101107791 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING- INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hcrcby affrm undcr penalty of pcrjury thal I m cxmpt from thc ContractoE' Licqc kw for thc following l@n (Se.7031.5 Buinss and Profsion Codc): Any City or Couty which rcqui!6 a pqmit to coNtruct, alt6, itnprovq danolish or repair oy stnctue. prior to its is@cq also requic thc applicat for such pcmit to filc a signcd stal@ot that he or shc is licGâ‚¬d plNet to the provisiom of thâ‚¬ Contrrctor's Licmscd taw (Chapts 9, Commcncing with Sation 7000 of Division 3 of thc Buins md PrcfesionsCode)orthathcorshe isexmptthtrfrommdthcbasisforthcallegedexmption. AnyviolationofSetionT03l.5bymy applicant for a pcrmit subjâ‚¬ts thc applicut to a civil pcmlty ofnot morc the fivc hundrcd dollus (t500). _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.7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who b,uilds or improves thereon. and who does such work himself or herself or through his or her own cmployees. provided that such irnprovernents are not intcnded or offercd for sale. I(, howet/er. the tuilding or improvement is sold within one )rcar of cornpletion. the Orvner Buildcr will have the hrden of proving tha he or she did not build or improve the property for the purpose of sale). -1, as owner of the propefiy. am exclusively contracting with licersed contraclors to construct the project (Sec. 7U4, Business and hofission Code: The Contractor's Liccnse Law does not apply to an owner of propcrty who builds or improves thereon, and who contracts for such projects with a Contracto(s) licersed pumuant to thc Contractor's Licersc taw). _l arn t]. &reason. DECLARATION I hereby affirm under poralty of perjury one of the following declarations: -l have and will maintain a Certificate of Consent to Sclf-lnsure for workcrs' compâ‚¬nsationt as provided for by Scction 3700 of the Labor Code, for the performance of the work for which thc pcrrnit is issucd. -l have and will rnaintain workers' compcnsation insurance. as required by Section 3700 of the l,abor Code, for the performance of the work for which this permit is issued. My workers' compssalion insurance carrier and policy numbâ‚¬f, are: Policy Number: Expires: _l certiff that in the performance of the work for which this permit is issucd. I shall not so ,ts to become subject to the workers' compensation laws of California. and agrec that if I employ any person in any manner should bccome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith cornply with thosc provisions. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an einployer to criminal penaltics and civil fines to one hundred thousand dollan ($100.000), in addition to the cost of compensation, damages as provided for the Section l-abor Code, interest and attorney's I)I.:('LARA'I'ION I hereby affrrn under penalty of perjury that I arn licensed under provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. Liccnsc Class: License Numbcr: llolo.f'nrrlronlnr. W I hcrcby affm undo penalty of psjury thal thqc is a construction lcnding agocy for the pofomcc of the work for which this pqmit b issucd (Se. 3097. Civ. C.). Lender's Name: Lcndcr's Address: APPLICANT DECLARATION I hercb}, affinn under penalty of perjury one of thc following declarations: Dernolition Pennits-Asbestos Notification Fedcral Regulations (Title 40. Part6) -Required Letter of Notifrcation -l cqtiry that thc fctoal rcgulatiom rcarding cbctos rmoval uc not applicablc lo this prcjet. 2[r{ cqtify that t tuve rcad this application md statc that thc abovc infomation is coret. I agG to @mply with all City md County drtrinmce md Statc taws retaing to buildi4 coretructioc and haeby authoria rcprffitativG of this City ed Coutrly to 6t6 upon the above mentioned property for Applicrnt or Agent Pcrnritec nAnlc , Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/VenUI nsu Iation Roof Sheathinq Shear Wall Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonry Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif. ft FINAL to/n/2,rl>tTu Certificate of Notes, Remarks, Etc.I Carrier:- Orrr,W I