10191670 - Permit - Laserfiche WebLink

Home Browse Search

SITE-WORK DATE ID/SIG. Set Backs Forms/Steel /Holdowns Erection Pads UFER Ground SLAB Floor Subfloor/V enUI nsulation Roof Sheathinq IZ/.:zv//6 Shear Wall Framinq lnsulation/Enerav Drvwall Ext.lint. Lath Brown Coat Masonrv Pool Fence T-Bar Handicao Rea. Deoutv Final Report Enqineer Final Reoort Flood Zone Certif. I I FINAL fo/1,,Vo Certificate of Occupancy ' Notes, Remarks , Etc. BUILD I NG-INSPECTOR RECORD COMMENTS v I OWNER BUILDER DELCARATION I hereby affinn u nder pt.."tmlty of perj ury that I run exe mpt from the Contractors · License Law for the fo ll owing rc.;.s.on (SccJ.031.5 Business and Professio n Code); Any City or County which requires a permit to construct. a lter. improve. demolish or reif.~ ~t1y structure. prior to its issuance. also requires the applicant for such pennit to file a s ign ed statement that he or she is licensed pursuant to the provisio ns of the Contrnctor·s Licensed Law (Chapter 9 , Commencing with Section 7000 or Div ision 3 of the Business and Professions Code) or that he or she is exempt therefrom and 1hc basis for the alleged exemptio n. Any v iola tion of Section 703 1.5 by a ny applicant for a pennit subjects the a pplicant to a civil penalty of not more than five hundred dollars ($500). _I. as owner of the property. or my employees w it h wages as their sole compensatio n. wiU do the work and the stmctlu·e is not intended ororTered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does 1101 apply to an owner of the property who buil& or improves thereon. and who does such work h imself or herself or 1hrough his o r her own em ployees. provided that such improvements are not intended or offered for sale . I f. however. the building or improvement is sold within one }'ear of completion. the Owner Builder will have the burden of proving that he or she did no1 build or improve the property for the purpose of sale), _I. as owne r of the property. run exclusively contractin g with licensed contractors 10 construct the project (Sec. 7044. Business and Profession Code: T he Contractor's License Law d oes not apply to an own er of property who bu ilds or improves thereon. and who contracts for such projects wit h a Co ntrac tor(s) licensed pursuant to the Contractor's License La w). _1 run e:i:empt under Section, ________ . 8 . & P .C. for this reason. Date.: ___________ Ow ner: _______________________ _ WORKERS' COMPENSATI ON D EC L ARATION I hereby affirm unde r penalty o f perjury o ne of the following declarations: _l have and w ill maintain a Certificate of Consent to Self-Insure for workers· compensation. as provided for by Scclion 3700 of1hc Labo r Code. for the perfonnance of the work for which the pcnnit is issued. _I have and will m aintain wo rkers· com pensation insurance. as required by Section 3700 of the Labor Code, fo r the perfonnan ce of the work for which t his pennit is issued. My workers· compensation insu rance can-ier :lnd polic y number are: _1 certify that in the pcrfomiance of th e wo rk for which this permit is issued. I shall no t employ any person in any manner so as to become su bject to t he workers' compensation laws of California. and agree that if 1 should become subjec1 to the workers' compensatio n provisions o f Sect ion 3700 of the Libor Cod e. I shall. fonhwi1h comply with those provisions. WARNING: Failure 10 secure workers' compensation coverage is unlawful. and shall s ubject an employer to crimin al penalties and civil fines u p to o n e hundred tho usand do llars ($100.0~0). in addition to 1he cost of compensatio n. damages as p rovided for the Secti~n 30~~ o f the Labor Code. inter~t and attonfy'Jes. Dale: / 2., -2-u -( ~A1111 Ii cn,~:. ____________________ _ LICENSED CONTRACTOR DEC LARATION I hereby a flinn under penalty of perj ury tlrnl I run licensed u nder provision of Chapter 9 (commencing with Sectio n 7000) of Divis ion 3 of the Business and Professions Code. and m y license is in full force and effect. LicenseClass L -"3"7 f;znber -R _ '5,n q /) C{-/ Dale /Z~-Zo -/le Conlra ~ ' -I) A a,,,,--- ""7-...; T C/ ~~N•TR' ,r·nnN LEN•'1w•f. ~ENry I hereby affirm under penalty o f perjury that there is a con.s.1ructio n lendid'g agctlcy for th e pcrfonnanc e of the work for which this perm it is issu ed (Sec. 3097. Civ. C,). Lender's Name: _________________________ _ Lender's Address: _________________________ _ APPLICANT DEC L ARATION I hereby affinn under penalty of perj ury one of the fol lowing d eclarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) _Required Letter o f Notification _I c enify that the federal regu lations regarding asbestos removal are not applicable to this project. _1 certify that I have read this appl ication and state that the vc infonnation is correct. I agree to comply with all C ity a nd County ordinances and State Laws 1clai;7ng~ to m:_~~::rru cuon. A,er -~/2y authon ze reprcsentatwes ofthts City and County to e nter upon the above m enlloned prope1t y for ms 1101/urpo.L. 1/ A ~ "-- Applican1orAgcnl Signnty cJ-.,, -, • &Y(__,,-Da le / 2. -Z.Q -/v::, Pcrmilce name (p rinl): <.::::..--r,-:?/1 h / f ~ c..£. c;:./.,} '· '2t;:;,. . ., (