101107988 - 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 bfloorA/e nUl n s u I atio n I Roof Sheathinq t/g?/,h laf,a Shear Wall /I Framinq lnsulation/Energy Drywall Ext./lnt. Lath Brown Coat Masonrv Pool Fence T-Bar Handicap Req Deputv Final Report Enqineer Final Report Flood Zone Certif I FINAL tols Lt J"o\2. Certificate of Occu Notes, Remarks, Etc. '. D- OWNER BUTLDER DELCARATION I hreby affm uodo pcnahy of pcfjury that I m qmpt ftom thc Cont6clo6' LiccN lrw for the following @n (Se.7031.5 Buinss and Profeion Codc): Any City or County which rcquirc a pcmil to anstruct, altq, improvq dctrclish or rcpail my struclurc. prior to its isuilcc, also rcquin thc applicmt for such pcmit to filc 8 signcd ststmt thal hc or drc is lic@scd pllls@t to thc FovisioN of tlE Cotrtrrctor's Liccnscd law (Chaptq 9, Comcncing wirh Sstion 7000 of Division 3 of rhc Buins md Prcfsions Codc) or that hc or shc is excmpt thqcfrom ild thc bais for the allegcd exmpion. Any violation of Sclion 703 I .5 by ey applicutforapmnitsubjetsthc applicanttoacivilpcmltyofnotmorcthefivchun<lrcddollm($500). _1. os owner of the property, or my employees with wages as their sole compcrnation, will do the work and the structure is not intcndod or offered for sale (Sec.7044, Business and hofessions Code: The Contractor's Liccnse law does not apply to an ouner of the popcrty who builds or irnproves ttrereoru and who does such work himself or herself or through his or her own cmployees. provided that such improvements are not intorded or offerod for salc. l[, how6/er, the building or improvemcnt is sold within onc ],car of complaion, thc Orvner Builder will have the burden of proving ilra hc or she did not build or impnove thc propoty for the purposc of sale). _1, as owner of thc propcrty. am exclusively contracting with licersed contractors to construct the project (Sec. 7M4, Brsiness and Prrofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Contracto(s) liccrsed pursuant to the Contractor's License l-aw). -IamexemptunderSection-,B.&P.C.forthisreason. flo lo. WORKERS' COMPENSATION DECI.ARATION I hereby affrm under paralty of pe"jury one of the following dcclarations: _l have and will maintain a Certificatc of Consent to Self-lnsure for workers' compcnsation. as provided for by Section 3700 of the I-abor Code. for the pcrformance of thc work for which the perrnit is issued. _l have and will maintain workers'insurance, as requircd by Section 3700 of the l-abor Codc, for the performance of the work for which this ts workers' comporsation insurance carrier and policy number are: a g) O Policy a _l ccrtify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workâ‚¬rs'compensation laws of California, and agree thal if I should become subject to the rvorkers' cornpensation provisions of Section 3700 of the Labor Code, I shall, forthwilh comply with those provisions. WARNING: Failure to se{ure workers'compensation coverage is unlawful. and shall subject an anployer to oiminaq*alties and civil fines up to one hundrcd thousand dollars ($100,000).in addition to the cost of Section 3076 j Code, interest and attorney's [ees..\ I DECIARATION I hoeby affrm under pcnalty of pcrjury that I arn licensod undcr provision of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in fu[ force and effect. Numbcr: I W I hmby affm unda Fnalty of pcrjury that thqc is a @ngruction lâ‚¬nding agocy for thc pqfollmcc of thc work 6r ttich this pqmil b issucd (Se. 3097, Civ. C.). Lender's Name: I-cnder's Ad&ess: APPLICANT DECLARATION I hoEby alnrm under pcnalty of perjury one of the following declarations: Demolition Pcrmits-Asbestos Notilication Federal Regulations (Title 40, Part6) -Required lrtter of Notification _l certi& that the federal regulations regarding asbcstos rcmoval are not applicable to this project. rvith all City and County above mentioned propaly for Applicant or Agent Pernritee nflme state that and County to enter upon the 4 Owner: for the cetiS that and State laws relating to D,.",4M-1J,,-- building