20173561 - Permit - Laserfiche WebLink

Home Browse Search

ELECTRICAL.INSPECTOR R ECORD APPROVALS DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION I hcrcby affirm under pcnalty of pcrjury thal I m cxcmpt frcm thc ContEctm' Liccnrc hw for thc followitrg msn (Ss.7031.5 Busincss and Profcssion Codc): Any City or County which rcquircs a Frmit to onslruct, altcr, improvc, demlish or rcpair any structurc. prior to its issuoncc. also rcquircs thc applicdt for such pcrmit to file a signcd statemnt thal h. or shc is liccnrcd pursuilt to thc prcvisions of the Con[&tor's Liccnscd law (Chaptcr 9, Comcrcing with Scction 7000 of Division 3 of thc Busircss and ProfcssionsCodc)orthathcorshciscxcmptthscfromandthcb{sisforthcallcgedcxcmption. AnyviolationofscdionT03l.5byrny applicant for a pcrmit subjets lhc applicant to a civil pcn8lty of not mrc lhan fivc hundrcd dollus ($500). _1. as owncr of thc prof,erty, or my ctnployccs with wagcs as thcir solc comlrcnsation, willdo thc work and thc struc'turc is not intcndcd or offcrcd for sale (Scc.7044. Busincss and hofcssions Code: Thc Contractor's Liccnsc l;tw does not apply to an owncr of thc proprty wtxl builds or improvcs thcrcon. and who docs such work himsclf or hcrsclf or through his or hcr own cmployccs. providcd that such inrprovernents arc nol intcndcd oroffcrcd for salc. If. howcvcr, ttrc building or improvcnrcnt is sold within one year of conrplction. thc Owncr Builder will havc thc burdcn of proving that hc or shc did not build or irnprovc the propeny for thc purprsc of salc). -1, as owncr of thc prolrcrty, am cxclusivcly contracting with licenscd conlraclors to conslruct lhc projcct (Scc. 7U4, Business and hofession Code: The Contraclor's Liccnsc Law docs not apply to an owner of propcrty who builds or improves thcrcon. and who contracts for such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Liccnsc taw). -l am cxempt under Scction-, B. & P.C. for this reason. Datc: 1VORK IrRS' COM PIiNSA'f I(lN DTiCI ARA'I'ION I hcrcby aflirrn undcr penalty of pcrjury ortc of the following dcclaralions: _l have and will maintain a Certificate of Consent to Self-lnsure tbr workers' compcnsation, as provided for by Section 3700 of the labor Codc, for the pcrformancc of ttrc work for which the pcrmit ls issucd. _l havc and will maintain workcrs' compcnsation insurance. as rcquircd by Sect ion 37fi) of thc labor Code. for the pcrformance of the work for which this permit is issucd. My workers' comJrcnsation insurance carrier and plicy number are: Policy Number: / Expires: _l ccrtily that in thc lrcrformancc of thc work for which this lrcrnrit is issucd. I shall not cmploy any person in any manncr so as to bccomc subjcct to the workcrs'compâ‚¬nsation laws of California. and agree that if I should bccorne subict lo the workcrs' compcnsation provisions of Scction 3700 of the L-abor Code. I shall. forthwith comply with thosc provisions. . ' WARNING: Failurc to sccurc workcrs' conrpcnsation covcragc civil fines up to one hundred thousand dollars ($100.000). in ts and the Scctiort 3076 of interest and fecs. I hcrcby affirm undcr pcnalty of pcrjury that I arn licensed provision of Chapter 9 (cornmcncing Section 70m) of Division 3 of thc Busincss and Profcssions Codc. and my license is in full forcc rutd effcct. .)ry;LtLicense I hcrcby uflirm undcr penalty of pcrjury that thcrc is issucd (Scc. 3097, Civ. C.). agcncy for thc pcrfornuncc of the work for which this permit is lrnder's Name: lrndcr's Addrcss: APPLICANT DF'CT ^ IL{IION I hcrebyaftirmundcr penalty of prjury one of the following declarations: Demolition Permits-Asbcstos Notification Fedcral Regulations (Titlc 40, Part6) -Rcqu ired l-cttcr of Notification _l certify that the federal regulations regarding asbestos removal arc not applicablc to this project. -l ccrrify that I have rcad this application and state that the\vc information is corrcct. I agree to comply with all City and County ordinanccs and Statc laws rclating to and hercby authorizc rcprcscntatives of this City and County lo cnler upon the abovc mentioncd propcrty for zlzrApplicant or Agent Permitee name Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Buildinq Under Slab / Floor Bonding I Grounding / UFER Transformers Torqueinq Sub-Panels Air Conditioners Roof Top Equipment Factorv Wired Unit Walls (Conduit) wails (Roush) Ceilings (Hard & Soffit Rouqh Ceilinqs [-Bar Rouqh) Meter Release Rouqh Service JMeter /.'\ FINAL b-4-71 \,1[p\4 Notes Re Etc. r ACI n7 Onl tr Owner:- I a ) l,tltL-