10199368 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD I SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION I hrcby affrm utrd6 pctralty of pcrjury that I m cxcmpt fiom thc Contladoc' Licw Law for thc following rcmn (56.?031.5 '' Busin6s and Prcfsion Code): Any City or County which requirs a pomit to construcl. altc, improvc, danolish or ttpair my stluctu€, prior tc its isuece. al$ rcquirB thc applicot for such p€nnit to filc a signcd statmmt that he or shc b lic€Nd pNant to the provisios of thc Contractor's Liccn*d kw (Chapts 9. Commcncing wilh S(tion 7000 of Division 3 of thc Busin* ed Prcfsions Code) or that hc or shc is cxmpt thqcfrom od the bosis for thc allcgcd cxoption. Any violation of Sc{rion 7031.5 by my. applicantforagrcrmitsubjetsthc applicanttoacivilpcnaltyofnolmorcthofivchundrcddollm($500). _.-_[. a-s o\rmer of the proper:ty. or my employees with wag6 as their sole compensation, will do the work and the structure is not tntendoJ or offered for sale (Sec.7044. Business anci Professions Code: The Contractor's License l-aw does not apply to an owner of the proprrry who builds or improvs theron. and who does such work hlmself or herself or through his or her own employees, provided that such improvanents are not intended or offered for sale. I[, however. the building or improvetnent is sold within one year of cornplaion. the Orvner Builder will have the hrden of proving tha he or she did not build or improve the propoty for the purpose of sale)./{_\ as owner of the propefiy. am exclusively contracting with liccnscd contractors to conslruct the project (Sec. 7U4, Business and hofession Code: The Contractor's License Larv does not apply to an owner of property rvho builds or improves thereon. and who contracts for such projects wilh a Contractor(s) licorsed pursuant to the Contractor's Licensc taw). I am exemot under Section o*",4-=/1-ZOLU Owrrer: ( I hereby affrrm under penalty of perjury one of the following declarations: __i have and will maintain a Certificate of Consent to Self-lnsure for workers'compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which the pennit is issued. {*rand will mainrain workers' compcnsation insurancc, as required by Section 3700 of thc Labor Code, for the pcrformancc of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: a Policy Number: Expires: __l certify that in the perforrnancc of the work for which this permit is issued. I shall not onploy any person in any manner ,so as to becorne subje<t to the rvorkers' compensation larvs of California. and agree that if I should becomc subject to thc and the Section -1076 of the labor Code. interest and attorney's o^rc, 0Z- il- Z1LO I hereby affrrm under pcnalty of perjury that I am licensed under provision of Chaptcr 9 (comrnencing with Section 7000) of Division 3 of the Rusiness and Professions Code, and my license is in full force and effect. Licensc Class:-- .-License Number: Drte:_ CONSTRUCTION LENDING AGENCY I hcby affrm unda pcnalty of pcrjury that th6c is a consruction loding ag@cy for the pefommce of thc work for which this pennit is issucd (Ss. 3097, Civ. C.). Lender's Name: Lender's Ad&ess: APPLICANT DECLARATION I herdry affum under penalty of perjury one of the following declarations: Dcmolition Pcrmits-Asbestos Notil-rcation Fedcral Regulations (Title 40. Part6) -Reqtiired Letter of Notification _l certi$ that the federal regulations regarding asbcstos removalare not applicable to this proJed. /,ceftify that I havc read this application and state that the above inforrnation ordinances and State Lau,s relating to the above mentioned propefly for Applicant or Agent Penrritee nrrne and o*", flZ - l/ - 10ZO Set Backs Forms/Steel/Holdowns 3*?-V)L&'-A t Erection Pads UFER Ground SLAB Floor Su bfloor/Ve nUl nsu lation Roof Sheathing Shear Wall Framing )-22-Za fbez 7 7 z17 lnsulation/Energy 9,-2" 4t fZeZ Dmvall 7+tl-o lZe i 'exl)nt.Lath lo-r-p tLc 3 ,u Trown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif FINAL [/,/?-zD (-O^s ,\./fug 21 Certificate of Occupancy Notes, Remarks, Etc.e4 4rr\4 a Carrier:_