101107514 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor S u bf Ioor/VenVl ns u latio n Roof Sheathing Shear Wall Framing lnsulationlEnerqy Drywall Ext./lnt. Lath Brown Coat l\/asonry Pool Fence T-Bar Handicap Req Deputv Final Report Engineer Final Report Flood Zone Certif I ,I FINAL 1/rt /t,J^,6lYh Certificate of Notes, Remarks, Etc.J OWN IiR I} UI I,DI.]R I)I.]LCA RAI'ION I hcrcby affrm undcr pnalty of pcrjury that I m cxcmpt frcm thc Contraclos' Liccns law for thc following rcasn (Scc.7031.5 Busincss arxl Prcfcssion Code): Any City or County which rcquircs s JErmil to @nstrucl, alto, imprcvc, dcmlish or rcpair any structurc. prior to its issuancc, dm rcquires the applicmt for such pemit to filc a signcd stolemnl that hc or shc is liccnscd purset to thc pmvisions of the Contretor's Liccnsd hw (Chapter 9, Commcrcing with Scction 7000 of Division 3 of thc Busincss and PrefcssionsCodc)orthatheorshciscxcnrptthcrcfromandthcbarisforthcallcgcdcxcmption. AnyviolalionofsccthnT03l.5byany applicanl for a pcrmit subjccts thc applicant to a civil pcnalty of not mrc than fivc hundrcd dollus (5500). _1, as owncr of thc proprty. or my crnployces with wagcs as their solc compcnsation. will do thc work and the stnrcturc is not intcndcd or offcrcd fbr salc (Soc.7044. Busincss and Profcssions Codc: The Contractor's Liccnse [:w docs not apply to an owner of thc propcrty who builds or improvcs thcrcrrn. and who docs such work himsclf or hcrsclf or through his or hcr own cmployccs. providcd that such improvenrcnts arc not intcndcd or offcrcd for salc. If. howcvcr. thc building or improverncnt is sold within one ycar of complction, thc Owncr Buildcr will have the burdcn of proving that hc or shc did not build or improvc thc propcrty for thc pur;nsc of salc). _1. as owncr of thc propcrty, am exclusivcly contracting with liccnscd conlractors to construct thc project (Scc. 7W, Busincss and Profcssion Codc: The Contractor's Licensc Law docs not apply to an owncr of propcrty who builds or improves thcrcon. and who contracts for such projccts with a Contractor(s) liccnscd pursuant to thc Contractor's Licensc taw). _l am cxcmpt undcr B. & P.C. for this rcason. ( )u'rrt.r. WORK T'RS' COM PENSA TION DECI ARATION I hercby affirrn undcr pcnalty of pcrjury onc of thc following declarations: _l havc :urd will nraintain a Certificate of Conscnt to Sclf-lnsure l'or workcrs' compcnsation. as providcd for by Section 3700 of the Codc, tbrthc pcrforn'nnce of thc work for which the perrnit is issucd. havc and will maintain workcrs'comlrcnsation insurancc. as rcquircd by Scction 3700 of thc labor Codc. for thc performancc of thc work for which this pcrnrit is issucd. My workcrs' compcnsation insurancc carricr and policy numbcr are: L _l ccrtify that in thc pcrforrnancc of thc work firr which this prrnit is issucd. I shull not crnploy any pcrson in any nlanncr so as to bcconrc subjcct to thc workcrs' conrpcnsation laws of California. and agrcc that if I should becomc subjcct to thc workers' compcnsalion provisions of Scction 3700 of thc latxlr Codc. I shall. forthwith comply with thoric provisions. WARNING: Failurc to securc workcrs' compcnsation coveragc is unlawlul. and shall subjcct an cmploycr to crirninal pcnaltics and civil fincs up to onc hundred thousand dollars ($100.0m). in addition to thc cost of conrpensation. damagcs &s providcd for thc Scction 3076 of the Code, interest and attorncy's fccs. I hcrcby affirm undcr pcnalty of pcrjury that I am liccnsed undcr provision of Chaptcr 9 (contmcncing with Scction 7000) of Division 3 of thc Busincss and Profcssions Codc, and my liccnsc is in full force iud ctfcct. Liccnsc o"ru' 8 W I hcrcby uflirm undcr Fnalty of Frjury that thcrc is a construction lcnding ogcncy for thc pcrformncc oflhc work for which this lErmit is issucd (Scc. 3097, Civ. C.). lrndcr's Narnc: lrndcr's Address: APPLICANT DECLARATION I hcrcty affrnn undcr pcnalty of perjury onc of the tbllowing declarations: Dcmolition Pcrmits-Asbcstos Notification Fedcral Regulations (Titlc 40, Parl6) _Requ ired l-ctter of Notification ccrtily that thc fcdcral rcgulations rcgarding asbcstos rcrmrvalarc not applicahle to this projcct. ccrtily that I havc read this application arxl statc that thc abovc infornration is corrcct. I agrce to comply with all City and County ordinanccs and Statc [:ws rclating to building of this City and Counly to entcr upon thc abovc nrcntiorrcd propcrty for Applicant or Agent Pcrnritee nanre l)urp()scs. and hcreby authorizc poricy*,,,n". B\)u\)cs-rLSZ*I+ Expircs: I I Dare:S/ txlzl t-