20172806 - Permit - Laserfiche WebLink

Home Browse Search

APPROVALS DATE ID/SIG.COMMENTS OWNE,R B UILDER DIII,CA RATION I hcrcby affirnr under penalty of pcrjury that I arn exempt frum the Contractors' License law for the following, reason (Sec.7031.5 Busincss and Prolbssion Codc): Any City or County which requircs a permit to construct, altcr, irnprove, demolish or rcpair any structure, prior to its issuance. also requires the applicant for such 5rcnuit to fih a signed statenrenl that lrc or she is licensed pur$rant to thc provisions of thc Contractor's Liccnscd law (Chapter 9, Commencing with Section 7fi)0 of Division 3 of the Business and Professions Code) or that he or she i.s exempl therefrom and the basis ltrr tlre alleged exenrption. fury violation of Section 7031.5 by any applicant for u lrrrnit subjects the applicant to a civil penalty of not more than five hundrcd dollars ($stltl). _1. as owncr ol'thc proprty. or rny ernployccs with wagcs as thcir sole compcnsation, willdo thc work and thc stnrcture is rnt interrdal or offered for sale (Scc'.7H{. Business and Professions Cqlc: The Contractor's Licensc l-aw docs not apply to an owncr of the pnrSrrty wlxr builds or inproves theranq and wlro docs srch work himself or herself or through his or her own enrployecs, provided that such improverrrcnts are not intcnded orollered for sah. Il. howevcr, thc building or irpmvcnrcnt is sold within c,ne )rar of completioru thc Owner Buikler will have thc burden of pmving that hc or shc did not buikl or improve tlrc propoty for thc purposc of sale). -1. as owner of the propefly, um exclusively contracting with liccnrrcd conlraclors to construct thc pmject (Sec. 7(X4, Business arxJ Prulesskut Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projccts with a Contractor(s) liccnscd pursuant to the Contractor's License Law). -Ianlexemr,tunderSectiotl-,B.&P.C.ftlrtlrisreason. WORKI'RS' COMPT,NSATION DECLARATION I hcrcby affirnr unclcr pcnalty of pcrjury onc of thc tbllowing declarations: -l have arxl will nrainlain a Certilicale of Consent to Self-Insure for workers' compensation, as pnrvided for by Section 3700 of tlre Labor Codc, for thc grerfornurrce of thc work for which thc pernrit is Lssued. _l have and will maintain workers'conrpensation insurarrce, as required by Section 3700 of tlre kbor Code, for thc perfornrarc-e of thc work for which ttris permit is issued. My workcrs' compensation iruurance carricr and frclicy numbcr are: Policy _l ccrrily that in thc pcrfornuncr'ol'thc work for which this pcrmit is issucd, I shall not enrploy any lrcrson in any manncr so as to bccornc subjccl to the workcrs' conrpcn.sation laws of Calil'ornia. and agrec that if I should bccomc subjcct to the workers' conrlxnsation provisions of Section 37fi) of the Labor Cule, I slull, forthwith comply with thosc provisions.. WARNING: Failure to sâ‚¬cure workers' compensation coveragc is unlawful, and shall subject an cmployer to criminal pcnahies and civil [ines up lo one hundred tlxrusand dollars ($100.000). in additkrn to tlrc cost of comgrcnsation, danuges as providcd for lhc Scction 3076 of thc labor Codc. intcrcst and attorney's fees. LICENSED CONTRACTOR DECI,AITATION I hercby affrnr under penalty of pcrjury that I anr licensetl under pnrvision of Chapter 9 (conrnrcncing with Section 7000) of Division 3 of the Busincss and Pmfessions Code. and my license is in full force and cffect. Liccnse Number: n,..^. CONSTRUCTION LENDING AGENCY I hcrcby allirrn undcr penalty of pcrjury that thcrc is a con.struction hnding agerrcy for the pcrlbrmance of the work for which this pcrrnit is issued (Sec. 3097. Civ. C.). l-ender's Nanre: lrndcr's Address: APPT,ICANT DECLARATTON I h:rcty aflirm undcr pcnalty of pcrjury onc of lhe following dcclarations: Dcnxrlition Pcrmits-Asbcstos Notification Fredcral Regulations (Title 40, Part6) -Rcquircd [.cttcr of Notification _l ccrtily that thc fcderal rcgulations rcgarding asbcstos rcrrxrval iuc not applicable to this prolxt. -l ccrtify tlral I havc read this application aml state that the ahrve infornution is corrcct. I agrc"e to conrply with all City ard Cnunty ordinanccs and State laws rclating to building construction, ard hcrcby authorize representativcs of this City and County to cnter upon tlrc above mcntioned propeny for inspcction purposes. Applicant or Agent Signature: Date:- Pcrmitec nalnc (print): Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildins Under SIab / Floor ,\ Bonding I Groundinq I UFER 9-1-21 u,hr)u\ Transformers V J Torqueincl Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Roush) Ceilinos (Hard & Soffit Rouqh Ceilings (T-Bar Rough) l\Ieter Release Rough ,,\ Service Meter 3-1''71 f,Y+/HN FINAL j-T- a viltfytr Notes, Remarks, Etc.(.// i \ ELECTRICAL.INSPECTOR RECOR D Rev. 08-07-201 5