101108032 - Permit - Laserfiche WebLink

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!NSPECTOR RECORD l SITE-WORK DATE ID/SIG COMMENTS O}YNFR BTIILDER DTLCARATION I hereby affinn under penalty of penurr- that I am exenlpt form the Contractors' License Law for the follorving reason (Sec.70-11.5 Business and Profession ('ode): Any ('ity or ('ounty s,hich requires a perrnit to constnrct. alter. improve. dernolish or repair any structure. prior to its issuance. also requires the applicant for such pcrmit to file a signed statement that he or she is licensed pursuanl to thc provisions of the Contractor's [.icensed l.arv (('hapter 9. ('omrnencing u'ith 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 exetnption Any violation of Section 7011.5 by any applicant for a permit subjects the applicant to a civil penaltv of nol more than live htrndred dollars ($500). 91. "r owner of rhe properry. or rny ernplol'ees s,ith rvages as their sole compensation. s,ill do the work and rhe stnicturc is not intended oroffered for sale (Sec.7044. Business and Professions C'ode: The Contractor's License [^arv dcrcs not apply lo an owner of the property rvho builds or improves thereon. and s,ho does such rvork himself or herself or through his or her own onployees. provided that such irnprovonents are not intended or offere<l for sale. lf. howo'er. the building or imp,rovement is sold within one year of ccrmplaion. the Orvner Builder u,ill have tlre burden of proving that he or she drd not build or improve the propertv for the puryose of sale). Yll. a. owner of the properly. arn exclusivelv contracting with licensed contractors to consttuct the pro.ject (Sec. 7044. Business and Profession Code: The Contractor's l.icense l.arv does not apply to an owner of property who builds or improves thereon, and rvho contracts for such prniects rvith a Contractor(s) licensed pursuant to the Contractor's [,icense l-aw). No I a,r, exempt under Section - . U. & P.C. for this reason. }T'ORKT'RS' COMPENSATION NTCI ARATION I hereby affinn under penaltv of penury one of the frrllorving declarations: *o I f,"". and s'ill maintain a Certificate of ('onsent to Self-lnsure for rvorkers' compensation. as provided for by Section -1700 of rhe Labor Code. for the performance of the work for which the permit is issued. YES _l have and rvill maintain rvorkers' compensation insurance. as required by Section 3700 of the l-:bor Code. for the performance of the rvork for which this permit is issued. My rvorkers' compensation insurance carrier and policy numbcr are: FrankCrum('arr icr': WC1'l-0G317-Ol oat01t2022 l:rpires:Policy Nurnber: NO I cerrify tlrat in lhc perfbrlrancc of the rvork firr rvhich this pcrrnit is issued. I shall not ernploy any person in any manner so as lo beconre sub.iect to lhe s,urkers'c()nrperrsalion larvs of ('alifornia. and agree that if I should become suh.iect to the workers' compensation provisiorrs of'Secliort .1700 ol'the l.ahor ('ode, I slrall. forthrvith comply u,ith those provisions.. \I'ARNING: Failure to sea'ure rvortem'cornpensation coverage is unlarvful. and shall subiect 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 provided for the Section 1076 of the l-abor C'ode. interest and attome),'s fees. Ltcl'NSEn CONTRJ{CTOR nFCt AR ITION I hereby afiinn under penaltl of Jrcriury that I anr licensed under provision of Chapter g (cornmencing n'ith Soction 7000) of Division -1 of ttrc Business and Professions ('ode. and my license is in frrll force and effect. c39 l-icense Class: 1007E45 [-icense Number (:ONS'I'RT'C'TION I FNNING AGl'NCY I hereby affinn under pcnaltl,of periury lhat there is a construction lending agency for the perfonnance of the work for which this permit is issued (Sec. .10t)7. ('ir'. ('.). [.ender's Name: l-ender's Address: APPI I('ANT NFCL^ R^TION I herebv atlinn under penalty of per1ury one of the followrng, declaratrons: Denrolrtron Pernrts-Asbestos Notrficalron Federal Regulalrons (Trtle 40, Part6) rc Required [-etterof Notilication tT t cerrify'that the federal regulations regarding asbest<x removal are not applicable to this proJect. t-E-s I certi&' that t have read rhis applicarion and state that thc atnve infonnation is correct. I agree to comply rvith all Ciry and Cotmty ordinances and State Larvs relating lo building construction. and hereby authorize representatives of this City and County to enter upon the above rnentioned properly for inspection purposes. Reroof I Roof (Diaphragm Sheathing/Frame)to /s/o^JrAh^ Structural Final /oV,!/t,ll,w*, Plumbing Under Floor I Under SIab Rough Shower Pan / Tub Test Water Service Sewer / Sewer Cap Gas Air Pressure Test Plumbing Final Electrica! 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.