101102332 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNERBUILDERDELCARATION . I I heretry affirrn under penalty of pajury that I m exempt from thc Contracton' Licmre lrw for thc following rcmn (Sa.7031.f ' Bwinss and Profeion Code): Any City or County rvhich rcquirB a pennit to coNlruct. alt6. improlc. dmolish or npair any struclure Jrior to its isumcc. alrc require thc applicilt for such tmit to file a signed stamot tha he or shc b licosed pummt to the previsioN of the Contractor's Licensed taw (Chapts 9. Commmcing rvith Setion 7000 of Division 3 of thc Businos md ProfesionsCode)orthathe orsheiscxemptthrcfromedthâ‚¬bosisforthe allegedexmption. AnyviolalionofSeclionT03l.5byany applicant for a pemit subjcts thc applicant to a civil poalty of not more than livc hundrcd dollm ($500). -_._1. as owner of the properly. or tny employees with rvages as their sole compensation. rvill do the work and the structure is not intenderl or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the prrcperty who builds or irnproves therqrn. and rvho docs such \r'ork himself or herself or through his or her os'n employees. providcd that such improvonents are not intendcd or offered for sale. lf. hou'ev'er. the buildinli or improvetnenl is sold N'ithin one y'ear I of cornpletion. the Orvner Builder will have the burden of proving that he or she did not build or irnprove the propoty for the purpose of sale). -1. as owner of the property. am exclusively contracting rvith licensed contractors lo construct the project (Sec. 7044. Business and Profession Code: The Contractor's License Larv does not apply to an owner of property rvho builds or improves thereon. ' and who contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License [,arv). _l am exempt under Section B. & P.C. for this reason. I)ale:Owner:_ DECLARATTON of perjury one of the follos'ing declarations:I hercby affirm under penalty -l have and rvill maintain a Certificate of Consent to Self-lnsure ft)r u'orkers' compensation. as provided for by Section -j700 of the Labor Code. for the pcrformance of the rvork for which the pennit is issued. -l have and will rnaintain rvorkers' compensation insurance. as required by Section 3700 of the Labor Code. for the perfonnance of the work for which this pennit is issued. My rvorkcrs' compensation insurance carrier and policy number are: :;; _l certifythat in the performance of the rvork for u,hich this permit is issued. I shall not onploy any person in any manner so as to become subject to the workers'compexsation larvs of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall. forrhwith comply rvith those provisions. WARNING: Failure to secure rvorkers' compensation coverage is unlawful. and shall subject an anployer to crirninal penalties and civil fines up to one hundred thousand dollars in addition to the cost of compensation. danages as provided for the Section -1076 Labor Code. interest and fces. ( I hercby affirrn under penalty of perjury that I arn licensed of thc Business and Professions Code. and nry license is I (cornnrencing with Section 7000) oIDivision -3j3-7ictin full force and effect.q License.r.rr,-! ( O ,rr"l\W Licensc e I hereby afTirm undcr penalty of perjury that issued (Sec. 3097. Civ. C.). is a construction lending agency for the perfonnance of the u'ork for u'hich this ;rrmit is Lender's Name: Lender's Address: APPLICANT DECLARA'TION I ho$y afiinn under penalty of perjury one of the follorving declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Par16) _Required [.etter of Notification -l ce{tify that the fcdaal regulatioro rcgrding cbetos rmoral qe not applicablc to this prcjst. Y2Yt caify rnat I havc,J,d this application md statethat the abovc infomation is cor$t. I agE to comply with all Cityand County ordinance al\ltatcfws relaring to building corutruction, ild hseby grhorizc rcprcstativ6 of this City md Co.unty togllsr upon thcil:"-ffi::::w ,.,", L)lu/q*"-"**'"fft-- Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUI ns u latio n Roof Sheathing Shear Wall Framing Insulation/Energy Drywall Ext./lnt. Lath Brown Coat [/asonry Poo! Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif I FINAL llull1 D. tt r'1fr â‚¬L,fl ry Certificate of Occupancy I tl Notes, Remarks, Etc.