20173225 - Permit - Laserfiche WebLink

Home Browse Search

ELECTRICAL.INSPECTOR RECORD 5 APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground Pole Bases Light Standards Spas. Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Darnpers Communications Cable Buildinq Under Slab / Floor Bondinq / Groundinq I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilinqs (Hard & Soffit Rouqh Ceilinos [-Bar Rouoh) Meter Release Rouqh Service [Meter t//ra\ FINAL 'll (lzr TG(13 Notes, Remarks, Etc.\---/ OWNER BUILDER DELCARATTON I hereby affrrm under pnalty of perjury that I am exempt from the Contractors' License Law for the following re&son (Sec.7031.5 Business aml Profession Code): Any City or County which requires a permit to construct, alter, improve, denmlish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed staternent that he or she is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9, Commencing with Section 7fiX) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant frrr a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($50tt1. _1, as owner of the profrerty. or my employees with wages as their xrh comlrcnsation, will do the work and the struclure is not intended or offered ftrr sale (Sec.7044. Business anrl Professions Code: The Contractor's License [-aw does not apply lo an owner of the progrerty wtn builds or impmves thercon, and whr docs such u,ork himself or herself or through his or her own employees. provided that such improvenrcnts are not interxled or offererl for sale. I[, however. the buikling or inprovenrcnt is sokl wilhin one ]t;r of comphtion. the Owner Buikler will have the burden of proving that tre or she dil not buill or improve the pruperty for the purp.rse of sale). -1, as owner of the property, am exclusively contracting with licensed contractors t() construct the project (Sec. 7044, Business and Profession Corle: 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 Contractor(s) licensecl pursuant to the Contractor's License Law). -lamexemptunderSectit.ln-.B.&P'C.forthisreason. WORKI.'Rs' COMPENSATION Dfr'Cr ^lLdTIOr\I hereby affirm under pnalty of perjury one of the following declarations: -l have antl will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code, for the performance of the work for which the permit is issued. _l have and will maintain workers' compensation insurance. as required by Section 37fi) of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and plicy number are: -â‚¬kâ‚¬Trzp.- Policy Number: ,EYnimc. {t r.rtitythat in the performance of the work for which this permit is issuetl, I shall nor employ any person in any mannertro ut; to becorne subject to the workers'compensation laws of Catifurnia, and agree that if I should become subject to the workers' "n*p.n*uiion provisions of Section 3700 of the Lahrr Code, I shall, firrthwith comply wirh those provisions.. WARNTNG: Failure to secure workers' compensation coverage is unlawful, and shall subject an employer to crirninal penalties and civil fines up to one hundred thousand dollars ($l(n.fin),addition to the cost of compensation. damages as providetl for the Section 3076 of Lahrr interest and attorney's I I hereby aft-rrm untler penalty of perjury that I am licensetl Chapter 9 (cornrnencing with Section ?UX)) of Division 3 of the Business and Professions Code, and my license is in full ftrrce ard effect. / u ?"fr:License Number: /rz I hereby affirm under Srenalty of prjury that there is a construction lending agency issued (Sec. 3097, Civ. C.). perftrrmance of the work for which this permit is Lender's Nalne: Lrnder's Address: AI?LICANT DECLARATION I hereby affirm under pnalty of perjury one of the following declarations: Denrolition Permits-Asbestos Notification Federal Regulations (Title 40, Pan6) -Required Lrtter of Notification _l certify that the federalregulations regarding asbestos renxlvalare not applicable to this project. -l certify that I have r"oh*rplication and state that the atnve information is correct. I agree ro comply with alt City and County onlinances and State Laws rclating to building construction, and hereby authorize representatives of this City and County to enter uJnn the a On'ner: Applicant or Agent ,*,, q//?,U lDermitee nanle ( print):