101107287 - Permit - Laserfiche WebLink

Home Browse Search

SITE-WORK DATE ID/SIG COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf !oor/VenUl ns u I atio n Roof Sheathing 1hzh,, Shear Wall t/I Framing Insulation/Energy Drywall Ext./lnt. Lath Brown Coat lt/asonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif ,t FINAL a h,14,n\,- Gertificate of Occu Notes, Remarks, Etc.I OWNER BUILDER DELCARA'IION I hcreby affirm urtdcr pcnalty of pcrjury that I am exenq)t from the Contractors' Liccnsc law for the following reason (Sec.7031.5 Busincss and Profcssion Codc): Any City or Counly which rcquires a pcrmit to construct, altcr, improve, dcmolish or repair any slructure. prior to its issuancc. also rcquircs thc applicant for such Jrermit to filc a signed statemcnt that he or she is licensed pursuant to the provisions of the Contractor's Liccnscd taw (Chaptcr 9, Commencing with Sc'ction 7000 of Division 3 of thc Business and Professions Code) or that hc or she is excmpt thcrcfrom and thc basis for thc allcged cxcmption. Any violation of Section 7031.5 by any applicant for a permit subjcrts the applicant to a civil pcnalty of not rnorc than fivc hundrcd dollars ($500). -1. as owncr of thc propcrty, or my cmployccs with wagcs as thcir sole compcnsation, will do thc work and ttrc stnrcture Ls not intendcd or offcrcd for salc (Sc'c.7044. Busincss and hofessions Code: The Contractor's License law docs not apply to an owncr of lhe proprty who builds or improvcs thcrcon. and who docs such work hirnself or herself or through his or her own employees. providcd that such im;lrovcnrcnts arc not intcmlcd orofferod for salc. lf. howevcr. thc building or inprovenrcnt is sold wilhin one )rear of comphtioo thc Owner Buildcr will havc ttrc burdcn of proving that hc or she did nnt buiH or inqrrovc thc propcrty for tlrc purposc of sale). -1. as owncr of thc proprty. am exclusivcly contracting with liccnscd conlraclors to construct thc projcct (Sec. l$dd. Susirrcss and Profcssion Codc: The Contractor's Liccnse Law docs not apply lo an owncr of property who builds or improves thcreon, and who contracls for such pojccts with a C-ontractor(s) liccnscd pursuant to thc Contractor's Liccnse l-aw). _l anrcxcmpt undcr Sccti<ln_. B. & P.C. for lhis reason. l)ntr. ()rr ner. WORKEITS' COMPENSATTON DECI ARATION I hcrcby affirnr undcr pcnalty of pcrjury onc of thc following dcrlarations: _l havc and will maintain a Ccrli[-rcate of Conscnt to Sclf-lnsurc for workers' comgrcnsation, as providcd for by Sc.ction 3700 of the [:bor Crdc. for thc grcrfornunce of thc work for which the pcrnrit is issued. _l have and will maintain workcrs' compcnsation insurancc. as rcquircd by Scction 3700 of thc labor Code. for the performarrce of the work for which this prmit is issuod. My workcrs' compcnsation insurancc carricr ad plicy numbcr arc: I'/z-3 /-Z/Policy _l ccrtify that in the Jrcrforrnarrcc of thc work for which this pcrrnit is issucd. I shall not crnploy any pcrson in any rnanner so as lo bccomc subjcct lo thc workcrs' conpcnsation laws of California. and agrce that if I should becornc subject to tlrc workcrs' compensation provisions of Scction 37fi) of thc l-abor Codc, I shall, forthwith cnmply with thosc provisions. r WARNING: Failurc to sccurc workers' compcnsation covcragic is unlawful. and shall subject an crnployer to criminal pcnaltics and civil fincs up lo onc hundrcd thousand dollars ($100.0m), in addition to thc cost of compcnsation, damages as providcd for the .o,J*i:,?Ti*:i LICET{SED CONTRACTOR TTF'CI ARA'I'ION I hcreby af firm undcr Jrcnulty ol'pcrjury that I arn liccrrsccl under provision of Chaptcr 9 (comnrcncing with Section 70m) of Division 3 of the Business and Profcssions Codc. and my liccnsc is in full t'orcc arxl etl'ect. l-iccnse c3 ) Numbcr:?C "-. / CONSTRUCTIoN LENDING AGENCY I hcrcby affirm undcr lEnalty of Frjury that thcrc is a mnstructbn hndinS agcrcy for thc JErformcc of thc work for which this Frmit is issued (Scc. 3097. Civ. C.). [rndcr's Narrc: lrnder's Address: APPLICANT DECLARATION I hcrcby affrmundcr pcnalty of pcrjury one of thc following dcclarations: Dcmolition Pcrmits-Asbestos Notilication Federal Rcgulations (Titlc 40. Part6) -Rcqu ircd [rttcr of Notification -l certify that thc fcderulregulations rcgarding asbcslos rennvalarc not applicablc to this projcct. with all City and County and County lo enter upon tlre Applicant or Agent Pernritcc nanre ( print ): _ BUILDING. INSPECTOR RECORD f Rev. 08-07-201 5 , o*", 7-l ?- U a