20173314 - Permit - Laserfiche WebLink

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APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARAI'ION I hereby affirm under penalty of perjury that I am exempt from the Contractors' License Law for the following reason (Sec.7031.5 Business and Profession Code): Any City or County which requires a permit lo construct, alter, improve, dennlish 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 70fi) of Division 3 of the Business and Pnrfessions Code) or that he or she is exempt lherefrom and the basis for the alleged exemption. Any violation of Section 7031 .5 by any applicant for a grcrmit suhjects the applicant to a civil penalty of not rnre than five hundred tlollars ($500). _1. as owner of the pmperty. or my employees with wages as their soh comJrcnsation, will do tlrc work and the structure is not intended or offeretl ftrr sah (Sec.7(X4, Business and Professions Ccxle: The Contractor's License Law does not apply to an owner of the pnrprty wtn builds or improves thcrcon. and wtxr does such work himself or herself or through his rlr her own employees, provided that such improverrcnts tue not intentled <lr offlercd for sale. If, however, the builtling or improvenrnt is sold within one year of completion, the Owner Buikler will have the burden of pmving that lre or slrc did not buih or improve the pmperty for the puryxrse of sale). -1, as owner of the property, am exclusively contracting with licensred contractors to construct thc project (Sec. 7(X4. Business and hofesskrn Code: 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 Contracto(s) licenscd pursuant to thâ‚¬ Contractor's License Law). -IamexemptunderSection-,B.&P.C.forthisreason.Date: Owner: WORKF'RS' COMPENSATION I)ncutt lTroN I hereby affum under ;renalty of perjury one of the following declarations: / / -t have and will maintain a Certifrcate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of thet lratxlr Cotle, for the performance of the work for which the permit is issued. sntill#liilHl'ffi:'l',":,rffi'flli:,,1'Il*';;1,J;T:l:,1lJ.:'#ff#ffi:l'fi,::n:*1'' forthe performanceof CJ). 1'l *^'07 certify that in the performance of the work for which this permit is, issued, I shall not empkry any person in any manner , antl agree that if I shoultl become subject to the shall, forthwith comply with thore pnrvisions.. so as to becorne subject to the wrlrkers'cornpensation laws of California, workers' compensation provisions of Section 3700 of the l-atnr Code, I WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an employer to criminal penalties antl civil fines up to one huntlred thousand dollars ($lm.m0), in addition to the cost of comfrcnsation, damages as provided for the 3076 of thc Latxlr Code. interest attorney's fees. o DECLARATION I hercby affirm under penalty of prjury that I am licensetl under proviskrn of Chapter 9 (comrnencing with Section 7UX)) of Division 3 of the Business and Professions Code, arxl my license is in full force and effect. iTs;l Nunrber: CONS'T'RUC'[ION LT]N DING AGE,NCY I hercby affirm under penalty of perjury that there is a construction hnding agency for the performance of thc work for which this permit is issued (Sec.3S)7. Civ. C.). Lender's Name: Lender's Address: AI'PLICANT DECLARAI'ION I trcrcby affnm under penalty of perjury one of the following declarations: Dennlilion Permits-Asbestos Notification Federal Regulations (Title 40, Pan6) -Required lrtter of Notifrcation -Jcertify that the federalregulations rcgarding asbestos removalare not applicable to this project. & certify that I have reatl this application and state that the atnve information is correct. I agree to compty with all City and County onlinances and State Laws rclating to building construction, and hereby authoriz.e representatives of this City and County to enter upon the lappicant or Agent)C ;r l'ermitee name Site-Work Underqround Pole Bases Liqht Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Groundinq / UFER 7-ll- Lt D-,zrftz Transformers ( Torqueino Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) Walls (Roush) Ceilinss (Hard & Soffit Rouqh Ceilinqs (T-Bar Rouqh) lVeter Release Rough *l'l4t r-? {z Service N/eter FINAL 7-Z?"r D-*.ta- Notes, Remarks, Etc. / ELECTR ICAL.INSPECTOR RECORD ra ) l Rev. 08-07-2015