40136049 - Permit - Laserfiche WebLink

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INSPECTOR RECORD SITE.WORK DATE ID/S!G COMMENTS OWNER BUILDTR DTLC ^ RATION I hereby affinn under penalty of periuW that I arn exanpt form the Contractors' License Law for the following reason (Sec.70.31.5 Business and Profession Code): Any City or County which requires a permil to construct, alter. improve. demolish or rtpair 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 Licensed law (Chapter 9. Commencing rvith Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption Any violation of Section 70-11 .5 by any applicant for a pcrmit subjecs the applicant to a civil penalty of not more than five hundred dollars ($.s00). !O-t. ur owner of the pro;rcrty. or my employees wirh rvages as their sote compensation, rvill do the work and the structurâ‚¬ is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the property rvho builds or improves thereon. and who does such wort himself or hcrself or through his or her own cmployees, provided that such improvanents arâ‚¬ not intendod or offered for sale. lf. however. the building or improvement is sold rvithin one ye r of complaion. the Orvner Builder will have the burden of p,roving that he or strc did not build or improve dre propertv for the purpce of sale). Y5. a. owner of the progrrty. am exclusively conracting rvith licensed contractors to constnrct the project (Sec. 7044. Business and Profession Code: The Contractor's License Las, does not apply to an owner of property rvho builds or improves thereon. and rvho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's License Larv). !o_l urr't exempt under Seclion B. & P.C. for this reason. \['OR.KTRS' COMPFNS{TION NFCI ARATION I hereby'affirm under penahy- of periury one of the following declarations: No I h.u. and rvill maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code, for the performance of the wort for which the permil is issued. YES _ I have and will rnaintain u'orkers' comf,ensation insurance. as required by Section -3700 of the [abor Code. for the performance of the rvork for u'hich this permit is issued. My workcrs' compensation insurance carrier and policy number are: . Securlty Natlonal( atTrer: sWC13073C0 Policy Number:__Expires: 10t2312021 NO _ I cerrifo that in lhe grcrformance 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' compâ‚¬nsation larvs of California. and agree that if I should become subject to the worters' compensation provisions of Section -1700 of the l^abor Code. I shall. forthwith comply with those provisions.. II'ARNING: Failure to secure rvorters'comgrnsation coverage is unlarvful. and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as providcd for lhe Section -i076 of the Labor Ccxle. interesl and attorney's fees. LICF'NSTN CONTRACTOR DFCI {RATION I hereby affirm under penalty of perjury that I am licensed under provision of Chapter g (commencing rvith Section 7000) of Division 3 of the Business and Professions Code. and rny license is in full force and effect. l.icense c20 c36 784495 License NurnberClass:_ (.ONSTRUCTION I FNNING {GTNCY I heretry affinn under penalty,of perjur)'that there is a construction lending agency for the perfornurrce of the work for which this permit is issued (Sec. .1097. Cir'. C.). [-ender's Name: l.ender's Address: APPI ICdNT NTCI ARATION I heretry atlnn under penalN of perjury one of the followrng declaratrons I)enrolrtion Pernuts-Asbe$os Notificatron Federal Regulatrons (Trtle 40, Part6) N! Required Letter of Notification YEs I cerlify that the federal rcgulations regardirrg asbestcx rernoval are not applicable to this proiecr. ttl , certiS/ rhat I have read this application and state that the above informarion is correcr. t agree to comply with allCity and Cowrty ordinances and State Laws relating to building construction. and hereby authorize representatives of this City and County to entcr upon the ahove mentioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame) Structural Fanal Plumbing 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 ,l Mechanical Final p/zt/zt (/v , Notes, Remarks, EJrc V v I