10191771 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DEL(:ARATION I hoeby affirm under pmalty of psjury thal I m excnrpl from the Contracto6' License Law for the follorving reason (Sec.70Jl.5 Businas md Prcfssion Code): Any ('ily or County which raluire a ponil to conslnrcl. alts. improve. denolish or repair aly slructure. prior to its issuace. also requirs the applicant for such pemit to file a signed statmmt that he or she is licmsed pursuant to the provisions ofthe Contractor's Licensed Law (Chapt6 9. Commencing $ilh Section 7000 ofDivision I ofthe Business and I'rofessionsCode)orthathcorsheisexernptthoehomandthebmisfortheallege<lexemption. AnyviolationofsetionT0-ll.5byany applicantforapmilsubjetsthe applicanttoacivilpef,alyofnotmorelhanfivehundreddollds($500). I. 6 owner ofthc proFEny. or my employffi with !vag6 6 their sole composation. rvill do the work ed the slnrclm is not intmdeti oroffqe<lforsle(Se.TM4.BusinqsmdProfessionsCodc:TheCof,lractor'sLicenseLawdoesnotapplytoanownqof thepnrpny whotrildsorimprov6th6@n.mdwhodo6suchrvorkhirnselforherselforthroughhisorhsownemployes. providcd that such improvmots rc not intmded oroffqed for slc. lf. hoN66. the boilding or improlonflt is mld *'ilhin onc 1w ofcompletion. the Orvns Builds rvill harc the hrrdo ofproving thal he or she did nol tuild or irnprove the prepqty for the puryr* of sale). I. d oN'nq oflhe propfiy, m cxclusivcly conlracting with licensed conlracloG lo construct lhe projd (Ss. 7M4. Buins and ProfssionCode:ThcConlraclor'sLicenseLarvdoenotapplylomorvnsofprop€rtyrvhobuildsorimprovGthssn. and who contracts for such prejsts with a Contractor(s) licssed pursuant lo the Contractor's License [aw). I arn ercnrpl undfr S(lion B. & P.C. for this re6on. Dste: Owner:_ WORKERS' CONIPENSA'I'ION DECLARATION I hereby amm unds poalty ofperjury one ofthe following drlaralions: _l havc md *ill mainlain a Ceflificate of Commt lo Self-ltrure for workqs comptrsatioo. 6 lrovided for by Section 1700 of lhe kbor Code. for the perfommce of lhe rvork for which lhe pfinil is isued. I have and will rnainlain workm compcnsation insurance. as rquired by Scction 3700 oflhe t,abor Code, for lhc psfomance of the rvork for rvhich lhis pennil is issued. My rvorkes compensalion insurance canier md Jxrlicy numbo oe: Caricn Policy Number:_Expircs: _ I cffify thal in the psfonnance ofthc rvork for rvhich lhis ponril is issued. I shall not ernploy any pmon in any manner so as to betome subjccl to lhe workm'cornpnsation larvs ofCalifornia. and agre that ifl should beconle subjffl to the workss'compmsalionprovisionsofSeclionST00oflhel.aborCodc.lshall.forthwithconrplywiththo*provisions. WARNING: Failurc to sure rvorkm'composlion cov@ge is unlarvful. and shall subiet m anploy,o to oirninal lFnahis and civil llnes up to onc huf,dred thouund dollm ($l in addition to of compenstion.as provided fur the Seclion.t076 Codc. int16l and allomey's DECLARATION I heeby a{Iirm undo pmalty ofpsjury lhal I m licm*d undq provision ofChaptr 9 (commencing rvith Setion 7000) of Division 3 of thc Busines md Profsions Code. md mv licse is in full force md effccl l-iceilsc Number; Ihdebyaffmund6penun,o,-,,o.n"',nffi*o.n*o,,,,*,,o,*"-fomilceoflheworkforwhichthistEmit6 issued (Sc. -1097, Civ. C.). Lender's N8E+ "U,Kru. APPLICANT DI'CLARATION I hoeby allm undo poalty ofpsjury one oflhe following dsltrations: Demolition Pmits-AsbGtos Notification Fcdsal Rcgulalions (Tille 40, Paa6) -Required Lelts of Notificalion I ccfliry lhat the fed6al regulations rcguding asbestos rmoval are not applicable to this prejet. I cdify that I havc read this application md state lhat the above infrrnnation is cor6l. I agre to conrply rvith all ('ity and County ordinancs md SIate [,arvs rclating to building of this ('ity and Counly to mts ufFn lhe above mmtioned propay for Appliceill or Agent Signature: I'ermilcc n{me (print)r md herebv aulhorize ,,,"rdt fI? Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/VenUl nsu lation Roof Sheathing Shear Wall Framing lnsulation/Energy Dnnryall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Enqineer Final Report Flood Zone Certif I N FINAL -?t -ta u+& Certificate of Occupancy Notes, Remarks, Etc. 4L-t l- t/^-rQ.l sr I t? /--vt ,,1 H -fiuhlrt ?-/)E-{yA)A,*tR9f) -5- 4--fi- ta.arrp l\ 1\ / .ttu uJA< tst -T\) dr.: e Jy.l"#)(w)r'r_I P2-*hw4yru \t'u T-0 OP'+T o MNq-\^hLL IJ )Or-}}ai-/-.tlOt ^