101102014 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING- INSPECTOR RECORD SITE.WORK DATE !D/S!G.COMMENTS OWNER BUILDER DELCARATION I hereby amrm unds pqalty of psjury that I on exempt film the Contraclorc' Lic@sc taw for the following,rwn (Se.7031.5 Businos and Profession Code): Any City or County which requirG a pqrnit to construct, altq, improvq donolish or repair uy structue. prior lo ils issumcc. also requirc the applicilt for such pennit to filo a signed statmflt thal h. or she is licoscd pmuilt to the provisiore of the Contractor's Liccnscd Larv (Chapts 9. Commmcing rvith Sation 7000 of Division 3 of the Busine md Profsions Codc) or that hc or shc is cxempt thecfrom md the basis for Ihe allcgcd cxmplion. Any violation of Sâ‚¬tion 70-l1.5 by my applicot for a pmit subjels lhe applicot to a civil pcnalty of not mor. the five hundred dollus ($500). __1, as owner of the propefly. or my emplolces with rvages as their sole compensation. rvilldo the rvork and the structure is not intended or offered for sale (Sec.7M4. Business and Professions Code: 'I'he Contractor's License Larv does not apply to an orvncr of the progxrty, \\'ho builds or inrproves thermn. and rvho does such u'ork hirnself or herself or through his or her orvn employees. provided that such improvanents are not intendcd or ofFâ‚¬red for sale. I[, horvev'er. the building or improvemert is sold wilhin one year of cornplaion. the Orvner Builder rvill have the hrden of proring that he or she did not build or improve the property for the purpose oF sale). -1. as owner of the property. am exclusively contracting rvith licenscd contractors to construct the project (Sec. 7M4. Business and Profession Code: The Contractor's License Law' does not apply to an owner of property who builds or improves thereon. and rvho conlracts for such projects s'ith a Contracto(s) licensed pursuanl to the Contractor's License Larv). -larnexemptunderSection-B.&P.C.forthisreason. l)al c:()rr ner: WORKER,S' COIITPENSATION DECLARATION I hereby affrrm under pcnalty of perjury one of the follorving declarations: __l have and rvill maintain a Ccrtificate ofConsent to Self-lnsure for workers' compensation. as provided for by Section .1700 of the Labor Code, for the pâ‚¬rformance of the work for rvhich the pennit is issued. _l have and rvill rnaintain workers' compensation insurance. as required by Section -1700 of the Labor Code, for the performance of the work for which this pennit is issued. My rvorkers' conrpensation insurance carrier and policy number are: c**futdLa4,l,/a/q-&z-t-M 'oricy Nunber: db-R-4d2 ? q g f 5Z' Expires: ll//p---( -l cqrify lhat in thc pcrfr,nnance of the uork for which this pcrrnit is issued. I shall not qnploy any ;rcmn in any mancr rc o to bccomc subjet to the rvo*m' compoution laws of Califomi.. dd agre that if I should beomc subjsl to the u,orkc' compastion prcvisioN of Scction 3700 of thc tibor Code. I stnll. fonh$ith comply with thos pmvisioN. WARNING: Failurc to surc riorkeN' omFmsation covoage is unlarvful, od shall subjct u mploya to qimiml pcnaltics ild[ civil fincs up to one hundrecl thousand dollars ($100.000). in addition to of darnages as for the Section 3076 l-abor interest and attorney's fees. I hereby afllrm uncler penalty of pcrjury that I arn license<l under provision of Chapter 9 (commencing rvith Scction 7000) of Division -3 of thc Business and Profcssions Code. and rny license is in full force antl eflect. License ('lass:C -'/O License Number:7 7 CONS TRUCTION LENDING AGENCY I hereby aflinn unde penalty of pcjury Ihat th6c G a consruction loding agmcy for thc Jufomocc of Ihe work for trhich this pcmit is issued (Sec. 3097. Civ. C.). Lender's Name: Lender's Address: APPLICANT DEC LARAI'ION I lrreb/y affrnn under penalty of perjury one of the follow'ing de<larations: Dernolition Pcrmits-Asbestos Notification Federal Regulations ('t'itle 40. Part6) -Required Letter of Notification -l cdiry that the fedaal rcgulations rcguding abGtos rmoval trc not applicablc to this prcject. -t cerrify that I have read this application ild stat. that the abovc infomation is conect. I agc to comply with all Cityand County ordinancB and Statc Laws rctating to building conslruction. ud hqcby au(horire re?remtativs of this City md County to otd upon tlrc above mentioned property for inspection ,\pplicartl or Agcnt Date: Pernritee nRme illAu Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/VenUI n s u Iatio n Roof Sheathing Shear Wall Framing !nsu !ation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif. FINAL fl-?l-F)ile'q ^Certificate of Occupancy Notes, Remarks, Etc.