40135510 - Permit - Laserfiche WebLink

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M ECHANICAL.I NSPECTOR RECORD ! APPROVALS DATE !D/SIG COMMENTS Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation Insulation Smoke Detectors Installed Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type Il Hood Grease Duct Fire Damper Openings Installation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release FINAL F,n^\t. J l!Sa a,h h Aq"r;"l [hrt or'\ Notes, Remarks, Etc.(rr/\ lA / tt /'z o>l ^/rt /ffv I hmby affm uod6 pcnalty of pcrjury thd I m cxcmp from thc Contractotr' Liccnsc law for thc following llen (Se.7031.5 Buines ard hofeion Code): Any City or County which rcquirc a pomit to costruct, altc, improvq donolish or rcpoir my struc{uc. prior to its bsucc. also rcquirc thc applicst for such Fmit to filc a signr{ $aroqt thrt he or she b licGcd glmant to thc provbioG of thc Contraclor'! Lienlcd lrw (Chapta 9, Comcncing with Sction 7000 of Divisioa 3 of thG BNitrs ud Profrsions Codc) or that hc or shc is qmp rh@from ad thc bsis for thc allcgcd qm6ion. Any violation of Setbn 703 1.5 by my applicant for a pemit subjets thc applicmt to a civil pmlty of not more thu fivc hundrcd dollus ($500). -1. as owner of the p,roperty, or my employecs rvith rvages as their sole compensation. will do the work md the structurc is not intended or offered for sale (Sec.7044. Business and Profcssions Code: The Contractor's License law docs not apply to an or*ner of the propcrty who builds or funproves thcron and who does such work hirnself or herself or through his or her own cmployees. provided that such improvanents are not intended or oflLred for sale. lf. horverrer. the h,rilding or improvernent is sold within one year of complaion, the Ourner Builder will have the burden of proving that he or she did not build or improve the propoty for the purposc of sale). -1. as orvner of the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Brsiness and hoftssion Code: The Contractor's License Law does not apply to an owner.of propcrty 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:_Owner:_ w()llKF.tts' ('ol\l PIiNSA'l'loN DI'('I,AIL\'I'ION I hereby affirm under penalty of perjury one of the follou'ing declarations: _l have and will maintain a Certifrcate of Consent to Self-lnsure for workers' contpensation, as provided for by Section 3700 of the Labor Code, for the perfonnance of the work for which the pennit is issued. -l have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code, for the perfonnance of the rvork for which this permit is issuod. My workers' compensation insurance carrier and policy number are: Lt PoticyNurnw,4L- oi611ol'61-'18 Expires:(, ' l. a6 Lz* _l certify that in the performance of the work for which this permit is issued. I shall not employ any pâ‚¬rson in any manner so as to bccome subject to the work6s' compensation laws of California, and agree that if I should become subject to thc workâ‚¬rs' .orpoouiion provisions of Section 3700 of the Labor Code, I shall, forthwith cornpty with those provisions.. I IVARNING: Failure to secure workcrs' compensation coverage civil fines up to one hundred thousand dollars ($100.000). in is unlawful. and a subject an crnployer to criminal paraltirs and thc of compensation. damages as provided for theIattorney's fees. I hereby affirm under penalty of perjury that I am licensed of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my licensc is in full force and effect. License Deou (p',rO' eOZl I hereby affrm under penalty of perjury that there is a construction issued (Sec. 3097. Civ. C.). for the performance of the work for rvhich this pcnnit is Lender's Narne: Lender's Address: ,r, ,c N.r rr"cl R I herdry affinn under penalty of perjury one of the follorving declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Par16) -Required Letter of Notification -l certi0 that the federal regulations regarding asbestos rernoval are not applicable to this project. -l certify that I have rcad this application and state that the above ordinances and State Larvs relating to building above ntentioned property for inspection Applicant or Agent Pennitee name hereby ^".L.,b,20 Ll the 'lass: Contrnctor: 4 _t