101102222 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING- !NSPECTOR RECORD SITE-WORK DATE ID/SIG COMMENTS OWNER BUlLDER DEL('ARATION I hoeby aflirm undfr pflalty of perjury that I m cxcmpt from lhe Conlracton' Licqs taw for thc following rcen (Se.70-11.5 Businss and Profcssion Cod.): Any City or County rvhich requiro a Jn'rnit to conslrucl. alto. improve demolish or repair uy structure. prior to its isuocc. also requirB thc applical for such peflnit to file a signcd statmol that he or shc is licmed pwant to the frovisions of the Contrctor's Licenscd [:w (Chapt6 9, Commencing wilh Selion 700O of Division 3 of the Busins atrd Profc$ionsCode)orthatlEorsheisexemptthqefromildthe bâ‚¬sisforlhe allegedexmrption. AnyviolaliooofSetionTOsl.5byan! applicantforapermitsubjctsthe applicanltoacivilpcnallyofnolmorelhilfivchundreddollus($500). __1. as o\r,ner of the propâ‚¬Tty. or my employets $'ith \r'ages as their sole compensation. w'illdo the w'ork and the structure is not interrdcrl or offered for sale (Sec.7M4. Business and hofessions Code: T'he Contractor's License Larv does not apply to an owner o[ the property rvho builds or irnproves thereon. and rvho does such rvod< hirnself or herself or through his or hcr orvn employees. provided that such inrprovonents are not intended or offcrd for sale. If. horvever. the building or improvemenl is sold within one year of cornplaion. the (hvner Builder uill have the burden of proving tha he or she did not build or improve the propa'ty for the purpose of sale). _ l. as o\t,ner of the properly. am exclusively contracting with licensed conlractors lo construct the project (Sec. 7044,llusiness and ttofession Code: 'l'he Contractor's License l-arv does nol apply to an o$'ner of property rvho builds or improves lhereon. and rvho contracts for such gnojects u'ith a Contracto(s) licensed pursuant to the Contractor's License Larv). -larnexemptunderSection.--.B.&P.C.forthisreason.Drte:_Orlrter: n'oix t.:ns' ('(lnl pl.nis,t I toirt DECLARA'I'ION I hereby alTirrn under penalty of pajury one of the follorving declarations: _ ,l have and rvill rnaintain a Certificate of Consent to Self-lnsure for rvorkers' cornpersation. as provided for by Section -1700 of the labor Code. for the performance of the rvork for s'hich the pennit is issued. _l have and rvill maintain workers' compensation insurance, as required by Section -i700 of the labor Code. for the poformance of the work for which this permit is issued. My workers' conrpensation insurance carrier and gnlicy number are: cmo, 5/ a./e Feu r/ poricyNu,na",, ?2 313q 3 --Expires: -eZ/y!?o'4 ' I cerrify that in the perforrnance of the rvork for u'hich this permit is issued. I shall not ernploy any person in any manner so as to become subject to the rvorkers' compensation larvs of California. and agree that if I should bectlnre subject to the workers' cornpensation provisions of Section 3700 of the l-ahrr Code. I shall. fonhrvith ctxrply rvith those provisions. ' WARNING: Failure to secure rvorkers' cornpensation coverag,e is unlau'ful. and shall subject an onployc'r to crinrinal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of cornpensation. darnages as provided for the Section -1076 of the Labor Code. interest and attorney's fees.I )--2 / Dtr('l.ARA'l'loN t hereby affrnn under penalty of perjury that I arn licensed under provision of Chapter 9 (comrnencing with Section 7000) of Division -1 of the Business and Professions Code, and my license is in full force and cffect. Lotzt7License Ctass: B [.icense Date:. / 1:-/)-:Dt2- Conrractor( W I hrcby affnn undr pcnalty of pcrjury that thqc is a consruclion lending agocy for thc pqfomilcc of thc wort for whhh thb psmh b issucd (Sc. -1097. Civ. C.). kndq's Nme: - Lender's Address: APPLICA N't DEC LARA'I'ION I ho$y affurn under penalty of perjury one of the follorving declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notification -l cerri$r that the lHeralregulations regarding asbestos rernoval are not applicable to this project. _l certi$ that I have read this application and state that the above infonnation is correct. I agree to comply with all City and County theordinances and Statc Laws relating to and hereby authorize representatives of this City and County to enter upon above rncntioned propoty for Applicunt or Agent Pernrifee nnme (print):- - E d ,1* - Dare,L t /t s /r-tZ Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/VenUI ns u lation //A tl Roof Sheathinq Eflr+r-L // t /Et/7 I .TZ.lC / fULSc-'l'{ lfll t 1 r-Ztual Shear Wall I Framing lnsulation/Enerqy Drynrvall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif //,FINAL / L/ZOU'//oc( Certificate of Occupancy Notes, Rgrnarks, Etc.. -^t 1 //L/t6r9 k/1.u4 ,#Tffi L'o/L