Fire Plan Check Application
#1 IDENTIFY YOUR PROJECT
Permit Holder Who Will Be Responsible and Liable For The Construction:
Property Owner Information
Licensed Design Professional In Charge of Project:
Designed Professional's Information:
Contact Information for Payment:
#2 IDENTIFY WHO WILL PERFORM THE WORK 2a – CALIFORNIA LICENSED CONTRACTOR’S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.
#3 IDENTIFY WORKERS’ COMPENSTATION COVERAGE AND LENDING AGENCY
I have and will maintain a certificate of consent to self-insure for workers’ compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I have and will maintain workers’ compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers’ compensation laws of California, and agree that, if I should become subject to the workers’ compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
#4 DECLARATION BY CONSTRUCTION PERMIT APPLICANT By my signature below, I certify to each of the following:
Please Fill in the Applicable Information
Should be Empty: