101102935 - Permit - Laserfiche WebLink

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SITE.WORK DATE ID/SIG.COMMENTS OWNER BI.'ILDER DELCARATION , I hcrcby affirnr undcr pcnalty of prjury that I am exempt from the Contractors' Liccnse [:w for thc following reason (Scc.7031.5 Busincss and Prot'ession Codc): Any City or County which requircs a pcrmit lo construct. ahcr, improve, dcmolish or rcpair hny structurc, prior to its issuancc, also rcquircs the applicant for such permit to frlc a signcd staternent that hc or shc is licenscd pursuant to the provisions of the Contractor's Licensed I":w (Chaptcr 9. Commcncing with Scrtion 7000 of Division 3 of thc Business and Profcssions Codc) or that hc or shc is excmpt thercfrom and thc basis for the alleged excmption. Any violation of Section 7031.5 by any app-licant for a perrnit subjects thc applicant to a civil penalty of not nrorc lhan five hundred dollars ($5001. .r I l. u* owncr of thc property, or my enrployecs with wagcs as thcir sole compcnsation, will do the work and thc sErrcturc is not rntcndcd or offcrcd for sale (Sec.7044, Busincss and Professions Code: Thc Contractor's Licensc l-aw does not apply to an owncr o[ the propcrly who builds or improves thcrcon arxl who does such work himsclf or hcrsclf or lhrough his or her own employces. providcd thut such imgnovenrents are not intcndcd or offcrcd for salc. If, howe'rcr. thc buiHing or inprovcrrnt is sold within one yciu of comphtiorr" thc Owrrcr Buildcr will have thc burdcn of proving that hc or shc did not build or improvc thc pnopcrty for thc pur;nsc of salc). {_,,as owncr of thc propcrly. ant cxclusivcly contract ing with liccnscd contractors to construct thc propct (Scc. 7044, Busincss Profcssit>n Codc: Thc Contractor's Liccnsc Law docs not apply to an owncr of propcrty who builds or improvcs thcrcon, who conlracts for such projccts with a Contractor(s) liccnscd pursuant to the Contractor's Liccnsc kw). and and DECLARATION I hcrcby affirm undcr pcnalty of pcrjury one of thc following dcclarations: { , nou"und will rnaintain a Ccrrificate of Conscnt to Sclf-lnsure for workcrs'compcnsation. as povidcd for by Scctbn 3700 of the Labor Codc, fbr thc grcrformancc of thc work for which the pcrmit is issued. il nor"and will nraintain workers' compensation insuruncc. as roquircd by Section 3700 of thc Labor Codc, for thc performarrce of thc work for which this pcrmit is issucd. My workcrs' comlrcnsation insurance carrier and plicy numbcr are: ulat _l ccrrify that in the Jrerforrr,ancc of the work for which this perrnit is issucd. I shall not cmploy any I .'person ln Bny manner so as to bccomc subjcct to thc workcrs' conqrcnsation laws of California. rurd agrec that if I should beconrc subjcct to thc workers' conlpcnsation provisions of Section 3700 of the labor Codc. I shall. forthwith cornply with those provisions. WARNING: Failurc lo scure workers' compcnsation covcrage is unlawful. and shall subject an cmploycr to criminal pcnaltics and compcnsation. danuges as provided for thecivil fincs to onc hundrcd thousand dollars ($100,000). in addition to thc cost of Scction Labor Codc. intercst and attorncy's fccs. LICENSED CONTRACTOR nncl-ArtATIoN am licenscd under provision of Chaptcr 9 (comnrncing with Sc.ction 7000) of Division 3 my liccnsc is in full force and efTcrt. I hcrcby alfirnr undcr penalty of pcrjury that I of the Busincss and hofcssions Codc. and r Liccnsc Nunrbcr: W I hcrcby flirm udcr Fnalty of pcrjury that therc is a conslruction lcnding agcmy for lhe pcrformcc of thc work fo] which this Frmit is issucd (SN. 3097. Civ. C.). Lcndcr's Narrrc: [-ender's Addrcss: APPLICANT DECLARATION I hacby allirrn undcr pcnalty of pcrjury one of the following dcclnrations: Dcnrolition Pcrmits-Asbcstos Notification Fcderal Rcgulations (Title 40, Part6) y' n"quirca -{l ccrtity that lhc fcdcnlEgulations rcgrrding ssbcstos rcmvslrrc rct applicablc to this prcj$t. jl ccnify that I havc read this opplication ard starc that ftc abovc informtion is corecl. I ogre to comply with all City snd County ordinares and Stutc [:ws rclating ]o building conslrction, ild hercby authoria rcprcsentaliws of this City and Counly to cnler upon thc abovc rrrcntioncd proprty tbr inspcction purposcs. Applicant or Agent Prrnrilee nirnro Set Backs I Forms/Steel/Holdowns I -?#7 '{) Erection Pads UFER Ground SLAB Floor Subf Ioo rlV enV Insulation Roof Sheathinq Shear Wall Framinq 4t 'a170 D*+6q lnsulation/Energy q 'LYlau)Dfr,td',r Drywall q rzfflZo PffYT ?, ltglfintllath 1,qo Dt tr67 lo/7/.ru Df{Ty-Y-( BroilfnCoat lgra-Mr,LL t,q v qla)Dtr#&,toltoltn Dffiffi [\Iasonry I Pool Fence T-Bar Handicap Req. Deputy Final Report Enoineer Final Report Flood Zone Certif I J -a FINAL 7 Certificate of Occupancy Notes, Remarks, Etc. -l BUILDING. INSPECTOR RECORD Rev. 08-07 -201 5 , ) /t4/ /ol2) B. & P.C. for lhis rcilson. Contractor:_ *,",2/^(u