101103835 - Permit - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNI'R IIUII,I)ER I)TiI,CARATION I hereby affrm under pcnalty of perlury that I am exempt fronr the Contractos' License law for the following rca$n (Sec.7031.5 Busincss and Prolbssion Code): Any City or County which requircs a pcrmit to construct, alter, improvc, dernolish or rcpair any structure, prior to its issuance. also requires the applicant tbr such prermit to file a signed staternenl that he or she is licensed pursuant to thc prrrvisions of thc Conlractor's Licenscd law (Chapter 9, Comrncncing with Scction 7fiD of Division 3 of the Busincss and Prot'essions Code) or thal he or she is exempt therefrom and thc basis fbr the alleged exemption. Any violation of Section 703 I .5 by any applicant for a perrnit subjects thc applicant to a civil penalty oI not more than live hundred dollars ($StXl). _1. as owner ol'thc properly. or my cmployees with wages as their solc cornpcnsalion, will do thc work and thc structure is rnt interxlctl or offcred for sale (Sec.7(X+, Business and Profcssions Cotle: The Contractor's Liccnse l-aw docs not apply lo an owner of the property who builds or improves thermn and who does such work himself or herself or through his or her own employees, provided that such improvenrcnts are not intended or olIercd for sale. ll. however, the building or improvenrcnt is sold within one )â‚¬ar of conrpletion, thc Owncr Builder will havc thc burden of proving that lrc or she did not build or improvc thc property for tlrc purposc of salc). _1. as owner of the propertyr am exclusively contracting with liccnrcd conlractors to conslrucl the pnoject (Sec. 7044, Business and hofessbn 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 Contractor(s) liccnsed pursuant to the Contractor's License l-aw). -IamexemPtunderSection-'B.&P.C.tbrthisreasolt. WORKIqRS' COMPT.:NSATTON DECLARATION I hercby atlirm under penalty of perjury one of the following dcclarations: / -l have and will nraintain a Certiticatc of Consent to Setf-Insure for workers' compensation. as provirlect for by Section 3700 of the labor Codc, for the performance of the work lor which thc permit is issued. ff,have and will maintain workers' conrpensation insurance, as required by Seclion 3700 of the Labor Code, for lhe Srcrformance of work ltrr this Jrcrmit compensation insurancc carricr antl plicy numbcr arc: ,,,.,L _l certify that in thc Jrcrtbrmancc of the work for which this pcrmit is so as to becorne subject to the workers'compensation laws of California, workers' conrlrcnsation provisions of Section 3700 of the Labor Code, I issucd, I shall not cmpkry any in any manner , and agrcc that iil should becorp subjcct to the shrll, forthwith comply with thosc provisions. WARNING: Failurc to secure workers'comfrcnsation coveragc Ls unlawful. and shall subjcct an employer to criminal pcnalties and civil firres up to one hundred thousand dollars (Slm.UU.to the cost of compensation. damages as provided for the Section the interest and atlorney's I hcrcby al'lirrn undc'r 1^-nalty of pcrjury that I am liccnscd 9 (cornnrcncing with Section 70m) of Division 3 of the Busincss and Profcssions Codc. and my license is in full tbrcc and clfcct. C\:@ 1r-rr* . \.4q.- CONSTRUC,TION I,ENDING AGENCY I hercby afl'irm under penalty of perjury that there is a construction lending agency for the performarrce of the work tbr which this permit is issucd (Scc. 3097, Civ. C.). kndcr's Namc: lJn(lr':r's Arltlrcss; A PPLICANT DECI,ARA TION I trreby affrm under penalty of perjury one of the following tleclarations: Denrolition Permits-Asbcstos Notification Federal Regulations (Title 40, Part6) _Required ktter of Notification with all City and County and County to enter ufnn lhe atxrve rncntioned property for ,r",., t^O\\tV^ Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loor/Ve nUl n su latio n Roof Sheathinq Shear Wall Framinq Insulatio nlEnerqv Drvwall Ext./lnt. Lath Brown Coat Jtlasonry Pool Fence (, T-Bar Handicap Req. Deputy Final Report Enqineer Fina! Report Flood Zone Certif I \ FINAL ,/ r'-/ 7 t/zt'"O -7ly"tl/ Certificate of Occupancy t /, a Notes, Remarks, Etc. ( Rev. 08'07-2015 renxrval are not applicable to this project. above information is corroct. I