101105859 - Permit (2) - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELOIRATION I hcrcby aftirm undcr pcnalty of pcrjury that I m cxcmpt frcm thc Contractom' Liccnrc [aw for the following rcason (Scc.7031.5 Busincss and Profcssion Codc): Any City or Counly which rcquires a Jrcrmit to cotrstruct, altc, improvc, demolish or rcpair any structurc, prior io it$ issuancc, also rcquires the applicant for such Frmit to filc a sigrcd statcnrcnt that hc or shc is liccnscd pursuant to thc prcvisiotrs of thc Contractor's Liccnscd [aw (Chaptcr 9, Comrncncirg with Scction 7000 of Division 3 of the Busincss and ProlbssionsCodc)orthatheorsheiscxcmptthcrcfmmsndthcbasisforthcallcgedcxcmption. AnyviolationofseclionT03l.5byany applicant for a permit subjccts thc applicant to a civil pcnalty of not mrc lhan five hundrcd dollss ($500). _1. as owner of thc profrcrty. or my employees with wages as their solc compcnsation, will do the work and the structurc is not intended or offcred for salc (Sec.7044, Business and Professions Code: The Contractor's Liccnse Law docs not apply to an owner of the propcrty who builds or improves thcrcon, and who does such work himsclf or hcrself or through his or her own employces. providcd that suclr irnprovcnrcnls arc not intcnded or offcrcd for salc. lf, howevcr, thc building or improvcnrcnt is sold within onc ycar of completion, thc Owncr Buildcr will havc thc burden of proving that he or shc did not build or improvc thc proprty for thc purpose of sale). -1, as owner of thc propcrty. arn cxclusively contracting with liccnscd contractors to construct thc project (Scc. 7U4. Busincss and hofcssion Code: The Contractor's Liccnsc Law docs not apply to an owner of property who builds or irnproves thereon. and who contracts lbr such projects with a Contractor(s) licenscd pursuant to thc Contractor's Liccnse Law). -lamexcmptundcrScction-,B.&P.C.tbrthisrcason. f \..t o.( t..,-^-. WORKERS' COMPENSATION DECLARATION I hcrcby afllrm undcr penalty of perjury one of the following declarations: _l havc and will maintain a Ccrtificatc of Conserrt to Self-lnsure for workcrs' compcnsation. as provided fbr by Section 3700 of the LAbor Codc. It**^,o t G work for fbr thc pcrforrnance of thc work for which thc pcnnit is issucd. will maintain workcrs'insurance. as rcquircd by Scction 370O of the Labor Codc, for the performance of this workers' compcnsation insurance carrier and policy number are: Policy _l ccrtity that in thc pertbrmancc of thc work tbr which this perrnit is issucd, I shall not so as to beconrc subjcct to the workcrs' compcnsation laws of Calitbrnia, and agrcc that if I in any rnilntrcr subjcct to thc workers' compensation provisions of Scction 3700 of thc Labor Code, I shall, forthwith cornply with those provisions. WARNING: Failure to securc workers'compensation coverage is unlawful, and shall subject an errrployer to criminal pcnalties and civil fincs up to one hundred thousand dollars ($100,000), in alition to the cost of compensation, darnages as provided for the and attorney's fees. Ann'icant: ,utnt //lnon,//91--Scction thc intcrcst LI DECLARATION L/ I hcrcby atllrm under pcnalty of pcrjury that I am liccnscd under provision of Chaptcr 9 (commcncing with Section 7m0) of Division 3 of thc Busincss and Codc, and rrry liccnse is in full forcc and ctlcct. Liccn';c /a W I hcrcl)y aflirm undcryEnolty of pcrjury that lhcrc is a comtruction lcnding agcncy for lhe pcrformancc of thc work for which this Ismit is issucd (Scc. 3097, Civ. C.). Lcndcr's Narnc: Lendcr's Address: APPLICANT DECLARATION I hcrcby aflirrn undcr penalty of perjury one of thc following dcclarations: Dcmolition Pcrrnits-Asbcstos Notification Fedcral Regulations (Titlc 40, Part6) -Rcquircd Lctter of Notilication -l ccrtily that thc t'cderal rcgulations rcgarding asbcstos rcmovalarc not applicable to this projcct. _l ccrtify that I have rcad this applicati<ln and statc that thc atxrvc intilrmation is corrcct. I agrec to comply with City and County ordinanccs and Statc Laws rclating to building construction, abovc mcntioned property tbr Applicant or Agent I'enrrilee nanre City l() cntcr thc Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loor/Vent/lnsu lation Roof Sheathing Shear Wall Framinq lnsu Iation/Enerqy Drywall Ext./lnt. Lath Brown Coat lt/asonry Pool Fence T-Bar Handicap Req. Deputv Final Report Enqineer Final Report Flood Zone Certif lr I -,s)s FINAL 0 (l^1V ID',IYW t/ Certificate of Occupancy Notes, Remarks, Etc ( rcprcscntativcs