10291383 - Permit - Laserfiche WebLink

Home Browse Search

SITE-WORK DATE ID/SIG. Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor SubfloorNent/lnsulation Roof Sheathinq Shear Wall Framinq Insulation/Energy Drvwall Ext.lint. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Cert if. 1 I I- FINAL "Z..\n \\b ~')9-.~ Certificate of Occupancy . - Notes , Remarks, Etc. BUILDING-INSPECTOR RECORD --COMMENTS OWNER BU ILDER DEL CARATI ON I hereby affmn under penalty of perjury thal I am exempt from th e Contractors' License Law for the fo llowing reac.on (Sec.7031.5 Bus iness and Professio n Code): Any City or County which requires a pcnnit to construct. alter, improve. demolish or repair uny Slructure, prior to its issuance, also requires the applicant for s uch pennit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's Licensed Law (Chapter 9, Commencing with Section 7000 of Divis ion 3 '51 the Business and Professions Code) or that he or she is exempt th erefrom and t he basis for the alleged exemption. Any violation of Section 70ll .5 ~>y any applicant for a pem1it subjects the app licant to a civi l pcaalty of not more than five hundred dollars ($500). _I. as owner of the property, or my employees with wages as t heir sole compensatio n. will do the work and the suucture is not intended or offered for sale (Sec, 7044. Business and Professions Code: The Contr actor's License Law does not apply to an owner of the property who builds or improves thereon. and who doe; such work himself or herself or through his or her own employees. provided that such improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year of compk.1ion. the O.vner Builder will have the burden of proving that he or she did not build or improve the propaty for the purpose of sale). _I. as owner of the property. am excl us ive ly contracting with lice nsed contractors to construct the project (Sec. 7044. Business and Profession Code: The Contractor 's License Law does not ap ply to an owner of property who bui lds or imp roves thereon, and who contracts for such proJccts with a Co ntracto,{s) licensed pursuant to the Contractor's License y Da t~runexempt undcrScc11on / l '{Bj~c;;;;;t}/A/tiJJI\ ~ • KllRS' CO~IPll~.T ION C DECLARATION I hereby affirm under penalty of perJury vmg declarat1011s _I have and will mamtam a Certificate o f Consent to Self-lnsure for workers· compensation. as provided for by Section 3700 of the Labor Code. for the perfonnance o f the wo rk for which th e permit is issued. _1 have and will maintain wo rkers· compensation insurance, as required by Section 3700 of the Labor Code. for the perfon nance of the work for which this pcm1it is issued. My wo rkers' compensation insurance carrier and poli cy num ber are; Carrier: __________________________ _ Policy Number:. _____________________ Expires: __________ _ _I cert ify that in the performa nce of the work for wh ich this pem1it is issued. I shall not employ any person in any manner so as to become subject lo th e workers' compensation laws of California. and agree that i fl should become subject to the workers' co mpensation provisi ons of Section 3700 of the Labor Code, I shall. forthwith comply with those provis ions. WARNING: Failu re to secure workers' compensation coverage is unlawful, and shall subject an emp~oyer 10 c7rirninal penal · and civil fines up to one hundred thousand dollars ( 00.000), in addi tion to the cost of co mpensation, damages as pro,iid or the Sectio n 3076 of the Labor Code. interest and atto ey·s f~. A . 1 /2, f Date:. _____ A icant: / // 11/J.P AYJ l.V'/ /11~ ' '\ •-_LARATI ON L1 C ll'.NS111 CO NTRA<"TllR ,/j: I hereby affirm under penalty of perjury that I am liccnsc&der provis ion of Chapter 9 (commenci • ith Sect ion 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Li ce nse Class.: _______________ License Number: _______________ _ Date .: ____________ Contrac tor: _____________________ _ CONSTRUCTI ON LEN DING AGENCY I hereby affirm und er penalty of perjury that there is a construction lending agency for the perfonnance of the work for which this permit is issued (Sec. 3097. Civ. C.). Lender 's Name: _________________________ _ Lender·s Address: _________________________ _ A PPLICANT D EC L ARATION I hereby affinn under penalty o f perjury one of the following declarations: Demolition Permits-Asbestos Notificatio n Federal Regulations (Title 40. Part6) _Req uired Letter o f Notification _I certify that the federal regu lat ions regarding asbestos removal are not applicable to this project. I certify, iat I have read this application and state that the abo ve info nnation is correct:::ZI agree to com ywith all City and County ordi . nc . nd State Laws rela_ting to,t1ildin constni ction. andjj1er a~t. e representatives o fthi . y and Cou1zty o en ter u n the a bove nt1oned prope,ty for tns peclt Op f"]" ) /) /Vt( r fi;; ;: I r (I/ Applicnn1 or ~'\gen1Signatur e: '//J.,,Jv" /// , {JI/J Date: / I~ )/{ ) Pcrmitc~n/4rint):_ /\/() \('I) { Ci ( J'TrriC111 /) 1 r)(J1 ';!) _/"---I '-' ~ -// l -- V