101107763 - Permit - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hacby a(fim undc pcrulty of pcrjury that I m cxcmpt fiom thc Contrectos' LicN trw for thc following rwn (Se.7031.5 Buinqs md Profcssion Code): Any City or Couty which rcquire a pemh to coNtruct, alto. improvq danolish or rtpoir my struc1uc, Srior to its isuucc, also requirs rhc applicmt for such pcrmit to file a signcd statmot that hc or shc is liccnscd psuilt to thc irovisios of thc Contractor's Licmscd Law (Chapts 9. Comcncing with Setion 7000 of Division 3 of thc BNin* ild Prcfc$ionsCodc)orthathe orsheisexmptthocfromudthcbasisforthcallcgedq@ption. AnyviolationofScclion?03l.5byuy applicatforapcntritsubjctsthc applicettoacivilpcnaltyofnotmorcthilfrvchun&cddollus($500). _1, as owner of the property, or my employecs with wagcs as their sole compensation, will do the work and the structure is not intended or ofFered for sale (Sec.7M4, Business and Professions Code: The Contractor's License [^aw does not apply to an owner of the property who btrilds or improves thereon, and who does such work himself or herself or through his or her own cmployees, provided that such improvonents are not intcnded or offered for sale. If. howe'ver. the building or improvement is sold within one yâ‚¬ar of complaion, the Owner Builder will have the burden of proving thd he or she did not build or improve the propoty for the purpose of sale). _1. as owner of the property. am exclusively contracting with liccnsed contractors to construct the project (Sec. 7O44, Business and Pnofessbn Code: The Contractor's License Law does not apply to an owner of property who builds or improves ther@n. and who contracts for such projects with a Contracto(s) licerscd pursuant to the Contractor's Licensc l-aw). -l am exempt under Section-. B. & P.C. for this reason. Owner: WORIGRS'COMPENSATIM DECLARATION I hereby affrrm under poralty of perjury one of the following declarations: _l have and will rnaintain a Certificate of Consent to Self-lnsure for workers'compensation, as provided for by Section 3700 of the ffi;for the performance ofthe work for which the pennit is issued. rvill rnaintain workers'3700 of the Labor Code. for thc performancc of this permit is and policy number are: Policy _l certify that in thc performance of the work for which this permit is issued, I shall not crnploy any person in any manner so its to become subject to the workers'compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall, forthwith comply with thosc provisions. WARNING: Failure to secure workers' compensation coverage is unlawful, and shall subject an onployer to crfuninal pcnalties and civil fines up to one hundred thousand dollars in addition to the of cornpensation, damages as provided for the Section 3076 of the Code. interest and DECI.ARATION I hereby affrrm under poralty of perjury that I arn licenscd under p,rovision of Chapto 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. 2 License Number: I W I hqeby affirm under pqElty of psjury that th@ is a coGtruction lmding agency for the pqfommce of thc work for which this pqmit b issuel (Sa. 3097, Civ. C.). Lender's Name: Lendcr's Address: A PPLTCAI\T DEC T.ARATION I haâ‚¬by alnrm under pcnalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Required Lcttcr of Notification J coti$ that the federal regulations regarding asbcstos rcmovalare not applicable to this project. (-r/"*ig/ that I have read this application and statc that the abovc information is correct. I agrce to comply with all City and County ordinances and State Laws relating to building City and County to enter upon the above mentioncd property for Applicant or Agent Permitee name (print): purposes. and hereby authorize ,,,",qf z/>-l Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/Venul n su lation Roof Sheathinq Shear Wall Framinq lnsulation/Enerqy Drywall Ext./lnt. Lath Brown Coat Masonrv Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif. *-a- Canrrra 4r h, -J $ -zt B^f {e FINAL te-ll-2|Degtr? {r Certificate of Occupancy Notes, Remarks, Etc. Date: