101105733 - Permit - Laserfiche WebLink

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-BUILDING. INSPECTOR RECORD- SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION I hrcby aflim undo pcnalty of pcrjury that I m cxcmpt from thc ContractoF' LiccN taw for the following r@n (5*.7031.5 BNin6s atd Profsion Codc): Any City or County which rcquirc a pomit to coGtruct, alto, improve, danolish or rqair oy strucluq prior to its isuucc, also requirc thc applicut for such pcnnit to file a signed stalmmt thai hc or slrc b licwd pwmr to the provisioN of tlrc Contrrctor's Licmsed law (Chapto 9, Comcncing with Sction 7000 of Divisioo 3 of thc Busine ud Prcfsios Code) or that hc or she is exmpt rh6c&om od the b6is for thc allegcd umption. Any viotation of Setion 703 1.5 by my applicatforapcmitsubjctsthc applicettoacivilpcnaltyofnotmorcthilfive hundrcddollus($500). -1. as owner of the property, or my employees with wages as their sole compensation. wilt do the work and the structure is not intended or offered for sale (Sa.7044. Business and hofessions Code: The Contractor's License Law does not apply to an owner of the property who builds or improves theron. and who does such work himself or herself or through his or her own employees. provided that such improvonants are not intended or offered for sale. If. howevcr. the building or improvemcnt is sold within one )tzr of cornplaiorL the Orvner Builder will have the hrden of proving that he or she did not build or improvc the propcrty for thc purposcof sale). -1. as owner of the property, arn exclusively contracting with licensed contractors to the Business lhereon,and Profcssion Code: The Contractor's License Law does not apply to an ownâ‚¬r who and who contracts for such projects with a Contracto(s)pursuant to License _l am undcr for this I hercby affirm under penalty of perjury one _l have and will maintain a Ceflificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the l-abor Code. for the performance of the work for which the pcrmit is issued. _l havc 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. My workers' compensation insurance carricr and policy numbcr are: a^J*. Policy _-l certi[ that in the performance of the work for which this pcrrnit is issued. I shall not employ any person in any manner so as to become subject workers' compensation to thc workers'compeflsation laws of California and agree that if I should become subject to the a provisions of Section 3700 of the Labor Code. I shall.comply those provisions. WARNING: Failure to secure workers'compâ‚¬nsation coverage dollars ($100.000). in is shall 'an onployer to and the rL civil fines up thousand the cost of as Section [abor and a I hoeby undcr Izun 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License Class: License Number: Contractor: W t hrcby afum undc pcnalty of pqjury thst thrc is a congruction loding agocy for thc pqfommcc of thc work for which rhis pfinit b isued (Se. 3097, Civ. C.). Lender's Narne: I-ender's Ad&ess: APPLICANT DECLARATION I hen*}, afnrm under pcnalty of perjury one of the following declarations: Oeryltition Permits-Asbestos Notification Fcderal Regulations (Title 40. Parr6) ,LAu*.a lato o f Not i licat ionr -/'- _l certifu that the federal regulations regarding asbcstos removal arc not applicable to this project. -l coti$, that I have read this application and state the ahrve to comply with City and County ordinanccs and State laws relating to building above mentioned property for Applicant or Agcnt Pernritt.c nAnre and correct. I of this City and to upon the Set Backs Forms/Steel/Holdowns f.,, ^'- c ^/Erection Pads -rr-A,etqn UFER Ground /tt -az - 7J SLAB Floor )9:7 (42 r/ I nsulation z?z h $t' F-al Xrb/ruol\--Roof Sheathing t ZFz-rl Shear Wall o)f-L-1 zq Framing ZT lL Lsz 4 lnsulation/Energy 7-Bar Drywall h ')2rc Lath 11 -Brown Coat gralatL $-{-Zel 7-Z)-11 Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif It I FINAL gltq 7.r -rtloCertificate of Occupancy I t \J Notes, Remarks, Etc.I I L.)d^ O ll ^^ ^,1rkl,rt 5.. ^lt*r-r> l.;-) , \ ll -\V I 12tt ./(-/ \- a7 t,'-L"J{to/ Gi Z a