101105278 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING- INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hereby afl-rm undcr penalty of perjury that I am exempt from the Contractors' Liccnsc [:w for the following reason (Sec.7031.5 Busincss and Profession Codc): Any City or County which rcquircs a Jrcrmit to construct, allcr. improve, dcrnolish or rcpir any structurc. prior to its issuancc. also rcquircs thc applicant for such pcrmit to filc a signcd slaterrcnt that hc or shc is licenscd pursuant to thc provisions of thc Contractor's Licenscd l-aw (Chapter 9, Commencing with Settion 7000 of Division 3 of thc Busirrcss and Profcssions Code) or that hc or she is cxcmpt thcrcfrom and the basis for the allcged cxemption. Any violation of Section 7031 .5 by any applicant for a permit subjccts thc applicant to a civil penalty of nol morc than fivc hundrcd dollars ($5001. _1. as owncr of thc property. or my cmployccs with wagcs as thcir soh conrpcnsation. will do thc work affl thc stnrcturc is not intendcd or otfcrcd for salc (Scc.7044, Business and Professions Code: The Contractor's Liccnse [:w does not apply to an owncr of thc proprty who builds or improvcs thcrcon and who docs such work hirnsclf or hcrself or through his or hcr own cmployees. providcd that such impnrvcrncnts are not intendccl or offcrcd for salc. If. howevcr. thc building or inprovernent is sold within onc ]car of cornphtion, the Owner Buildcr will havc thc burdcn of proving that hc or she did not buih or irnprovc the pmprty lbr thc puryrcsc of salc). _1. as owncr of thc propcrty, am exclusivcly contracting with liccnsed contraclors to construct thc pro.icct (Scc. 7W, Busirrcss and Professinn Codc: Thc Contractor's Licensc Law does not apply lo an owncr of property who builds or improvcs thcreon, and who contracts for such Srojects with a Contracto(s) liccnscd pursuant to the Contractor's Liccnse kw). _l am excmpt under Scrtion-. B. & P.C. for thi.s reason. Dale:__( )rvlrcr. WORKERS' COM PET{SATION DF'CI ARATION I hcrcby affirm undcr penalty of pcrjury one of the following dcrlarations: _l have and will maintain a Certificatc of Consent to Sclf-lnsure for workers' compcnsalion, as povidcd for by Section 3700 of thc labor Code. for thc performancc of thc work for which the pcrmit is issucd. _l have and will maintain workcrs' compensation insurarrcc, as rcquired by Section 3700 of the Labor Code, for the performarce of the work for which this pcrmit is issucd. My workcrs' compcnsation insurance carricr and grlicy numbcr arc: Carricr: _l ccrrify that in thc pcrformance of the work for which this pcrrnit is issued. I shall not employ any pcrson in any manner so as to become subjcct to thc workcrs' compcnsation laws of Calil'ornia. iurd agrcc that if I should bcconrc subjcct to thc workers' cornpensation provisions of Section 3700 of the l.abor Code, I shall, forthwith comply with thosc provisions. WARNIN(]: Failurc to sccurc workcrs' conrpcnsation covcragc is unlawful. and shall an crnploycr to criminal penalties and one hundred thousand dollars ($100.000). in damirges as provided for tlt intercst and altorncy's 23 c)La j I hcrcby atlirm undcr pcnalty ol'pcrjury that I anr liccnscd provision of Chaptcr 9 (comnrcncing with Scction 7000) of Division 3 of thc Business and Professions Code, and nry liccnse is in full forcc alxl cffcrt. Liccnsc il 2il2,1? W I hcrcby affirm undq pcmlty of Frjury thd thcrc is tr @nsrudion lqrding agcrcy for lhc pcaformcc of thc work for which this ptmil is issucd (Sc. 3097, Civ. C.). bndcr's Nam: lrndcr's Addrcss: APPLICANT DECLARATION I lrocby aftinn undcr penalty of prjury one of thc folkrwing dcclarations: Dcmolition Pcrmits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6) -Rcquircd l-cttcr of Notification -l certify that thc fedcralrcgulations regarding asbcstos rcrnvalare not applicablc to this projcct. _l certify that I havc rcarl this application and state that the above information is corrcct. I agrcc to cornply with all City and County ordinanccs and Statc [aws rchting to building authcrrizc represcntatives of this City and County lo cnter upn thc abovc rncntioncd propcrty for inspcction r\pplicnnt or Agent t\ I'ernrilee nanre zuLO Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loo r/VenUl ns u latio n tl^.^^ Roof Sheathino /Z/dl/a,z 2 /7#l a/ Shear Wall //\t Framinq lnsulatio nlEnergy Drywall Ext./lnt. Lath Brown Coat [\Iasonry Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif I a /2 / tl/cnzo -Y'M 7,/ /(/-- FINAL Certificate of Occupancy Notes, Remarks, Etc. Rev. 08-07-201 5 Policy Numbcr: Expires: civil fincs Scctiott /