30143666 - Permit - Laserfiche WebLink

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INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNER BU I LDT'R NELCAR.ATION I hereby affinn under penalty of periury that I am exempt form the Contractors' License Lau' for the following reason (Sec.70l1.5 Business and Profession Code): Any City or County rvhich 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 provisions of the Contractor's l-icensed Larv (Chapter g. Commencing with Section 70fi) of Division -1 of the Business and Professions Code) or that he or she is exetnpt therefrom and the ba-sis for the alleged exemption. Any violation of Section 70-11 .5 by any applicant for a pernrit subjects the applicant to a civil penalty of not more than five hundred dollarc 1$-s00). Y f . .r owner of the properq,. or my employees rvith s'ages as rheir sole compcnsation. will do the rvort and the stnrcture is not inrended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's l.icense l-aw does not apply to an owner of the propâ‚¬rty rvho builds or imp,roves thereon. and rvho does such rvort himself or herself or through his or her own employees. provided that such imgnovements are not intended or offerod fcr sale. If. however. the building or imp,rovement is sold within one year of complaion, the Orvner Builder rvill have the burden of proving that he or she did not build or improve tre properw for thc prpcsâ‚¬ of sale). YEi. a-. owner of rhe property. am exclusively contracting rvith licensed contractors to construct the project (Sec. 7044. Business and Profession Code: The Contraclor's l-icense [.arv does not apply to an o$'ner of property who builds or improves thereon, and who contracts for such proiects with a Contracto(s) licensed pursuant to the Contractor's License Law). !! t a, exempt under Section . B. & P.C. for this reason. woRKF RST COMPFNS^TION nFCl r RJ{TION I hereby alTinn under penalty of perjury one of the following declarations: f t n.". and u'ill mainrain a Certificate of Consent ro Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code. for the performance of the work fcrr rvhich the permit is issued. YES _l have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the performance of the work for which this pennit is issued. My workers' compâ‚¬nsation insurance carrier and policy number are: . Sccurfi Nrtlona!( arner: J)olicv swc1307380 Nunrber:_Expires: 1012312021 NO _- l certi$'that in the performance of the rvork for rvhich this permit is issued. I shall not employ any person in any mann6 so as to become suh.iect to the rvorkers' compâ‚¬nsation larvs of California. and agree that if I should become subject to the worten' compensation pnrvisions of Section -1700 of the Labor Code. I shall. forthrvith cornply with those provisions.. WARNIN(i: Failure to secure rvor*,ers'compensation coverage is unlarvful. and shall subiect an employer to criminal pcnalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section -1076 of the l-abor Code. interest and attomey's fecs. LICENSF'N CONTRACTOR TIECI ^ RATION I herehy alTirm under penalty of periury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and rny license is in full force and effect. c20 c3E l-icense ('lass:78.L05 License Number CONSTRIICTION I FNUNG AGTNCY I hereby affinn under penalty of perjury that there is a construction lending agercy for the per"formance of the work for which this permit is issued (Sec. .1097. Civ. C.). l.ender's Nante: l-endc'r's Address: APPLICANT NFCT AITATION I herebv aflinrr under penalty of perjuw one of the followrng declarations l)enrtllitron Pernrrts-Asbestos Notrficatron Federal Regulalrons (Title 40, Part6) !a Required Letterof Notification YEs I cer1ifu that the federal regulations regarding asbesros removal are not applicable to this project. YES'-- I cerri& that I have read this application and state that the above infonnation is correct. I agree to comply with all City and Coutty nrdinun.., and State Larvs relating to building construction. and hereby authorize representatives of rhis City and County to enler upon the above mentioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame) Structural Final Plumbing Under Floor I Under Slab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test /r /> Plumbing Final 'l Itsh,llri> W\I Electrical I I \-/ Service (Meter / Panel) Grounding / Bonding Rough Electrical Final Mechanical Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc