30143354 - Permit - Laserfiche WebLink

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SITE-WORK DATE !D/SIG.COMMENTS O\TNER BU ILDER DT LCARATION I hereby affirm under penalty of perjury that I am exempt form the Contractors' License Law for the following re:son (Sec.70.1L5 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 staterncnt that he or she is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9. Commencing with Section 7000 of Division -i of the Business and Professions Code) or that he or she is exempt therefrcrm and the basis for the alleged exemption Any violation of Section 7031.5 by any applicant for a pcrmit subjects the applicant to a civil pcnalty of not more than live hundred dollars ($-s00). Nl l. "r owner of the prope'rty. or my employees r.r'ith wages as their sole comgrcnsation. rvill do the wort and the structure is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License [:w does not apply to an owner of the propcrty who builds or improves thercrrn, and who does strch work hirnself or herself or through his or her own cmployees. provided that such improvanents are not intended or offered for sale. lf, howo.er. the building or impnovement is sold within one year of complaion. the Owner Builder will have the burden of proving that he or she did not build or improve the properil for thc purpcâ‚¬ of sale). !! l. a. owner of the property. am exclusively contracting with licensed contmctors to construct the project (Sec. ?044. Business and Itofession Code: The Contractor's License Larv does not apply to an owner of property rvho builds or improves thereon. and who contracts for such prcjects with a Contracto(s) licensed pursuant to the Contractor's License Law). [o I .r, exempt under Section B. & P.C. for this reason. WORKFRS' COI}I PF'NSATION DT'CI A,RATION I hereby affirnr under penalty of periury one of the following declarations: !o-t f,ru. and rvitt maintain a Certificate of Consent to Self-lnsure for workers' compensarion. as provided for by Section 3700 of the Labor Code. for the performance of the work for which the permit is issued. YES _ I have and will maintain workers' compensation insurance. as required by Section .17fi) of the Labor Code. for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: . Sccurtty ilrtlonal( arner: 1112312021 Policy Number: NO Expires: _ _l certilr'that in the performance of the rvork for which this permit is issued. I shall not employ any person in any manner so as to become subiect to the rvorkers' compensation laws of California. and agree that if I should become subject to the workers' cornpensation provisions of Section .1700 of the Labor Code. I shall. forthwilh comply with those provisions.. WARNING: Failure to secure workers'compensation coverage is unlarvful. 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. darnages as provided for the Section 3076 of the l-abor Code. interest and attomey's fees. LI('F'NSTD CONTRA('TOR t}FCI ^ RATION I hereby affinn under Srcnalty of grr.iury that I arn licensed under provision of Chapter 9 (commencing with Section 7000) of Division J of the Business and Professions ('ode. and my license is in full force and effect. c2(}C30 [.icense ('lass:7E4495 License Number C()NSTRI.ICTION I T'NNIN(; AGFNCY I hereby afTirm under penalty of per.jury that there is a constnrction lending agency for the performance of the rvork for which this permit is issued (Sec. .1097. Civ. C.). l-ender's Name: Lender's Address: APPI ICANT NFCI {R,ATION I heretry affimr under penalty of per1ury one of the followrng declarations: Denrolrtion Pernrits-Asbestos Notification Federal Regulatrons (Trtle 40. Part6) p_ Required Letterof Notification vel I catify that the federal regulations regarding asbestos removal are not applicable to this project. 1t-t , certiS, that I have read this application and state that the above information is correcl. t agree to comply with all City and County ordinances and State Laws relating to building construction. and hereby authorize representatives of this City and County to enter upon the above menlioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame) Structural Final PIum bing Under Floor I Under Slab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test -^ Plumbing Final /b-/>zl Lqryq ) 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. INSPECTOR RECORD t\