policy Nurnber: YES _ _l certify that in the performance of the rvork for rvhich this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' cornpensation laws of California. and agree that if I should bccome subject to the workers' compâ‚¬nsation provisions of Section 3700 of the Labor Code. I shall, forthwith comply with those provisions.. WARNING: Failure to secure rvorkers'compensation coverage is unlawful. and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section 3076 of the [,abor Code. interest and attomey's fees. LICFNSTN CONTRACT()R NFCI ARATION I hereby affrrm under penalty of perlury that I am licensed under provision of Chapter9 (commencing with Section 7000) of Division -3 of the Business and Professions Code. and my license is in full force and effect. c39 [-icense Class: !14E37 l.icense Nunrber CONSTRUCTION I F'NNING AGFNCV I hereby afllnn under penalty of perjury that there is a construction lending agerrcy for the performance of the work for which this permit is issued (Sec. 3097. Civ. C.). Lender's Name: iloNE NONE l.ender's Address: APPI ICANT NFCI ARATION I herebv afl[mr undel penalty of per1ury one of the followrng declarations: Denrolrtion Perntits-Asbestos Notrficatron Federal Regulatrons (Title 40, Part6) !1 Required l-etterof Notification YEg f certi$/ that rhe lederal regulations regarding asbestos removat are not applicable to this project. a t-I , cefli$/ that I have read this application and state that rhe above information is correct. I agree to comply with all City and Cotnty ordinances and State l,aws relating to building construction. and hereby authorize representatives of this City and County to cnter upon thc above mentioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame)C - 2,7-J bYLryfr fi fii 6l+ b-+Ih cr*P t$^r?l Structural Final G-7,-z.l Plumbing (-/L\- 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.