101106778 - Permit - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hqeby aflirm undo poalty of pojury that I m cxempt from thc ContractoE' Licorc t w for thc following rcen (5â‚¬.7011.5 Businas and Profesion Code): Any City or County which rcquirc a pcrnit to smtruct, alt6. imprcve. dmolish or repair ily structue. prior to its issuoce, alrc rcquirG thc applicmt for such pemit to filc a signcd $alm6t that lrc or strc b licscd pwut to the prcvisioru of the Contractor's Licenscd Law (Chaprs 9. Commcncing with Setion 7000 of Division 3 of the Busins od Prcfsions Code) or that he or shc is exempt thqcfrom md thc b6sis for thc allcged crmption. Any violation of Sdion 7011.5 by any applicantforapmnitsubjctsthe applicanttoacivilpenaltyofnotmorcthmfivchundreddollrs($500). _1. as owner of the property, or my employees with wages as their sole compensation. will do the work and the structure is not intended or offered for sale (Sec.7M4. Business and hofessions Code: The Contractor's License law does not apply to an owner of the property rvho builds or improves thereon. and who does such wo* himself or herself or through his or her own employees. provided that such improveinents arc not intended or offcred for salc. If. howerrer. thc building or impovement is sold within one )tzr of cornpletion. the O'r,vner Buildcr will have the burden of proving that he or she did not build or improve thc property for the purpose of sale). _1. as owner of the property, am exclusively contracting with licensed contraclors to construct the project (Sec. 7U4, Business and Profcssion Code: The Contractor's License Larv does not apply to an orvner of property who builds or improves thereon. and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Law). -l am exempt under Section-, B. & P.C. for this reason. Drte: Owner: WORKERS' COMPENSATTON DECLAIIATION I hereby alfirm under penalty of pojury one of the following declarations: _l have and will maintain a Cefltficate of Consent to Self-lnsure for rvorkers' compensation, as provided for by Section 3700 of the I"abor Code. for the po'formance of the work for which the po'rnit is issued. _l have and will maintain workers'3700 of the Labor Code, for the performance of the work for which this permit is and policy number are: ,- Policy { _l certify that in the perforrnance of the work lbr which this pennit is issued, I shall not ernploy any person in any manner so as to become subject to the workers'compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall. forthwith comply with those provisions. WARNING: Failure to secure workers' compcnsation coveragc is unlawful. and shall subject an onployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. darnages as provided for the Section 3076 Labor interest and attorney's fees. I hereby affrnn undcr penalty of perjury that I anr licensed 9 with Secrion 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Nurnber: I hereby affrm under penalty of perjury that there issued (Sec. 3097. Civ. C.). Lcnder's Narne: a construction lending agency for the work for which this perrnit is Lcnder's Address: APPLICANT DECLARATION I her*/y affinn under penalty of perjury one of the following declarations: f)cmolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notification _l cerri& that the Heral regulations regarding asbestos removal are not applicable to this project. _l certi& that I have read this application and state that the above information is corrcct. I agree to comply ordinances and Statc Laws relating to building construction, and hereby authorize representatives of this City with all City and County and County to enter upon the above mentioned property for Applicant or Agent Pcrmitee Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bfloor/VenUl n su !atio n Roof Sheathing Shear Wall Framing lnsulation/Enerqy Drlnryall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req Deputy Fina! Report Engineer Final Report Flood Zone Certif II a FINAL 0ll l'fl7\tD*ffir Certificate of Occupancy I Notes, Remarks, Etc. I