20173113 - Permit - Laserfiche WebLink

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APPROVALS DATE ID/SIG-COMMENTS Site-Work aa Underqround '/zd 4 0^o*L I Pole Bases Lisht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under SIab I Floor Bonding I Grounding I UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Roush Ceilings (T-Bar Roush) l\Ieter Release Rouqh Service Meter FINAL vcr'zl l? i- tS JelastYl Notes, Remarks, Etc. 1 OW N ER B UI LDER DEI,L-A RA'I'ION I hereby affirm under penalty of Jrcrjury that I am exempt from the Contractors' License Law for the frrllowing 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 requires the applicant for such permit to file a signed staterEnt that he or she is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9. Commencing with Section 7fiX) of Division 3 of the Business and Pmfessions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by any applicant for a permit subjects the applicant to a civil penalty of not nnre than five hundretl dollars ($500). _1. as owner of the property. or my employees with wages as their sole compensation. will do the work and the structure is mlt intentled or offered firr sale (Sec.7014. Business and hofessions Code: The Contractor's License Law does not apply to an owner of thc property whr builtls or improves thercon. antl wh does such work himself or herself or through his or her own employees, provided that such improvenrents afe not intenrletl or offered for sale. If, hlwever, ttrc building or inTrrovenrnt is rckl whhin one )â‚¬ar of completion, the Owner Buikler will have the burden of proving *ut he or she did not buikl or impnrve the pnrperty for the purprse of sale). _1, as owner of the property, am exclusively contracting with licensed contractors to construct the pnrject (Sec. 7044. Business and Pnrfession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts frlr such pnljects with a Contracto(s) licensed pursuant to the Contractor's License Law). -IamexemptunderSection-,B.&P.C.forthisreason.Date: Owner: }VORK ERS' C( INI I'ENSA'I'ION D} CLARA'I'ION I hereby affirrn under penalty of perjury one of the following declarations: -l have and will rnaintain a Certitjcate of Consent to Self-lnsure for workers' compensation, as pnrvided for by .Section 37fi) of thc Labor Code, ftrr the perfirrmance of the work for which the permit is issuerl. _l have and as by Section 37U) of the Labor Code, for the lrcrformance of the work frlr carrier and plicy number are: - Policy _l certifythat in the performance of the work fur which this permit is issuetl, I shall not empkry any person in any manner so as to become subject to the workers' compensation laws of California. and agree that if I shoukl become subject to thc workers' compensation provisions of Section 37fi) of the l-ahlr Cule, I shall. forthwith comply with thore pnlvisions.. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hun<Ired thousand dollars ($100,m0), in addition to tlre cost of comJrcnsation, damages as provided firr the Section 3076 of the Lahrr Code, interest and attorney's fees. a ur,", - Scf-22( I hereby afhrm under Jrcnalty of perjury that I am licensed untler provision of Chapter of the Business and Professions Code, and my license is in full force and effect. I with Section 7fi)0) of Division 3 l License o Number:- u*", ? S. 1- .Z)ZI >( I hercby affirm under pnalty of perjury that thcre is a construction lending agency for the perftrrmance of the work for which this permit ls issued (Sec. 3097, Civ. C.). Lender's Name: [.ender's Address: APPLICANT DECLARATION I ffiy affnnr under penalty of perjury one of the following declarations: Denmlition Permits-Asbestos Notification Federal Regulations (Title 40, Pan6) -Required [-etter of Notification -l certify that tlre federalregulations rcganling asbestos rernlval are nol applicable to this project. G"rnify that I have read this application and state that the above inforrnation is correct. I agree to conqrly with atl city anrl county ordinances and State [:ws rclating to building construction, ancl hereby authrrize reprcsentatives of this City and County to enter upon the above mentioned property for inspection /@?oo? ><o^r",-l'('2021--------v-Applicant or Agent l'ernritet nanle ELECTRICAL-INSPECTOR RECORD ( ev.08-07-2015 <+^\.o