101107518 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE-WORK DATE !D/SIG COMMENTS OWNER BUILDER DELCARATION I hercby affirm undcr penahy of perjury that I m cxcnrpt from thc Coflractos' Liccnre Liw for thc following reamn 15@.7031.5 Busincss and Pmfcssion Crxlc): Any City or County which rcquires a pcrmit to construct. trlts, improvc, dcmolish or rcpair any structurc. prior to its issuance, also rcquircs thc applicant for such Jrcrmit lo filc a signcd statcmnt that hc or she is liccnrcd pursriant to thc prcvisions of thc Coilmclor's Liccnsd taw (Chaptcr 9, Commercing with Section 70O0 of Division 3 of thc Busincss and' PrcfcssionsCodc)orthathcorshcisexemptthcrcfromandlhcbasisforthcallcgcdcxcmption. AnyviolationofScctionT03l.5byany applicatrt for a pcrmit subjets thc applicant to a civil pcnalty of not nrore than fivc huDdrcd dollus ($500). -1. as owner of thc proprty. or my cmployces with wagcs as their sole compcnsaliotl, will do thc work and thc structurc is not intcndcd or ol'fcred tbr sale (Sec.7044. Business artd Professions Code: Thc Contractor's Liccnsc Law does not apply to an owner o[ the proprty who builds or inlprovcs thcrc.on, and who docs such work hirnself or hersclf or through his or hcr own ctnployccs. providcd that such improvcments euc not intendcd oroffcrcd for salc. lf, however, thc building or improvcmcnt is sold within one ycar of conplction, thc Owncr Builder will have thc burdcn of proving that hc or shc did not build or improve the propcrty for thc purpose of salc). -1, as owncr of thc propcrty, anl exclusively contracting with licenscd contractors to construct the projcct (Scc. 7W, Busincss and Profession Codc: Thc 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) liccnsed pursuant to thc Contractor's License Law). -lamcxcmptunderSection-,B.&P.C.forthisrcason.r t..t,.. WORKERS' COMPENSATION DECLARATION I hcrcby affirm under pcnalty of pcrjury onc of thc following declarations: -l have and will rnaintain a Ccrtificate of Consent to Sclf'-lnsurc fbr workcrs' compcnsation, as provided for by Section 3700 of the Labor Codc, for thc performancc of thc work for which thc pcrmit is issucd. -l havc thc work and will maintain 3700 of thc l,abor Codc, for thc pcrformance of Ibr which this policy numbcr arc: Policy -l certity that in thc pcrformancc of thc work fbr which this pcrmit is issued. I shall not cnrploy any pcrson in any manncr so as to bcconrc subjcct to thc workcrs'compensation laws of Califbrnia. and agrec that if I should becomc subject to thc ' workers' cornpensation provisions of Scction 3700 of thc Labor Codc, I shall. forthwith cornply with thosc provisions. WARNING: Failurc to sccurc workers'cornpensation coveragc is unlawt'ul. and subjcct an cmploycr to criminal pcnaltics and civil lines to onc hundrcd thousand dollars ($100,000), in addition the darnaqcs as providcd for the Scction and fccs. DECLARATION I hcrcby alfirm undcr pcnalty of pcrjury that I arn liccnsed undcr provision of Chapter 9 of thc Busincss and Profcssions Codc, and my liccnse is in f'ull forcc and cffcct. Scction 7000) of Division 3 , Liccnsc ,a Nunrbcr: CONSTIII.ICTION I,I'N I)ING AG I'N CY I hcrcby aflirm undcr Jrcnalty of Frjury that thqe is a construction hnding agcncy for the pcrformncc of thc work for which this lErmit is issucd (Se. 3097. Civ. C.). lrndcr's Namc: kndcr's Addrcss: APPLICANT DECLARATION I hcrcby allinn under penalty of perjury one of the following dcclaratiolrs: Dcnrolition Pcrmits-Asbcstos Notification Fcdcral Rcgulations (Title 40, Part6) -Rcqu ircd lrttcr of Notification -l ccrtily that the fcdcral regulations regarding asbcstos rcnxrvalarc nol applicablc to this projcct. statc that thc abovc inlbrmation is corrcct. I with all City and County abovc mcntioncd propcrty tbr Applicant or Agent Pernritee nanre and and County to entcr upon Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bf !oor/Ve nt/l nsu I atio n Roof Sheathinq Shear Wall Framinq lnsu Iation/Enerqy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif bhunt- \2o.^(-rr 9-1 -21 \-rIFINALQ-a4t /TlL Certificate of Occupancy Notes, Remarks , Etc. -l ccrtily that I havc rcad ordinanccs and to