101104138 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Set Backs ,7 \ Forms/Steel/Holdowns ,3t24 f \7-h Erection Pads , (., UFER Ground SLAB Floor S u bf loor/Ve nVl n su I atio n R ).YI.'ILIRoof Sheathinq ,0._2'h Shear Wall Framing O ,o_.%)dYlt v lnsulatio nlEnerqy / Drywall Ext./lnt. Lath Brown Coat [Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif FINAL l-5 -7o'7 Certificate of Notes, Remarks, Etc. OWNI,R It U I T,I)I.:R I)I'I,CA RATION I hereby affirnr under penalty of perjury that I anr exenrpt from the Cbntrirctors' l.icense l-aw f<rr the following reason (Sec.7031.5 lhsrncss and Prolbssion Code): Any City or Countv which rcquires a ;rcrmit to construct. altcr. improvc. demolish or rcpair any structure, prior to its issuance. also requires the applicarrt tbr such Jrernrit to file a signed statement that he or she is licensed pursuanl to thc prnvisions of thc Contractor's Licensed l-ilw (Chapter 9, Commcncing with Section 70fi) ol' l)ivision 3 of the Business and Prot'essions Code) or that he or she ls exempt theretiom and the basis lbr the alleged exenrpti<ln. Any violation of Section 7031 .5 by any applicant for a pennit subjects the applicant to ilcivilpenaltyof not npre than five hundred dollars ($5m). _1. as owner of thc pr('rpcrty, or my cmployces with wages as thcir solc compensation, will do the work and thc structure is not interxled or offered for rialc (Sec'.784. Business and Prolessions CtxJe: The Contraclor's Licensc Law does not apply to an owner of the property wlxr builds or improves thereon and who does such work hinrself or herself or through his or her own employees, provicled that such improvements are not intendcd or ollcrcd for salc. ll. howevcr, the building or rmprovenrnt is soH within one year of conpletion, the Owncr Buikhr will have thc burden of prcving that lre or shc did mt buikl or impmve thc pnopelty for llr purposc of sale). _1. as owner of the property, am exclusively contracting with licensed conlraclors to conslruct the projcct (Sec. 7(X4, Business altd Pmfession Code: The Contractor's License Law does not apply to an owner of property who builds or inrproves thereon. and who contracts lor such projccts with a C]ontracto(s) licen.sed pursuanl to the Contractor's License taw). -IanrexemptunderSectitln-'B.&P.C.lbrthisreastln.I 1...,.. W ( ) R K FIRS' COM Plln-SATI( ) N DECI,ARATION I hcrcby atlirm undcr pcnalty of pcrjury onc of the tbllowing dcclarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' conrpensation, as provided for by Section 3700 of the Lahor Codc. for the Jrerformance of thc work lor which thc pcrmit is Lssucd. _l have and will maintain workers' compensation insurance, as required by Section 3700 of the l-abor Code, for lhe perfornrance of the work ltrr which this pcrmit is Lssucd. My workcrs' compcnsation insurancc carricr ant plicy numbc'r arc: Policy Numher: lixpires: _l ccrtity that in the prtbrnuncc of thc work for which this pcrmit is issuctl, I shall not cnrploy any pcrson in any manncr so astobcconrcsuhjccttothcworkcrs'cornpcnsationlawsofCalifornia.andagrcethatiflshouldhccomcsubjccttothc workers' compensution provisions of Section 3700 of the Labor Cotle, I shall, forthwith conrply with tlxrsc provisions. WARNING: Failurc to sccurc workcrs'conr;rcnsation covcmgc is unlawful. and shall sub.icct an enrployer to criminal pcnaltics ancl crvil lines up to one hundred thousand dollars (Sl(n.(XX). in additiorr to thc cost oI cornpensation. rlamages as provided for the Section 3076 of the l-ahrr Cbde, inlerest and attornev's fees. l)atc: T,ICENSED CoNTRACToR DECLARATION I hereby al'linn undcr p*nalty ol'pcrjury that I arn liccnsed under provision ol'Chaptcr 9 (cornmcncing with Scction 7000) ol'l)il'ision 3 of tlrc Busincss and Profcssions Codc, arnd my liccnse rs in full force and clfcct. Liccnsc Class: Licensc Numbcr: Controctor: CON.STRUCTION I,I.:NDING AGENCY I hereby aflirnr under Jrenalty of perjury that there is a construction lendlrg agern-y for the performance of the work tbr whrch this permit is issued 1$ss. -1O97, Civ. C.). [-ender's Name: [-cntlcr's Addrcss: APPLICANT DECLARATION I hereby affrnr under penalty of pcrjury one of the following dec'larations: Denrolition Pcrmits-Asbcstos Notification Federal Regulations (Title 40, Part6) _Required [rtter of Notification _l certify that the federal regulations regarding asbestos rcmoval are not applicable to this project. _l certify that I havc read this application arxl state that thc above information is correct. I agrce to comply with all City and County ordfurances aml State l-aws relating to building corstructiou and hereby auttmrize rcpresentalives of this City and County to enler upon thc abovc mcntioncd propcrty tbr inspection purposes. Applicunt or Agcnt Dute:_ Permitee rurme (prlnt): 0B-07-2015 t7\-/ \r/\, ,r(\ vwbu