101108105 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE-WORK DATE !D/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloo r/Ve nUI n s u Iatio n ,l , Roof Sheathinq Tlz,olzr Shear Wall (l t I L-/ Framing lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence \ T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif. I FINAL lolc b .tlCertificate of Occupancy \./ Notes, Remarks, Etc. \/ OWNER BUIl,DER I hoeby aflim unds pcoalty of perjury that I m exmpt from thc ContracloB' LiccE Law for thc followinS rcn (Se.7031.5 Busins ard Profcssion Codc): Any City or County which rcquirc a pcrnh to coBtruc{r altc, improvc, danolish or rrpair uy structuc, prior to its issumcc, also rcquira thc applicilt for such pcmit to filc a signcd ststmdt thal hc or shc b liccNd pwant to thc provisiom of thc Contrrctor's Liccnscd Law (Chaptq 9, Commcncing with Sctiotr 7000 of Division 3 of thc Buils md Prcfsiom Codc) or that hc or shc is cxcmpt thscfrom ild thc bosis for thc allcTcd qmption. Any violation of Serbn ?031.5 by any applicurforapornitsubjststhc applicuttoIcivilpaaltyofnotmorqthilfivehundrcddollffi(S500).t _1. as owner of the property, or my employces with wages as their solc comporsation, rvill do thc work and the stnrcturc b not intended or offered for sale (Sec.7044. Business and Professions Code: Thc Contractor's Licensc law does not apply to an owner of the property who builds or irnproves thereon, and who does such work himself or herself or through his or hcr own cmployees, provided that such improvoncnts are not intcndcd or offered for sale. If. howerrer, thc building or improvanent is sold within one year of compleion. the Orvner Builder will have the hrden of proving tha hc or she did not build or improve the p,ropoty for the purpose of sale). -1, as owner of the propcrty, am cxclusivcly contracting with liccnsed contractors to construct the project (Scc. 7044, Btsiness and hofusion Code: The Contractor's License Law does not apply to an owner of property who builds or improvcs thereon, and who contracts for such projects with a Contractor(s) licarscd pursuant to the Contractor's Liccnsc Law). _l arn exempt undcr B. & P.C. for this reason. Owner: WORKERS' COM'ENSATION DECLARATION I hereby allirm under poralty of perju.y one of the following declarations: -l have and will maintain a Cenificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the tabor Code, *Afiau, unor Ihe work for for the pcrformancc of the work for which the po'rnit is issued. s'iII maintain workers'3700 of the l-abor Codc,for the of which this p,ermit ls and policy number are: &u.) 2t -l certi& that in the pcrformance of the work for which this pcrmil is issued, I shall not ernploy any pcrson in any manner so as to bccome subject to the workers'compensation laws of California. and agree that if I should become subject to the workers' compensation I WARNING: Failure to provisions of Section 3700 of the l^abor Code I shall, forthwilh comply with thosc provisions. scrure workers'compensation coverage is unlawful. and shall subjcct an anployer to criminal panaltics and dollars ($100.000), in addition to the cost of compensation, damages as provided for thecivilfineslo one hundred thousand Se<tion interest and attorney's 2 C-1 a ./. I hercby affrrm under penalty of perjury that I arn licensed under Chapter 9 (commencing with Scction 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.t o4 6gz1 7 ,clir^-A czf W I hocby alfm udc poralty of pqjury that th6c is a @Ntruclion loding agmcy for thc po fomcc of rhc work for which thb psnit is issucd (Se. 3097, Civ. C.). Lrnder's Name: I-cnder's Address: APPLICANT DECLAIIATION I hereby afnrm under penalty of perjury one of the following declarations: Demolition Pcrmits-Asbcstos Notifrcation Federal Regulations (Title 40, Pafl6) _Required t ctter of Notification certi$ that the federal regulations regarding asbestos removal arc not applicable to this project.\- I have read this application and state that the above infonnation is correct. I all City and County and State [.aws relating to above mcntioned property or Agent Pernritee nBme 1r'5 7 upon the Exoires: t purposcs.