101108006 - Permit - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloo r/VenUl ns u Iatio n Roof Sheathing Shear Wall Framing Insu lation/Energy Drywall Ext./lnt. Lath Brown Coat [\Iasonry Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif 't z Jst*',t -b -l l-?nL o--,-,P 4Z FINAL /o' 1l- ?t fr4P ttz Certificate of Occupancy Notes, Remarks, Etc. OWNER I}UII,I)EIT DELCN RA'I'ION I hqeby amrm unds penalty of pqjury that I m exempt from thc Contr&toE' Licffi Lrw for thc following .mn ('Se.i3 t.S BEin6s md Profsion Codc): Any City or county which rcquire a pannit to @Ntruct. alta, improvq dmolish or rcpair uy structrc. priot Io its issuuce, also rcquic lhc applicet for such pcrmit to file s signcd slalmot that he or dE is lictrcd pNant to thc provisiom of thc Contrrctor's Liccnscd Law (Chaptq 9. Comencing with Setion 70O0 of Division 3 of thc Businegs od Prcfsions Code) or that hc or shc is excmpt thccfrom ud thc basis for thc 8llcgcd qmpion. Any violation of Sctiotr 7031.5 by any applicanl for a pcrmit subjats thc applicat to a civil pffilty of not more thil five hundrcd dollus ($500). _1. as owner of the property, or my ernployees with wages as their sole cornpensalion. will do thc work and the structure is not intorded or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's License Law does not apply to an owner of the propory who builds or irnproves theron. and who does such work himself or hersclf or through his or her own crnployecs. provided that such irnprovancnts are not intended or offered lor sale. lf. howsr/cr. the building or improvemcnt is sold within one ]Ear 6f cornplaion. the Orvner Builder will have thc burden of proving ttra he or she did not build or improve the property for the purpose o'f sde). _1. as owner of the properly, am exclusively contracting with liccnsed contractors to construct the projcct (Sec. 7U4, Business and Profcssion Code: Thc Contractor's License Law does not apply to an owner of property who builds or improvcs thereon, . ' and who contracts for such projecrs with a Contractor(s) licensed pursnant to the Contractor's Liccnse l-aw). _l am exempt under B. & P.C. for this reason. WORKERS' COMPENSATION DECLARATION I hcreby affrrm under penalty of perjury one of the following declarations: and will maintain a Certificate of Consent to Self-lnsure lor workers' compensation! as provided for by Section 3700 of the Code. for the perfonnance of the work for which the pennit is issued. and will maintain workers' compensation insurance. as rcquired by Sertion 3700 of thc Labor Code, for thc performance of work for this permit is My workers' compensation insurancc carrier and policy number are: Policy _l certify that in the performance of the rvork for which this perrnit is issued, I shall not ernploy any pcrson in any manner so as to bccome subject to the rvorkers' compensation laws of California. and agree that if I should become subject to the rvorkers' composation provisions of Section 3700 of the Labor Code, I shall, forrhwith comply with those provisions. WARNINC: Failure to secure workers' conrpensation coverag,e civil frnes up to one hundred thousand dollars ($100.000). in and Section 3076 of the Code, interest and attorney's fees. DECI,,ARATION I hercby affirm under penalty of perjury that I arn licensed under provision of Chapter 9 (comrnencing with Section 7000) of Division 3 of thc Business and Professions Code, and my license is in full force and effect. W t hmby affm undo pcsatty of pcrjury thal thqc is a con$ructbn knding agacy for thc psfomcc of thc work for which this pqmit b issucd (Se. 3097, Civ. C.). kndd's Nme l,ender's Address: APPLICANT DECLARATION I horby aflinn under penalty of perjury one of the following dcclarations: Demolition Permits-Asbestos Notification Fedcral Regulations ('title 40, Part6) Later of Notification that the federalregulations regarding asbestos removalare not applicable to this projed. I have read this application and state that the above infonrtation is correct. I ordinances and State laws relating to building construction. and hereby authorize the above mentioned property for inspection Applicant or Agent Pernritee ntrnre ,",.,4ltz./>-l Expires: Licensc Clu*' 3 L.O ,",., 3l>-al2-l License