101102279 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILI)ER DELCARATION I hcrcby allirm undcr pcnalty of pcrjury thal I am cxcmpt liom lhc Conlruchrs' Liccnsc law ti)r thc following rcawn (Scc.7031.5 Busincss alxl P()fcssiur G).lc): Any City or Counly which rcquircs a lrcnnit lo construcl. allcr. improve. dcmolish or rcpair a[y slNcturc, prior kr its issuancc, als rcquircs lhc applic{nt li)r such lrrmil to lilc a sighcd statcmnt tlEt hc or she ir licenscd puGualt to lhc pruvisi()ns of lhc Contmctor's l,ienscd Law (Chaplcr 9, Commcncirtg wilh Scclion 7fiX) rf Divisioo .J of thc Busincss and Prclbssions Culc) ('r thal hc or shc is excmpt thcrctiom and thc basis lbr thc allcgcd cxcmption. Any viohtion of Setion 7O.l I .5 hy any applicantlirrapcrmitsuhjststhc applicanttracivilpcnallyotnotmorcthatrlivchundrcddolles($500). _1, as owncr of thc pK)frcrty. or my crnpk)yccs with wagcs as thcir solc compcnsati()n, willdo tlrc wrlrk and thc structurc is not intcrrdcd or()U'cred lilr salc (Scc.7044. Busincss and Pnrlbssiorrs Crxlc:'fhc Contractor's Liccnsc Law dtrcs not apply to an owner ot' thc prrJrcrty who builtls or improvcs tlrcrcon, and wlxr tlocs such work himself or hcrsclf or lhroush his rlr her own cmpkryccs, pnrvided that such improvcrncnts arc n<lt intcndcd or oltbrcd firr salc. If, lrowcvcr, thc building or inrprovcnrcnt is sold wilhin onc ycar ol'com;rle-tion. thc Owncr Buildcr will havc thc burdcn ol'proving that hc or slrc ditl nut huiltl or improvc thc proJrcrly tilr thc purpose of salc). _1. as owncr of'the pn)perty. am exclusivcly corrlracting with liccnscd contractors to constmct lhc pnrject (Sec. 'lt$4. Busincss and Pnllbssion Codc: 'l'hc Contractor's Liccnsc Law docs not apply lo zur owncr of propcrly who builds or improvcs thcrcon, and wlxr contracts lirr such projccts with a Conlractrlr(s) liccnscd pursuant to thc Contractor's Liccnsc Law). -Iantcxe[lptundcrScctitrn-'B.&P.C.tilrthisreastllt' lVORKERS' CON I I'ENSATION DECI,ARATION I hcrcby all'inu unde-r pcnalty of pcrjury onc ol'thc lirlkrwins dcclarations: _l havc and will maintain a Certil'icatc of Consent to Sclt'-lnsurc lirr workcrs' compensation. as provided firr hy Section 3700 of thc Labrlr Codc. lilr thc pcrlirrmancc of thc wrlrk for which thc pcrmit is issucd. _l havc arrd will mtintain workcrs' compcnsation insurancc, ils rctluircd hy Scct ion .17()0 of tltc L:rhor Code, firr thc pcrfirrntancc of the work tirr which this pcrnrit is issucd. My workcrs' conrpensatiorr insurtncc can'icr"antl prlicy numbcr arc: rO I t =Policy 7 _l certrty lhat in the pcrlirrnrance'of the wrlrk tirr which this pernrit is issucd, I shall not empkly anv person in any m&nncr so as lo bcconrc suhjcct to thc workcrs' compcnsation laws of Calilirrni:r. and agrcc lhat if l should bccome subjcct to thc - wrlrkcrs' comlrcnsati<ln provisions of Scctiru J700 ol'thc Lahrr Corlc. I shall, lorthwith comply with those pnrvisiotts. WARNING: Failure to sccure workcrs' cornpcnsation coverasc is unlawt\rl. tntl shall subjcct an cmploycr lo criminal lrcnaltics and civil tirrcs up lo onc hundrctl tlxrusand dollars (S100,(X)0), in Irt of danragcs as providcd lirr thc D attorncy's f'ccs. I hercby aU'irm under pcnalty of perjury that I anr licensctl undcr pnrvision of Challtcr 9 (contnrcncirrg with .Section 7000) of o[ thc Busincss and Pnllbssions Cotlc, and nry liccnsc is in litll tbrcc and cllbct. Divisin.l 66YS?l-icc-rrsc -, o I hcrcby allirrn undcr pcnalty of pcrjury that thcrc is a construction lcnding agcncy issucd (Sec. 3097, Civ. C.). Lendcr's Name: tlre pcrlilrnrancc ol'thc work tirr which this pcrnrit is Lctrrlcr's Arldrcss: APPLICANT DECLARAI'ION I lrcreby atlirrn under pcnalty of perjury orrc of thc tirlklwins dcclarations: f)c mo lit io n Pcrnr it s-Asbcstos Not il'ical ion Fcdcral Rcgu lat ions lT it lc 40. Part 6) _Rcquircd [-cttcr of Notitication with all City and Courrty and County to entcr uporr the Applicartl or Agenl 'll Itt'rrttilee nanlc Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bf loor/VenVI nsu lation Roof Sheathinq Shear Wal! Framing lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat lMasonry Poo! Fence T-Bar Handicap Req. Deputy Final Report Enqineer Final Report Flood Zone Certif. I I F!NAL 7 ttllo PL|L(lhbrrrr Certificate of Occupancy ,l I I Notes Etc.J =+ t !