10282189 - Permit - Laserfiche WebLink

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BU!LDING- INSPECTOR RECORD SITE.WORK DATE !D/SIG COMMENTS Owner-tluilder I hereby aflirm under penahy of perjury thal I am exenrpt form the Contractors' License Law for the followinS reason (se 703 1.5 Businds and Profession ('ode)r Any ('ity or Counly which rcquires a peflnit to construct. altcr. improvc. demolish or rcpair any structure. prior to its issuance. also requires thc applicanl for such pennit to filc a signcd statemcnt that hc or she is liccucd puGuant to the prolisions ofthc Contractor's Lrcensed Lsw (Chapler 9. Conrmencing w[h Section 7000 of Division ] of the Rusiness .nd Professions Code) or lhal hc or shc is excmpl lh.r.from and lhc basis for thc rllcgcd cxemption .Any violation of Scction 70-l L5 by any applicant for a pcmit subjccts thc applicanl to I civil pcnally ofnol morc lhan fir,c hundrcd dolla6 ($500). _ -1. as owncr ofthe propcny, or my cmployees with w6ges as thcir sole compensalion. will do thc work and thc structurc is not intcnded or offered for sale ( Sec ?044. Business and Professions Code: The Contractor's License Law does nol apply to an owner of the propcny who builds or improvcs lhcreon. and who docs such work himsclfor hersclfor through his or hcr own ernployecs, provided thal such improvcmenls tre not intended or offcred for sale. lf. howcvcr. the building or irnprovcment is sold within one ycar ofconlplclion, the Orvncr-Buildcr will have thc burden ofprovinB lhat h. or shc not build or improve for lhc purpose ofsale). I. s own.r ofthc propmy, 8m cxclusivcly contraoing with licenscd contractoF to coNtrucl thc projccl ( Scc. 7044, Buinos aod Profession Code The Contrador's License hw do6 not apply to an owner ofpropedy who builds or improves lhercon . snd who contracts for such proJects wilh a contractor(s) licensed pursuant to lhe contractor's Law.) I am cxcmpt undd Scclion &lhis rcason. Date:()s'ner: WORKERS ('OMPENSATION DE('LARA'IION I hereby aftlrnr under peralty ofpc{ury onc oflhe following declarations: I hav€ and will maintain a Ccnificatc ofConscnt to Sclf-lnsure for workers' compenetion, as provided for by Section l70o ofthe trbor Codc. for the pcrfonnancc ofthe work ior which thc pcrmit is issued. I have and wrll maintarn workers' conrpenstion insurance. as required by Section 3700 oflhe tlbor Code, for the performancc ofthe work for which this permit is issued. My workers' compenstion insurance carier and policy number are: Policy Numbcr:_____Expircs: ('l his scction necd not b" .o,npl"t"d if th" p"r.it i. f* On" h,.d*d d.k, 1il 00l or lcss) I cenify lhal in thc perfonnancc ofthe work for which lhis permit is issucd. I shall nol li anv manner so 6 to became sublect to lhe workers @mpenstion laws ofCalifornia, and ifr compensation provisions ofSection 3700 oflhc tabor Codc. I shall. Datc: Applicant lVARNING: Failure lo secure workers' compensation coverage is and subJect an employer lo criminal pcnalties and civil fincs up to onc hundrcd thousand dollars ($l 00.000).in addition to lhc cost of compcnsarion. damaSes 6 provided for the Section 3076 of the Lsbor Code. interesl and sttorney's fees LICENSED CONTRACTORS DECLARATION I hercby affrm undcr pcnalty ofpojury that I m liccnscd undcr povision ofChaptcr 9 (commcncing wirh Scction 7000) ofDivision I of th€ Busincss and Profcssioru Codc, md my license is in full forcc md cffect. Licesc I)atc: License Numbcr _ Contractor: _ CONSTRUCTION LENDING AGENCY I hcreby affirm under penalty ofperjuy that lhere is I coNtruclion lcnding agcncy for the perfomance ofthe work for which this pcrmit is issucd (Scc.3097. Civ. C.). Lender's Name Lender's Address: APPLTCANT'S DECLARATION Dcmolition Pcnnils-Asbeslos Notificarion Federal Rcgulations ('fitlc 40. Paa 6) Required Lctter of Notificatioo _l ccnify lhal the fcdcral rcgulations regarding 6bestos rernoval are applicable to rhis proj€ct _- I ccniry thal I havc rcad this lhat the above corecl. I agrce to cornply wilh all City and Counly ordinanccs and State laws relating to abovc mcntioncd propeny Applicanl or aSent Pcmittec name (print), _ and ofthis City and County lo enter upon thc Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/VenUlnsul Roof Sheathing Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL ll / t1/ rt/^t'\44, Certificate of Occupancy rl Notes, Remarks, Etc. Canier:_ *n