20173905 - Permit - Laserfiche WebLink

Home Browse Search

OWNER BUILDER DELCARATION I h6cty affm und6 pcnalty of pojury that I m qemfl fiom thc ContracloN' Licce lrw for thc following r@n (56.70]1.5 Buine od Profsion Code); Any City or Couty which rcquirc a polnil to @nstruct, altq, imprcvg danolish or rrpair uy structue. prior to its i$@cc. also requirc thc applicet for such pcnnit to filc a signcd statmqt that hâ‚¬ or shc b licaucd pmuut to thc provisioN of thc Contractor's Liccnsed law (Chaptq 9. Commencing with Selion 7000 of Division 3 of ahc Bsin6 ed Prcfessions Codc) or thal he or shc is exempt thGâ‚¬from ud thc basis for thc allcgcd aonption. Any violstion of Setion 7031.5 by any applicanlforspmitsubjetsthc applicanttoacivilpmaltyofnotmorcthefivehundrcddollm($500). _1, as owner ofthe property. or my ernployees with wages as thcir mle compensation. willdo the work and the structure is not intendcd or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License l-aw does not apply lo an orvner of the propo'ty who builds or improves thereon. and r*'ho does such wort himsclf or herself or through his or her own employees, provided that such improvonents are not intended or offered for sale. If, howet/â‚¬r. the building or improvcmort is sold wilhin one year of complaion, the Orvner Builder will have the hrden of proving tha he or she did not build or improve the propaty for the purposc of sale). -1, as owner of the propeny. arn exclusively contracting with licensed contractors to construct the project (Sec. 7U4, 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 Contracto(s) licensed pursuant to the Contractor's License Law). _l arn exempt under Section_. B. & P.C. for this reason. Dete, WORJ(ER^S' COM PENSATION DECLAIIATION I hereby affrrm under penalty of perjury one of the following declarations: _l have and will rnaintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code, for the perfonnance of the work for which the permit is issued. -l have and will maintain workers' compensation insurance. as required by Section 3700 of the labor Code. for the po'formance of the rvork for which this pennit is issued. My workers' compensation insurance carrier and policy number are: -l certify that in the perforrnance of thc work for which this permit is issued, I shall not onploy any person in any manner so :rs to becornc subject to the rvorters'cornpensation laws of California. and agree that if I should become subject to the rvorkcrs' cornpensation provisions of Section 3700 of the Labor Code. I shall. forlhwilh comply with those provisions.. WARNING: Failure to secure workers' cornpensation coverag,e is unlawful. and shall subject an onployer to criminal poralties and civil I'rnes up to one hundred thousand dollars ($100,000), in addition to the cost of compensation. damages as provided for the Section -3076 of the Labor Code, intcrest and attorney's fecs. Date:Annlinrnt. LICENSED CONTRACTOR DECI."ARATION I hereby alTirm 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 Codc, and my license is in full force and effect. Policv Number: Exoircs: License Class: Liccnse Number: Date: Contractor:_ W t hrcby aflim undo pcnalty of pcrjury that th@ is a @nstructbn loding ag6cy for thc pGfollme ofthc wort for which this pqrnit b issucd (Se. 3097, Civ. C.). Iadd's Nmc: Lender's Address: APPLICANT DECLARATION I herelry affurn under penalty of perjury one of the following declarations: Demolition Pennits-Asbestos Notification Federal Regulations (Title 40. Parr6) -Recluired Letter of Notification -l cdify that thc Gd6al rcgulatioE ntrding 6b6tos rmoval rc not eplieblc to this prcj61. -l cdiry that t have ud this application {d state that thc abovc information is corâ‚¬t. I agrc to comply with all City ud County ordinancG ud Statc laws relating to builditrg construclio.r, dd h6cby authorizc rcpreqtativc of this City od Couty to @tq upon thc abovc mcntioned prcpaty for impâ‚¬tion purpos6. Applicant or Agent Perrnitee nRme (print):____ APPROVALS DATE ID/SIG COMMENTS Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm lDampers Communications Cable Buildins Under Slab / Floor I I ,,a Bondinq I Groundinq / UFER 0lr tN 0,@1ru w Transformers Torqueing Sub-Panels Air Conditioners l-t/,tlJ -a, Roof Top Equipment lm6(lalil ltr Ututh >v; w Factory Wired Unit I t, Walls (Conduit) Walls (Rough) Ceilinqs (Hard & Soffit Rouqh Ceilings (T-Bar Roush) Meter Release Rough Service Meter It It -aureh*FINAL tolulat ?V6 rlNotes, Remarks, Etc. no n7 r)n{ tr ELECTRICAL,I NSPECTOR RECORD Owner:_ t