30143548 - Permit - Laserfiche WebLink

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INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILNTR DFLCARATION I hereby alTirm under penalty of periury that I am exempt form the Contractors' License Law for the following reason (Sec.7031.5 Business and Profession Code): Any City or County which requires a pcrmit to construct. alter. improve. demolish or repair any structure. prior to its issuance. also rcquires the applicant for such permit to file a signed statemcnt that he or she is licensed pursuant to the p,rovisions of the Contractor's [.icensed Larv (Chapter 9. Commencing with Section 7ffX) of Division .1 of the Busines and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption Any violation of Section 70-l I .5 by any applicant for a permit subiects the applicant to a civil penalt-v of not more than five hundred dollars ($.s00). f,o l. ,, o\\,ncr of rhe property. or my employees rvith rvages as their sole compensation. will do the wcrt and the stnrcture is not intended or offeretl for sale (Sec.7M4. Business and Professions Code: The Contractor's License [.aw does not apply to an ovner of the propâ‚¬rty rvho builds or improves thereon. and rvho does srch wort himself or herself or through his or her own anployccs, provided that such improvements arc not intended or offered for sale. lf. hcnverrer. the building or imp,nrverrcnt is sold within one year of ccrnplaion. thc Owner Builder u,ill have the burden of proving that he or she did not build or improve ttre properw fcn the purpose of sale). NO t. at o\\,ner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044. Business and Profession Code: The Contractor's License Law does not apply lo an owner of property who builds or improves thereon. and rvho contracts for such projects rvith a Contracto(s) licensed pursuant to the Contractor's l-icense Larv). No I .rrl exernpt rrncler Section . B. & P.C. for this reason. \I'ORKF'RS' COMPT'NS^TION NFCI A]IATION I hereby affrnn under penalty of perjury one of the following declarations: *! t n.". and will rnaintain a Certificare of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the l.abor Code. for the performance of the rvork for which the pennit is issued. YES _l have and rvill maintain rvorkers' compensation insurance. as required by Section -1700 of the [:bor Code. for the performancc of the work for which this permit is issued. My rvorkers' compcnsation insurance carrier and policy number are: FARTERS IN3URANCE EXCHANGE Carrier: ---^oaaoatat Policy Numbcr: oen',/2021 [:r pires: NO I certify that in the performance of the work for which this Frrmit is issued. I shall not employ any person in any manner so as to hecome suh.iect to the rvorkets'compensation larvs of California. and agree that if I should become subject to the workers' compâ‚¬nsation pror,Lsions of Section -1700 of the Labor Code. I shall. forthwith comply with those provisions.. WARNIN(i: Failure to secure worters'compensation covemge is unlawful. and shall subiect an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to lhe cost of compensation, damages as provided for the Section -1076 of the l-abor Ccxle. interest and attomev's fees. LICENSFD ('ONTRACTOR t}FCI AR ATION I hereby alTinn under penalty of perjury that I arn licensed under provision of ('hapta'9 (conrmencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. c3c [,icense Class: 7a0'ee [.icense Number CONSTRII('TION I FNNING AGFNCY I hereby affirm under penalty of perjury that there is a constnrction lending agency for the performance of the work for which this permit is issuc<l (Sec. .1097. Cir'. ('.). Lender's Name: l-ender's Address: APPI ICANT ]IF('LAR.ATI()N I herebv aflimr under penalw of perluw one of the followng declaratrons I)enxrlrtron Pernrrls-Asbe$os Notifrcation Federal Regulatrons (Title 40. Part6) No_ Required l.etter of Notifi cation YEs l certifi,lhat the federal regulations regarding asbestos rernoval are not applicable lo this pro.iecr. YEg I cenify that I have read rhis application and state that the above infonnation is correct. I agree to comply with all City and County ordinances and State Larvs relating to building construction. and hereby authorize representatives of this City and County to enter upon the ahove mentioned property for inspection purposes. Reroof Roof (Diaphragm Sheathing/Frame) Structural Final Plumbing Under Floor I Under Slab Rough 7)-Zoa {Lcnzr,t Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final /'"9o4/rLLte ffi-zr/ Electrical Service (Meter I Panel) Grounding / Bonding Rough Electrical Final Mechanica! Gas Air Pressure Test Rough Piping (HW, CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc.