101103384 - Permit - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf Ioor/VenUI nsu Iatio n Roof Sheathino Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat N/asonrv Pool Fence T-Bar Handicap Req. Deputv Final Report Enqineer Final Reoort Flood Zone Certif FINAL [21-b tL ? tS,JgtE, gLfl Certificate of Notes, Remarks. Etc. owN!.tfl I LDER DELCA RAT I()N I hereby affirnr untler penalty of perjury that l;mn exemf,lrnr the Contractors' License law for the following reasoo (Sa;.7031.5 . Ilusiness and Prol'ession Code): Any City nr tnunty which requires a permit to construct, alrer, irnprove. demolish or rcpair any structure, prior to its issuance. also rcquires the applicant tbr such pernrit to file a signed staternetrl that he or she ls licenscd pursuanl to thc. provisions of thc' Contractor's l,icensed I^aw (Chaptcr 9, Commencing with Section 7fiX) of Division 3 ol'the Business and Prot'essions Code) or that he or she is exempl therefiom and the basis tbr tlre alleged exemption. Any violation of Section 7031 .5 by any applicant for a pennit subjects the applicant to a civil penalty of not more than live hundred dollars ($5001. _1. as owncr ol'thc propcrty. or my ernployccs with wages as their sole compcnsation, will do thc work and the stnrcture is not intended or offered for sale (Sec.7O44, Busincss and Pnrfessions Ccxle: The Contraclor's Licensc Law does not apply to an owner of the prcprty wlxl builds or improves thermru arxl wtxr dtlcs such work himself or herself or through his or her own employees, provided that such improvenrcnts are not intended or ollered for sale. Il, however, thc building or improvcnrnt is sold within one )aar of conrplcti<lru thc Owncr Buikbr will havc the burtlcn of pnrving that lre or she dirl not buikl or impmve thc propaty for thc purpsc of sale). -1. as owner of the propcrty, am exclusivcly contracting with licenscd contraclors to construct thc project (Scc. 7044, Business aml holssirm Code: The Contractor's License Law does not apply to an owner of prolrrty who builds or improves thereon. and who conlracts for such projects with a Contractor(s) licensed pursuant to the Contrador's License Law). -IanrexcmplunderSection-,B'&P.C.fbrthisreason'I1... ,.. lV( )RK I,:RS' ('( )t\IPI.:NSA'l'l( )N I)F]CI,ARATI()N I hcrcby atlirm undcr pcnalty of perjury onc of thc tbllowing declarations: _l have and will nraintain a Certificate of Consent to Sclt'-ln-sure for workers' c',onlpensation, as provided for by Section 3700 of the I-,ahor Code. for the Jrcrformarrce of thc work for which thc permit is Lssued. Code, for the Jrcrformance of are: poticy r.rrnlu.r'R ZZd tt 2l) -2-O rixpircs:t -t z _l ccrtity that in thc pcrformance of the work for which this permit is issuetl, I shall not enrploy any pcrson in any manner so as to bccorne subject to the workers' compcnsation laws of California, and agrce that if I shnuld bccorne subject to the wodrers' comJrnsation provisions of Section 3700 of thc Labor Cotle, I slrall, forthwith comply with thosc provisions. WARNING: Failurc to sccure workers' comlrcnsation covcmgc is unlawful. and shall subjcct an cmploycr to criminal penaltics and civil lines up to one hundrcd thousand dollars ($ltn.(U0;, in addition to thc cost of conrpensation, damages as provided for thc Section 3076 of the [-atnr Code, interest and attorney's fees. V - s-zc:/\f 1...,.. DECLARATION I hcreby al'lirrn undcr pnalty of perjury that I arn licenscd undcr provision of Chaptcr 9 (cornmcncing with Section 7000) of l)ivision 3 of thc Bu.sincss and Profcssions Code, and my liccnsc is in full lbrce and clfcct. 1oflZ?.oLiccnsc Pernritee nanre Numbcr: o"r", n-5'2D Qrur^rn coxsrntrcrlon I hereby allrrnr under Jrenalty of perjury that there is a construction hndfurg agency lbr the Jrcrftrrmance of the work tbr which this pcrnrit is issued (.Sec. 3097, Civ. C.). Lender's Name: lrnder's Atldrcss: APPLICANT DECLARATION I hereby affirm under pcnalty of perjury one of the following declarations: Demolition Permits-Asbcstos Notification Federal Regulations (Title 40, Part6) _Requircd lrtter of Notification _l certify that thc federal regulations regarding asbestos removal are not applicable to this project. lb certify thal I havc reatl rhis applicarion and sratc that the above informalion is correct. I agrec ro comply with all City and County ordinance.s and State Laws relating to building constructiorL and hereby authorize representatives of this City and County to enter uJnn thc atxrvc mcntionctl prolru-rty lilr inspection Applicant or Agcnt \l purposes. a"Z^^(-*h.-7 -t'za Rev. 0B-07-201 .,",,C-?a, /B-\ License ,{>f ch^{. t ".-.--$.-,\^-^-- ^^--- It -.^- I