20170634 - Permit - Laserfiche WebLink

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E LECTRICAL-I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Lisht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm lDampers Communications Cable Building Under SIab / Floor Bondins I Groundinq / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinss (T-Bar Roush) Meter Release Rough Service Meter FINAL Notes, Remarks, Etc. OWNER BUILDER DELCARATION I hrcby a(frm und6 penalty of pqjury thar I m qmpt from the Contrac{oB' LiceN kw for thc following wn (Se.7031.5 Buines ad Profwion Code): Any City or County which rcquim a po'rnit to @Gtrucl, alts, imprcvg &molish or repair uy structure. prior to its i$umcq also requirB the applicut for such pcrmil ro file a signed statmmt that hc or she is licenscd p$uilt to thc prcvisioro of the Contractor's Licensed law (Chaptq 9, Commocing with Seclion 7000 of Division 3 of thc Busincs ud Profesions Codc) or that hc or shc is exempt thqefrom ad the b6is for the allcged amption. Any violation of Sslion 70-11.5 by uy applicantforapomitsubjetsthe applicanttoacivilpenaltyofnotmorcthilhve hunclrcddollm($500). _1, o ownq of the propsty. or my employG with wsgs 6 their elâ‚¬ compâ‚¬mation, will do the work ad the stnrlw b not intmded or offered for sle (Sc.7044, Businas ud Prcfssiom Codq The Contractor's LiccN law doB not apply to il oms of thâ‚¬propqty whotuildsorimprovcthoon,mdwhodoesuchmr*himselforhwlforthroughhborhaomcmployces, prcvided that such imprownts e rct intqded or offqed for sale. If, howd6, the building or improvmot is $ld within one y@ ofomplaion. the Owno Buildq will havc thc hrdo ofFovirg tlld he or shc did rct build or improre the propary for the purpos of slc). _1, as owner of the property, arn exclusively contracting with licensed contractors to construct the project (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 projects with a Contractor(s) licensed pursuant to the Contractor's License Law). -l am exempt under Section-, B. & P.C. for this reason. Date: g9ESESLCOMPINSAIION I hftby affm undq pcnalty of pqjury onc orru rouo*iogffiq _I have anl will maintain a Cstificatc of Colmt to Sclf-lEre for rcrkc' ompqrs*ion s provided for by Setion 3700 of thc Labor code, for the pqfomcc of the mrk for which thc pqmit b isucd. y' have md will maintain workc' compcroation imuancg 6 rcquircd by Sction 3700 of thc lzbor Codc for thc pqfotlme of fhe wrk for which this pqnit is isued. My worko' ompersdion ilsuecc ffii6 ed policy nmbe re' r-*,&//Vr't fr?Y *+ce(4 ^:* -l @ni& that h the psforrucc ofthc work for which this pemit is issucd, I shslt not mploy ily pcmn in uy mm6 rc c to bcorc subjet to thc mrt6'@mpqBation lam of Califomi4 ad agrc tha if I should beome subjel to thc work6' @mpostion prcvisiorc of Sction 3700 of thc labor Codc I shall, forthwith comply with tho* prcvisiore.. WARNING: Failure to secure workers' compensation coverage is unlawful. and and civil fines up to one hundred thousand Section 3076 of the Labor Code. interest dollars tn the and I hereby affirm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License c.q<oq to I hereby affirm under penalty of perjury that there a agency of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: Lender's Address: APPLICANT DECLARATION I hereby affinn under penalty of perjury one of the following declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40, Part6) -Required Letter of Notification -l certi$, that the federal regulations regarding asbestos removal are not applicable to this project. -l certiff that I have application and state that the ordinances and to building the above rnentioned Applicant or Agent Pernritec nanre for inspection information lb1 Rev. 08-07 5