101103668 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING- INSPECTOR RECORD a SITE-WORK DATE ID/S!G.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bf loor/Ve nUI ns u Iatio n Roof Sheathing Shear Wall Framing 1 c1'2o2P Insulation/Energy Drywall Ext./!nt. Lath Brown Coat Jt/asonrV Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif. -,J JrSdFINALI l-rf t/0 Certificate of Occupancv INoJes, Bemarks, Etc. ?-^l I a.. YMUilCt 4r@)|4 to1 OW N I.:R Il U I LDI.,R D I.:LCA RA'f ION I hereby affirm under penalty of perjury that I am exempt from the Contracton' License Law for the following reason (Sec.7031.5 Ilusiness and Prot'cssion Code): Any City or County which requires a pcrmit to construct, alter. irnprove. demolish or repair any structure, prior to its issuance. also rcquires the applicant tbr such grcrmit to file a signed staternenl that hc or she is licenrcd pursuant to thc provisions o[ the Contractor's Licensed t:w (Chapter 9, Commencing with Section 7000 ol'Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and tlrc basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pennit subjects the applicanl to a civil penalty of not more than five hundred dollars ($stltt). _1. as owner ol'thc propcrty. or rny ernployces with wages as their solc compen.sation, will do the work and the slruclure is not interrlcd or ofTered for sale (Sec.70{a, Business and Professions Ccxlc: Thc Contractor's Licensc l:w docs not apply to an owner of the prupefly who builds or improves thereorL and who docs such work himself or herself or through his or her own employees, provided that such improvenrcnts are rnt intended orollcrcd for salc. Il, however, thc building or improvenrcnt is soH within one )tar of conphtion, the Owner BuikJ,er will have the burden of pmving that lre or she tlitl not build or improve thc property for the purgtse of sab). _1. as owncr of thc propcrly, am exclusively contracting with licenrcd conlraclors to construcl tlrc project (Sec. 7044, Busincss and h,ofesskm Code: The Contractor's License Law dcrcs not apply to an owncr of pr<lprty who builds or improves lhereon. and who conlracts for such projects with a Contractor(s) liccnscd pursuant to the Contractor's Licensc Law). -IantexcmptunderSection-,B.&P.C.tbrthisreason.I1...,. ' W( )RK l',:RS' ('( )t\I IIENSA'l'l( )N I)}:CI.ARATI0N I hcreby allirm undcr pcnalty of pcrjury one of the tbllowing dcclarations: _l have ard will maintain a Ccrtificate of Conscnt to Selt'-lnsurc firr workers'conrpensation, as provided for hySection 3700 of the Labor Code. for the Jrcrformance of the work lbr which the prmil is lssued. _l have and thc work t<lr will AS by Section 3700 of the Lahor Code, for the performance of sarricr and plicy numbcr are: Policy _l ccrrify that in thc pertbrnrance of thc work for which this pernrit is is.sucd, I shall not employ any person in any manner so as to bcconre subjcct to the workers' compensation laws of Califonria. and agrcc that if I should becom; subject to the workers' conrpensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with those provisions. WARNING: Failure to sccure workers' comlrcnsation covcnge is unlawful. antl shall subject an employer to criminal pcnalties and civil lines up to onc hundred thousand dollars ($l(n,UX)). in addition to the cost of compensation. damages as provided for thc Seclion of Labor Code, interest and attorney's fees. I,I('ENSI.:D ('()NTRA ('T0R I hcreby allirrn undcr pcnalty of pcrjury that I arn licenx'd of thc Bu.sincss and Profcssions Code, and my license is DECLARATION undcr provision ol'Chapter 9 (cornrnencing with Sectkrn 7ffn) of Division 3 in full forcc and clfect.b ?rCRIL [.icc'nsc Numbcr: a CONSTRUCTION I,F]NDING AGENCY I hereby aflirm under penalty of perjury that there is a construction hnding agency for the Srerformance of the work for which this pcrmit ls issucd (Sec. 3097, Civ. C.). Lcndcr's Nanrc: APPLICANT DECLARATION I trreby affrm under pnalty of pcrjury one of thc following doclarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) _Required lrtter of Notiflrcation -l certify that the federal regulations regarding asbestos removal &rc not applicatrle to this pro.iect. -l ccrtify rhat I havc rcad rhis application and state rhat lhe above information is correcl. I agrcc to comply with all City and Counry onlfutances anrl State Laws relating to building construction, and hereby authorize representatives of this City and County to enler uSron the above mentioncd propcrty for Applicrnt or Agcnt I'ennitee nanlr a 0B-07-2015 D DnarbaE )Tlulllt+lna yollyta ( 1 lv 1Al1 )l|/vlil tv ( knder's Address: