101106078 - Permit - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE.WORK DATE^a ID/SIG.COMMET.ITS OW]!ER BUILDER DEI.CARATION I hrcby affm undo pctulty of pcrjury thar I m cxcmpt from the Contracto6' Licmc I.3w r?rr thc follorrig lwn (Se.703 1.5 IJuins and Profsion Code): Any City or County which require a pcmit to @Gtruct, altq, imprcvq dcmolish or npat uy stuctrc. pdor to its issuilcc, also requiG thc applicet for such psmit to filc a signed slalm@t that hc or $c b licsEâ‚¬d plNilt to thc provisiom of thc Contrctor's Liccnsed Law (Chapts 9, Comcncing with Sstion 7000 of Division 3 of the Bwins md Profesions Codc) or that hc or shc is cxmpt thqcfrom ad the b6sis for the allcged exmpion. Any violation of Setbn 7031.5 by uy applicant for a pemit subjsts the applicant to a civil pemlty of not morc thu fivc hundred dollrs ($500). _1. as owner of the property. or my employe$ with wages as their sole compcnsation. willdo the work and the structure is not intendod or offerd for sale (Sa.7044, Business and hofessions Code: The Contraclor's License Law does not apply to an owner of the property who builds or improves ther@n, and who does such work himself or herself or through his or her own cmployees, provided that such improvonents are not intended or offered for salc. If, howeiver. thc building or improvement is sold within one )Ear of complaion, the Orvner Builder will have the burden of proving tha he or she did not build or improve the property for the purpose of sale). __t, as owner of the propâ‚¬rty. am exclusively contracting with licensed contraclors to construct the project (Scc. 7044, Btsiness and hofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projccts with a Contracto(s) licersed pursuant to the Contractor's License taw). -l am exempt under Section-. B. & P.C. for this reason. I)q I o' WORKERS' COMPENSATTON DECLARATION I hcreby allirm under pcnalty of perjury onc of the following declarations: _l have and will maintain a Centificate of Consent to Self-tnsure for workers' compcnsation, as provided for by Section 3700 of the I-abor Code, for the performance of the work for which the permit is issued. _l have and will maintain workers' compâ‚¬nsation insurance. as requircd by Section 3700 of the l-abor Code. for the performance of the work for which this permit is issued My workers' compcnsation insurance carrier and policy numbcr are: And*. Policy Number: Expires: fil*tt that in the performance of the work for which this p,ermit is issued, I shall not ernploy any person in any manner so as to become subjcct to the workers'comporsation laws of California, and agree that if I should become subje*t to the workers' compensation provisions of Section 3700 of the l-abor Code, I shall, forthwith comply with those provisions. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an onployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to thc cost of compcnsation. damages as provided for the , Section 3076 of the Labor Code, interest and attorney's fees. I hereby affrrm under 3 of the Business and Professions Code, and my license is in full force and effect. License Nurnber:0 Dare: + llA/rr1 1-l w W I hmby affm unda pcnalty of pcrjury that th6c is I @nstruciion lmdiog agocy for fic pofommce of the mrk for which this p6nit b issucd (Se. 3097, Civ. C.). Lf,dd's Nmc: Lendcr's Address: APPLICANT NECLARATION I hqrby affm undq Fnalty of perjury onc of thc following dclaratiom: Dcmolition Pcmit$Asb6t$ Notification Fcdqat Rcgulations (Titlc 40, Part6) -Rcquircd trtto of Notifiqlion -*r^rr, ,* ,tre fcdaal rcgulatiore regEding 6b6tos rmoval e nor applicablc to this prcjct. l-?o,,,ry ,nn I have rad this application sd state that the abovc infonnalion is conct. I agre to @mply with all City and County ordhilcG od Statc lrws rclairg to building coretrucrion, and hoeby authorirc rrF6@tativ6 of this City ad Couty to atq uIDa 0E above mentioned property for inspection 6Applicant or Agent I I'crnrilcc nanrc Iten I 0 Set Backs D Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUl n s u Iatio n Roof Sheathins Shear Wall Framinq .-zq4 O CRJ ) lnsulation/Energy Drywall /rr$J&7q-z {UC?-'7 Ext./lnt. Lath Brown Coat Masonry Pool Fence ( T-Bar tLcri n Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif FINAL L (-i-'ru*v2r7Certificate of Occupancy Notes, Remarks, Etc. O