Laserfiche WebLink
SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby allrm undcr Fnally ot Frjury that I am cxcmpl fr()m tlE Conlraclos' Liccn* kw fbr thc tilllouing rcavtn (Scc.7031.5 <br />Busirrcss anl Profcssion Colc): Any City or Coutrty which rcquircs a lsmil kt construct. altcr. improve, dcmrlish or rcpair any <br />struclurc, pri()r to its i$suatrcc, also rcquircs the applicant for such lrcrmil lo filc s signcd statcmnt that hc or slrc is liensd pursualt <br />l(, thc pruvisions of thc Contraclor's Liccnscd Lau (Chaptcr 9, Commcncing with Scction 7UX) of Division -l of thc Busincss and <br />Prctbssions Codc) or that hc or shc is excmpt thcrehom aftl thc hasis ftrr thc allcgcd crcmplion. Any violation of Scclion 70.1 1.5 by any <br />0pplicant tilr a Jrcmit subjets thc &pI,licatrt kr a civil pcnalty of not morc than livc huudrcd dollus ($500). <br />_1. as owner ol'thc propcrty, or my employccs with wages as thcir solc compcnsation, will do thc work atil ttrc structurc is not <br />intcndcd or otl'crcd lirr salc (Sec.7044, Busincss and Prot'cssiorts Crxle: Thc Contraclor's Liccnsc Law dtrcs not aPply to an owncr of <br />thc propcrty who buikls or impn)vcs thcrc()n. and who drrcs such work himscll'rlr hcrsclf or thrlugh his or hcr own cmployccs. <br />pnrvidcd that such improvcrncnts arc m)t intcftlcd or oll'crcd tilr salc. If, howcvcr, thc huikling or impnrvctrrcnt is sokl within onc yciu <br />ol'conrplction, thc Owncr Builder will havc thc burden ol'proving that hc or shc did not build or inrprove thc pruperty lirr thc puryx)st ol <br />salc). <br />_1. asowncrof the propcrty, amcxclusivclycontracting with liccnscd contractors to construct tlrc pnrjcct (Scc. 7(X4. Busincss <br />antl Profbssion C<ldc: 'Ihc Contractor's Liccnsc Law docs not apply to an owner o[property who builds or improvcs thcrctu't, <br />and who contracts tirr such prcjccts with a C<lntractor(s) liccnscd pursuant to thc Contractor's Liccnsc Law). <br />-IamexcmptunderScction-,B.&P.C.tbrthisrcastln. <br />IVO RKEI(S' (]ONT PF]NSATIO N <br />DI.]C]LARATION <br />I hcrcby all'irm undcr pcnalty of Jrcrjury onc of thc lirlklwing dcclarations: <br />_l have urd will maintain a Ccrtiticatc of Consent to Sclt'-lnsurc lilr workcrs' comJrcnsation, as pnrvidcd ltrr by Scctiott 37fi) of thc <br />Latxrr Codc, lilr thc Jrcrlilrmancc ol'thc work lilr which thc ;rcrmit is issuctl. <br />_l havc and will maintain workcrs' compcnsation insurancc, as rcquircrl by Scction -1700 ol'thc Labrtr Codc, tirr thc Jrcrlilrmancc of <br />thc wrlrk lilr which this pcrmit is issued. My workcrs' compcnsation insurancc carricr urd 1xllicy numbcr arc: <br />Policy Numbcr: Expires: <br />_l ccrtity that in thc Jrcrlilrnrancc of thc work tbr which this Jrcrmit is issucd, I shall mtt cnrpkry any lrcrson in any manncr <br />so as to hcconrc subject to thc workcrs' compcnsatiotr laws of Calitilrnia, and agrcc that if I should bccomc subject to tlrc <br />workcrs' comJrclrsation provisions ol'Scction -17(X) of thc Latxrr Crxlc, I shall. tbrthwith comply with thosc pnrvisions. <br />WARNING: Failurc to sccurc workcrs'compensation covcragc is unlawlul, and shall subjcct an cmpklycr to criminal pcnaltic* and <br />civil lincs up to onc hundrcd thousand dollars ($lU),000), in addition to thc cost of compcrtsation, damagcs as providcd tirr thc <br />all()rrrcy's <br />I hcrcby allirm undcr pcnalty of pcrjury thal I am liccnscd undcr pnrvision of Chapler 9 (commcncing with Scction 7UX)) of Division J <br />of thc Busincss and Pnrl'essions Codc, and my liccnsc is in tull ftrrcc and cll'cct. <br />Liccnse <br />G+' <br />W <br />I hcrcby aflirm undcr JEnalty of Jrcrjury that thqc is a constructbn lcndhg agcrey for thc lElbrmnce of lhc work for which lhis tsmit is <br />issucd (Se. .109?, Civ. C.). <br />lrndcr's Name: <br />[.cndcr's Addrcss: <br />APPLICANT DECLARATION <br />I lrrcby all-rrn undcr pcnalty of Jrerjury one of thc lbllowing dcclarations: <br />Dcmolition Pcrmits-Asbcstos Notification Federal Regulations (Title 40, Part6) <br />_Rcqu irctl l-cttcr of Notilicatkln <br />_l cerlily that the l'cdcralrcgulations rcgarding asbcstos rcn'xrvalarc n()l applicahlc to this pro.icct. <br />6rr'y that I havc rcatt this apptication antl with all City and County <br />and Courrty to enter uJxtn thcordinanccs and Statc Laws rclating to <br />atxrvc- mcntionc'd proFrcny lilr insJrcctiorr <br />Applicant or Agent <br />Penrrilee narne <br />thc ahrvc intirrnration <br />o*", ? -2/-2t? <br />Set Backs <br />Forms/Stee!/Holdowns <br />Erection Pads <br />UFER Ground <br />SLAB Floor <br />Su bf loor/VenVI n s u latio n <br />Roof Sheathing A <br />Shear Wall t\ <br />Framing I -%-Zo Vilil'){,), <br />lnsu lation/Energy (//It <br />Drywall L an-4 X"Yh,L <br />Ext./lnt. Lath v \-/ <br />Brown Coat <br />[\Iasonry 1 <br />Pool Fence <br />T-Bar JgE fro\[ cu ]rL t0 --7-V)vJ{ou <br />Handicap Req L,AIJ) ,\, \-/ <br />Deputv Final Report <br />Engineer Final Report <br />Flood Zone Certif <br />/ <br />FINAL k"rtl: I <br />Certificate of I <br />Notes, Remarks, Etc. <br />-- <br />BUILDING. INSPECTOR RECORD <br />Florr nP.-n79f}16 <br />l-^ <br />t,\'-\9-A1t