20170960 - Permit - Laserfiche WebLink

Home Browse Search

ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNIiR BI.' II,DER DD,I,CARATTON I hcreby affirnr under penalty of perjury that I arn exenrpt fronr the Cbntractors' License [:w for the following rearcn (Sec.7031.5 liusiness and Profession Codc): Any City or County which rcquires a pcrmil to construct. altcr. improve. demolish or repair any structurc, prior to its issuance. also requires the applicant for such pennit to file a signed slaternent that lr or she ls licensed pursuanl to thc provisions of thc Contractor's l.iccnscd Iaw (Chapter 9. Commcncing with Section 7000 of Division 3 of the Busincss and Professions Code) or that lre or she is exempt therefronr and thc basis for thc alkged exemption. Any violation of Section 7031.5 by any applicant for ir pennit subjects thc applicant to a civil penalty of not more than five hundred dollars ($5tXt1. _1. as owncr ol'the property. or my ernployccs with wages as their sole compensation, willdo thc work and the structurc is not interrdcd or offered for sale (Sec.7H4. Business and Pnrfessions Ctxle: The Contractor's License Law does not apply to an owner of the pnlperty wlro builds or imprcves tlrcreon, and wlxr does such work himself or lrcrself or through his or lur own entployees, providcd that such irnprovcrnents arc not intcndcd or ol'fered l'or salc. Il, however, the building or improvcrnent is sold within onc ycar of completiorl the Owner Buildcr will havc the burden of proving that he or she did rxlt build or imprcve thc prcpcrry for the purpose of sale). _1. as owner of the property, am exclusively contracting with licensed conlractoni to construcl the prcject (Scc. 7044, Business anri hotbssi<nr Corle: The Contractor's License Law dtrs not apply to an owner of property who builds or inrproves thereon. and who conuacts for such projccts wilh a Contractor(s) liccnscd pursuant to the Conuactor's Liccnse kw). _l anr exempt under Section-, B. & P.C. lbr tltis reason. WORKI,IIS' COTIT PENSATION DECLARATION I hcrcby aflirm under penalty of pcrjury onc of thc lirllowing dcclarations: _l have and will nraintain a Certilicate of Consent to Self-lnsure for workers' compensation, as providcd for by Section 3700 of the Labor Code, for the Jrerformarrce of the work for which thc pcrrnit is issued. _l have and will nuintain workers'insurarrce, as required by Section 3700 of lhe Labor Code, for lhe ;rcrfonrmtrce of thc work lirr which conrprensation insurancc carricr arxl lxrlicy nuntbcr iu'c: O .D Policy _l ccrtify that in thc lrcrfornuncc of thc work frrr which tlris pcrmit is issucd, I shall not cmploy any ftcrson in any manocr lio as to bccomc subject to lhc workers' conrpensation laws of California. and agrce that if I should beconr subjcct to thc workers' conrlrnsation provisions of Section 3700 of the Labor Cqle, I slrall, forthwith conrply with thosc provisioru.. WARNING: Failure to secure workers'compensation covemge is to crirninal pcnahies and civil IIrcs up to oue hundred thousand dollars (S100.000t. in danugcs as provided for the attorncy's [ces. I hereby affirnr under penalty of perjury that I anr licensetl under provision of Chapter 9 (cottrnrncing with Section 7000) o{ Division 3 of the Business and Code, and rny license is in ful! force and effect., Liccnse a a CONSTRUCTION LENDING AGENCY I hereby aflirm undcr pcnalty of perjury that therc is a construction lending agency for the performance of the work ltrr which this pcrmit is issued (Sec. 3097. Civ. C.). [-cnder's Name: lrndcr's Address: APPI,ICANT DECI,ARATION I lxrcty aflinn undcr penalty of pcrjury onc of thc lirllowing dcclaralions: ' Dcnrolition Pcrntits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40, Part6) -Rcquired lrttcr of Notification to this projcct. agrcc to conrply with all Cily and County of this City and County to entcr upon thc ab<lve mcntioned property for inspection Applicant or Agent Pcrntitcc nanle asbcstos rcrnval not *n -,2#,2@ Site-Work Underground Pole Bases Liqht Standards Spas, Pool, Fountains Siqns (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding I Grounding I UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls Walls (Roush) Ceilinqs (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) N/eter Release Rough Service N/eter /t A FINAL 'LlzLttt Jtr- T5L,I Notes, Remarks, Etc.t,\/.tl \.o pl ?p a --'U t v I -, Rev. 08-07-2015 o .'Y ,)