10189247 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING-INSPECTOR RECORD SITE-WORK ID/SI~ COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/Vent/lnsulation Roof Sheathing 6 t1,../ /1" I /0 I ll Ir~ 5 . 7r..v I r-::11.i ~ Insulation/Energy f I~ I /t i 5 -~ l0f1.I ~ Ext.lint. Lath l Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif. FINAL Certificate of Occupancy I I vv 'I-"' Notes , Remarks, Etc. OWNER BUI LDER OELCARATION 1 hereby affirm under penalty of pc1jury that I run exempt from the Con1rac1ors· License L1w for the following re!~•mn (Sec.7031.5 Business and Profession Code): Any City or Comuy wh ic h requires a pennit to construct. alter. improve. dem olish or rej>air any structure. prtOr to i1s issuance. also requires the applicant for such pennit to file a signed statemen t that he or she 'is lic'ensed pttcs~an t to the provisions of the Contractor·s Licensed Law (Chapter 9. Commencing with Section 7000 of Division 3 of the Business and Professions Code) or that he or she is exempt 1hcrcfrom and the basis for the alleged exemption. An y violation or Section 703 1.5 by any applica nt for a pennil subjects the applicant to a civi l penally of not more than five hundred dollars {$500). _I. as owner of the prope11y. or my employees with wages as their sole compensation . will do the work and the structure is not intended or offered for sale (Sec. 7044. Business and Prorcssio ns Code: The Contractor·s License Law does not apply to an owner or the prope11y who builds or improves thereon. and who does such work himse lr or hers elr or through his or her own employees. prov ided that such improvements are 1101 intended or offered for sale. If. however. the building or im provement is sold within one year or completion. !he Owner Builder will have the burden of pro\~ng th at he or she did not build or improve the propaty for 1he purpose of sale). _I. as owner of the property. am exclusively contracting wilh licensed co ntractors to co ns1111ct the project (Sec . 7044. Bus iness and Pmfcssion Code: The Conlrn ctor·s License Law does not apply 10 an owner o f proper1y who bu ilds or irnpro\·es 1hcreon. and who contracts for such projccls wit h a Contrnctor(s} lic ensed purstrant lo the Contractor·s License Law). _I am exempt under Sec tion, ________ . 8. & P.C. for this reason Dnte: __________ Ow ner:_~--~~--~~~~------------ WORKERS' COMPENSATION DECLAllATI ON I hereby affirm under penalty o f perjury one of the following declarations: _1 have and wi ll maintain a Cert ifi cate of Consent to Self-Insure for workers· compensation. as pro vided for by Section 3700 of the Labor Code. for the pcrfom1ance o f the work for which the pen11it is issued. .., _I ce11ify tha1 in the performance of the work for which this permit is issued. I shall no I employ any person in any manner 4 so as to become subject to the workers' co111penso.1ion laws of Cali fornia. and ag ree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall. fo11hwit h comply with those provisions. WARN I NG: Failure to secure workers' compensation coverage is unl awful. and shall subject an emp loyer to ffiminal penalties andJ civil fines up to one hundred thousand dollars lli l 00.000), in addit ion to the cost of compensation, dmnages as provided for the Section 3076 of th e Labor C~e. interest and att~mcy· ~v} jJ fX /L Ontc:--A \ -!22-lb A pplic t: JI ( A / l~ { I \IJE, LAl!A T ION ' 4 ~ . u ,,Ns1 D l"'olhT!AY'T( R V \.I\) \,i, I hereby affirm under penalty of perjury thnt I am liccn St."CI l~cr provision ofClw1ptcr 9 (commencing w11I cction 7000) of Division 3 of th e Business and Pro fessions Code. and my license is in full force and effect. '" License((llms: ~ • <icenscNumbcr: B 4-3'1--0'fl;.J On te t , -:· '2.---5 ~ i ~ Co nt m tXf ):} /1 /1 -,,., /V' a '\ ' , r·nNsTnu~1L ~~,: • :Jr-cvV \A) \ / I hereby affirm under pcr1 alt yof pc1j ury 1lia1 there is a constnictN lending agency for the perfom1ance of th~o1\.; for whi ch this permit is issued (Sec. 3097, Civ. C.). Lender"s Name: _________________________ _ Lendcr·s Address: _________________________ _ A PPLICANT DEC LARATION I hereby affi rm under penalt y o f pe1jury one of th e follow ing declarations: Demol ition Penn its-Asbestos No1 ilica1ion Federal Regulations (Title 40. Pa116) _Requi red Letter of Not ification _I cenify that th e rederal regulations reganling asbestos removal are not applicable to this project. J ' _1 cC111fy thilt I have read th1s appl1cat1o n and state that th e above 1nfo1 111at1011 1s concct I ag1ee 10 com ply \\ 1th a ll Cny amt County ordmances nnd State Laws relating to buildin g constnact10n. and hcr(\1o/1'?r:e rep1esentat1ves oftlus C it y and C'ount y to e nler upo n the above mcn11oncd property for mspecho~n· A 11 I\ I J , Appli cant or Agen t Signntnr.J / LI //'vV V ) / 1) l Onie 1 l .-1,_,' ' l (,c; Pcrmitcc name (p rint): ~· /i') \f"Y? P I <'J .--, ,), I A1/'I /} J -I .. ·-1 -