101100935 - Permit (2) - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OIVNER BUILDER DEL('ARATION I herelry amrm undq pqalty of perjury that I m qempt fipm lhc ContracroE' l-icmsc larv for thc following rql (Str.7031.5 Businos and Profosion Code): Any City or County $hich requirs a Jumit to conslruct. altq. improvq dcrnoli#irr repair arly struaue. prior to ils issumce. also rcquire thc applicant for such pennit to file a signed statmmt that he or shc is licmsed psuml to the Fovisions of the Contractor's Licensed Larv (Chapts 9. Commencing with Sation 7000 of Division 3 of the Busines and Pref*sions Code) or that hc or she is cxmpt thcefrom and lhe basis for the allcgcd crmption. Any tiolation of Seclion 7031.5 by any applicantforapennitsubjststhe applicanttoacivilpenaltyofnotmorcthanfivehun&cddolltrs($500). l. as ow'ner of the property. or my employefs $'ith wages as their sole cornpensation. s'illdo the rvork and the stntcture is not intenderJ or offered f<lr sale (Sec.7044. Business and Professions Code: 'l-he Contractor's l-icense Larv does not apply to an orvner of the properry rvho builds or improves therqrn. and rvho does such work hirnself or herself or through his or her orvn employees. provided that such improvonents are not intended or offcrd for sale. lf. hos'ever. the building or improvernent is sold rvithin one yeru of cornpletion. the Orvner Builder rvill have the burden of proving that he or she did not build or improve the propeny for the purlnse of sale). , _ I. as owner of the property. atn e.\clusively contracting u,ilh licensecl contractors to construct the projecl (Scc. 7044. Business and Ptofession Code: 'l'he Contractor's License La*, does not apply to an ow'ner of propeny u'ho builds or itnpro!'es thereon. and rvho contracts for such projcrcts rvith a Contracto(s) licensed pursuant to the Contractor's License Larv). _ I am exetnpt under Section--B. & P.C. for this reason. Dale:_0wner:_ tt'bnxl:tts' t'<int pr.ns,t t lon l)li('1.,\R,\'l'loN I h6eby aflirm unds penalty ofpajuryone ofthe follorving dclrations: - I hale md uill maintain 8 Ccrtificate of CoNflt to Sclf-lnsurc for rvorkm' compostion. o povidcd for by Sation 3700 of thc tibor Code. for the pafomancc of thc wort for which the pmit is issued. *Jrave and will maintain workm' compensation ireurancc. 6 requircd by Sslion 3700 of thc Labor Code, for thc pafomance of 'the work for which this pcmit is isued. My workm' compensation insurilcc caris od policy nurnbo uc: ,^*,, AWLv I Lara ?VVlLUr r9li"r*u.uo,lAfL S(J 1t rct? - - ----E-on*,1t / t /-nl. &caity tt xin thc pcrformance of the work for which this pqrnit is issued. I shall not ilploy any pqson in 8ny mnns Kfu-io beorne subjct to thc workqs'mmpensation laws of Califomia. md agc that if I should becomc subj(t to the rvorkm' ompmslion prcvisiom of Setion 3700 of th. tabor Codq I shall. fonh$ith comply with tho* prcvisions. \!'ARNIN(J: [:ailure t() sccure \\'orkcrs'to crirninal peflalties and civil fines up to one hundred thousand as provided for the Section -1076 of the Labor Code. interest and attorney's fees. 3t 4 I hereby a{Tirm under penalty of per.iury that I arn licensed under 9 (cornmencing rvith Section 7000) of Division 3 of the Business and Professions Code. zurd nry license is in full florce and effect License Class:_Cto _ l,icense Nurnber:4?j7€? ,*",-3PU!4 Contracro,,-V tVt-taf- So\d,L CONSTRUC'I'ION LENDING AGENCY I hmby affirm unde poalty of psjury that thqe is a coNtruclion loding aSency for lhe pqfonnuce of the rvork for rvhich this pcrmit is issued (Se. -1097, Civ. C.). Lcnde's Name: Lender's Adclress: A PPLICANT DEC LARA"I'ION I hereby aflinn under penalty of perjury one of lhe follorving declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40. Pan6) -Required l-etter of Notification _ _l corify that the federal regulations regarding asbestos rcrnoval are not applicable to this project. is correct. I agree to comply rvith all ('ity and ('ounty I representatives o[this City and County to enler upon the above mentioned property for Applicnnt or Agent Permitee name (print): _ ancl state that the ahove r)a,e 7rc1 [n Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUI ns u I atio n Roof Sheathing Shear Wall Framing Insulation/Energy Drwvall Ext./lnt. Lath Brown Coat [/asonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Flnal Report Flood Zone Certif FINAL q [Fh zo Dfvvan,n.wY/ Certificate of Occupancy lr -' t I Notes, Remarks, Etc. (