101101865 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG COMMENTS OWNER BUILDER DELCARATION I hcrcby aflirm undcr Fnally of Frjury that I m cxempt fn)m thc ContrachN' Liccnsc L:w for thc following rcas)n (Se.70.11.5 Busincss ad Pnrlession Cu.lc): Any Cily or County which rcquircs a fEmil to crnslrucl. allcr. inrprove. dcmolish or rcpair any slruclurc, prirr k, ils issuance, also rcquircs lhc applicant for such Jtrmit to tile a signcd stalcmcnt lhat hc or shc is liccnsd pu6urnl to lhc provisions of thc Contmctor's Liccnscd law (Chaptcr 9, Commcncing with Secti(ln 7U)O of Division J of thc Busincss and Prufcssions Codc) or that hc or shc is cxcmpt thcrcliom ud thc hasis for lhc allcScd cxcmpti(tn. Any violation of Setion 70-l 1.5 by nny xpplicul li)r a lrcmil subjccts thc {pplicant lo a civil penahy of nd morc than livc hundred dollars ($500), _1, as owncr ol'thc propcrty, or my crnployccs with wages as thcir solc comlrcnsation, will do thc work arxl thc struclurc Ls not rntcrrlcd or oll'crcd lirr salc (Scr.7044. Business and Prot'essions Crxlc: 'I'hi Contractor's Liccnsc [-aw docs not apply to an owncr of thc pnlpcrly wtxr builtls or improves lhcrcrln, and who drrcs such wolft himsclf or hcrsclf or thn)ugh his rlr her own employccs. providcd that such intpnrvcnrents arc not intcnded oroltbred lbr sah. Il, txrwcvcr. thc burfring or impnrvcrnent is stlkl within()nc ycar of comphtion, thc Owncr Buikler will have the hurdcn of proving lhat he or she did not build or improvc the propcrty for thc purJxrsc of sale). ) _I, as owncr ol'lhc propcrty, am cxclusivcly contracting with liccnscd conlractors to construct lhc prtrjcct (Sec. 7(X4, Busincss arxl Pmtbssrrn Codc: 'f hc Conlractor's Liccnsc Law docs not apply lo an owner of prolrcrty who builds or improvcs thcrcon. and who conlracts tirr such projccts with a Contractor(s) liccnscd pursuanl lo thc Conlractor's Liccnsc t-aw). _l anr tundr-r P.C. tilr this rcason. I hcrcby al'l irm unrlcr pcnalty of prjury onc of the dcclural iorts: _l havc aml will maintain a Ccrtificatc ol'Consent to Sclt-lnsurc lilr workcrs' comJrcnsalion. as pnlvidcd for by Scction 17fi) of the Labor Ctxlc, lor thc Jrcrlilrmance of thc work firr which the Srermit ls issued. _l havc anrl will nraintain workcrs' comJrcnsation insurancc. as rcquircd hy Scction 37fi) of lhe Labor Code, ftrr thc Jrcrfirrmancc of the work lirr which this prmit is issucd. My workcrs' compensation insurance carricr anl Jxrlicy numbcr are: Policy Nunther: Expircs: _l ccrrity that in thc pcrlbrmancc of thc work tilr which this Jrcrmit is issucd, I shall not cnrpkry any lrcrson in any manncr xl as to hcc<lnrc subjcct to thc workcrs' comJrcnsal ion laws of Calilirrnia, and agrce that if I should hcctlnrc subjcct to thc workcrs' comJrcnsation pnrvisions of Scction -l7U) of the Lahor Crxic. I shall. tbrthwith comply with thrlrc provisions. WARNING: Failurc to sccure workcrs' comJrcnsation covcrag,c is unlawlul, and shall suhjcct an cmpkrycr to criminal pcnalties and civil llncs up lo onc hunrlred thousattd dollars in addition to thc cost of compcnsation, damages as provided lirr thc Scction J076 thc Codc, inlcrcst and I I herehy al'lirm unr.lcr Jrcnalty of Jrcrjury thal I am of Chapter 9 (commcncing with Section 7firu) of Division J of thc Busincss and Prot'essions Codc, and my license is in full lilrcc and ell'ccl. Liccnsc Nurnbcr: W I hcrcby allirm undcr pnalty otpcrjury lhal thcrc is a conslructi)n bn'lir8 agcncy for thc [Erti)mncc of thc work for which this lmit is issucd (Scc. -1097, Civ. C.). kndcr's Namc: lrndcr's Address: APPLICANT DECLARATION I trcreby allirm undcr Jrcnalty of pcrjury onc of the tbllowing dcclaral ions: Dem<llit ion Pcrmit s-Ashcstos Notiticat krn Fcderal Rcgulat ions ('l'it lc 40, Part6) _Rcquired [*ttcr of Notitication _l ccrlity that thc t'cderal rcgulations rcgarding asbestos rcmovalarc nol applicablc to this pnrjcct. _l certily that this applicalion with all City and County and County lo cntcr uJxrn thcorrlinanccs and rclating to atxlve nrcntioncd Applicant or Agent Pennitee nanre lilr Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loor/VenVl ns u lation Roof Sheathinq Shear Wall Framinq lnsu Iation/Enerqy Drywall Ext./lnt. Lath Brown Coat l\/asonry Pool Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif . FINAL l?l u t4 f lam.rrr il4v) Certificate of Notes, Remarks, Etc.