101107456 - Permit - Laserfiche WebLink

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INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUII DER NEI CARATION I hereby affirm under penalty of perjury that I am exempt form the Contractors' l-icense Law for the following reason (Sec.7031.5 Business and Profession Code): Any City or County which requires a permit to construct. alter. improve. demolish or repair 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 l.icensed l.aw (Chapter 9. Commencing with Section 7000 of Division .1 of the Business and Professions Code) or that he cn she is exempt therefrom and the basis for the alleged eremption. Any violation of Section 7031 .5 by any applicant for a permit subiects the applicant to a civil grcnalty of not more than fir'e hundred dollars ($500). E1f . r. owner of the property'. or my employe',es rvith rvages as rheir sole compcnsation. rvill do the work and rhc stnrcturc is not intend or offeretl for sale (Sec.7M4. Business and Professions Code: The Contractor's Liccnse Law does not apply lo an owncr of the propâ‚¬rty rvho builds cr improves thâ‚¬Tâ‚¬rrn. and u,ho does strch wort himself or hcrself or through his or her own cmployees. provided that such imFrovernents are not intended or offered for sale. If. howa,er. the building or improvenrnt is sold within onc year of ccrrplaion. the Orvner Builder rvill have the burden of p,roving that he or she did not build or improve the propefi fs the ptnpose of sale). Y!1. ur owner of the property. am exclusively conh'acting with licensed contractors to constnrct the project (Sec. 7044. Business and Profession Code: The Contractor's l,icense [,arv does not apply to an owner of property rvho builds or improves thereon. and rvho contracts for such prrriects rvith a Contracto(s) licensed pursuant to the Conractor's License Larv). !!-t "r exempt under Secrion -. B. & P.C. for this reason. WOR.KFR.S' COMPFNS ^TTON TIECI {]IATION I hereby alTinn under penalty of perjury one of the following declarations: No-t h.u. antl rvill rnaintain a Certificate of Consent to Self-tnsure for workem' compensation. as provided for by Section -1700 of the Labor Code. for the performance of the rvork for which the permit is issued. NO __ I have and s,ill maintain rvorkers' compensation insurance. as required by Section -1700 of the Labor Code. for the performance of the u'ork for s'hich this pcrmit is issued. My rvorkers' compcnsation insurance carrier and policy number are: Carrier:_ Policl'Nurnber:Expires: YES I cerlify thal in the perforrnance of the rvork for u,hich this permit is issued. I shall not employ any person in any manner so as lo become subiect to the workers'compensation larvs of California. and alree that if I should become sub.iecl to the rvorkers' compensation provisions of Section 3700 of the labor Code. I shall. forthwilh cornply with those provisions.. WARNIN(i: Failure to secure s'orters' compensation coverage is unlau'fu|. and shall subiect an employer to criminal penalties and civil fines up to one hundred thousand dollars ($lm.0m). in addition to the cost of compensation. damages as provided for the Section .1076 of the Labor ('ode. interest and attomel"s fccs. LICF'NSF'N CONTRACTOR DFCI ARATION I hereby alfinn under penalty of periury that I am licensed under provision of ('hapter g (commencing rvith Section 7000) of Division .1 of the Business and Professions Code. and my license is in frrll force and effect. [-icense ('lass:l-icense Number CONSTRUCTION I FNNING ^(]FNCY I herehy affinn under penalty of per.iury that there is a construction lending agency for the perfonnance of the work for rvhich this permit is issued (Sec. 3097. Cir,. C.). Lender's Name: Lender's Address: APPI I('^NT DEC! {R.^TION I herebv aftinn under penalN of per1ury one of the followrng declarations. Denrolrtion Pernrrts-Asbestos Notrfication Federal Regulalrons (Trtle 40. Pan6) rc Required Letterof Notification tEs f cerrify that the fecleral regulations regarding asbestos removal are not applicable to this prqect. tT , cefliry that I have read rhis applicarion and state that thâ‚¬ above information is correct. t agree to complv s'irh all City and Cotnty ordinances and State Ias's relating to building construction. and trereby authorize reFnesentatives of this City and County to cnter upon the above mentiond propefl), for inqrcction purposes. Reroof fF. Roof (Diaphragm Sheathing/Frame)-3 Lr^> EA Structural Final q-rl =2 u{h/}l) Plumbin 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 Pane!) Grounding / Bonding Rough Electrical Final Mechanical Gas Air Pressure Test Rough Piping (HW,CW, etc.) Exhaust Ducts Mechanical Final Notes, Remarks, Etc. t