101108219 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hercby atfm under penalty of psjury that I m exempt from the Contrscton' Licw law for the following rron (Se.7031.5 Buincs md Profcion Codc): Any City or Couty which require a pemit to snstruct, alts, improvq dmolish or rcpair uy strucluc. prior to its isumcq also rcquirs the applicut for such pcnnit to file a signâ‚¬d ststmmt that he or she b licq$d pmuilt to thc povisiom of the Contractor's Licenscd taw (Chapts 9, Commencing with Setion 7000 of Division 3 of the Buins ad Prefe$ioN Codc) or that hc or shc is qempt thrcfrom ad the basis for thc alleged exmption. Any violation of S*{ion 7031.5 by uy applicantforapemitsubjetsthe applicanttoacivilpmltyofnotmorethdfivehundreddollm($500). __1, o owns of the property. or my employu with wags o thcir $le compensation, will do rhe work ud thc stnrcluc b rct intqdcd or offqed for slc (Se.7044, Busins ed Prcf6sioN Codc: Thc ContBctq's LiccN law do6 not apply to u oma of the propgty who buil6 or imprcvc thq@n, ud who do6 schwrk hirelf or hffilf or thrcugh his or ho om mployc, providcd that such imprccmts rc not inladcd oroffqcd for slc. If, howq. the buildiry or improvmt is rld whhin one )q ofcompletioo, the Osos BuiHq will haw the hrdo ofproving that he or she did not build or inprovc the prcpaty for thc puposof ulc). -1. u omr of thc prcpoty. m cxcluively contracring with licqtsâ‚¬d cotrtnctoE to coctoct thc Fojet (56. 7044, Busitrs md Profesbn Codc: Thc Contractor's Licmsc Law do6 not epply to m own6 ofpropcay who builds or improvs ths@n, and who contracts for such prcjets with a Conrmcto(s) lic@scd pNud[ to thc Contractor's Lic@ taw). -l m cxcmpt undq Sction-, B. & P.C. forthis rcen. }VORKERS' COMPENSATION DECLAR/TTION I hereby alTirm under penalty of perjury one of the follorving declarations: _l have and will maintain a Certil'rcate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Labor Code. for the performance of the work for which the perrnit is issued. _l have and rvill maintain workers' compensation insurance, as required by Section 3700 of the Labor Codc, for the pcrformancc of the work for which this permit is issued. My workers' compersation insurance carrier and policy numh are: Policy Nurnber: Expires: _l certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so ils to become subject to the workers'compers:ltion laws of California. and agree that if I should become subject to the workers' compcnsation provisions of Seclion 3700 of the l-abor Code, I shall. forthwith comply wilh those provisions. WARNING: Failure to secure workers'compensation coverage is unlawful. and shall subject an anployer to crimind poralties and civil fincs up to one hundred thousand dollan ($100,000), in addition to the cost of compensation. damages as provided for the Section 3076 of the Labor Code. interest and attorney's fees. Applicant: LICW DECLARATION I hereby allirm under penalty of perjury that I am licensed under provision of Chapter 9 (commencing with Scction 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License Class: License Numbcr: CONSTRUCTION LENDING AGENCY I hrcby affum undo pei8lty of pcrjury thal th@ is 8 construction lcoding ag@cy for thc po forc of thc wrk for which this portrit b issucd (Se. 3097, Civ. C.). Lcndq's Nme: Lcnder's Ad&ess: APPLICANT DECLARATION I hetEby alfrrm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Pan6) _Required Letter of Notification _l certify that the federalregulations regarding ashtos removal are not applicable to this project. _l ceni& that I have read this application and statâ‚¬ that the above infonnation is correct. I agrec to comply with all City and County ordinances and State Larvs and hereby authorize representatives of this City and County to etter upon the above rnentioned property for Applicrnt or Agent Pcrlni(ee nflnrc to r0-8-?l Set Backs Forms/Steel/Holdowns ) Erection Pads UFER Ground SLAB Floor S u bfloor/Ve nUI n s u lation Roof Sheathinq Shear Wall Framinq lnsulation/Enerqy Drynruall Ext./!nt. Lath Brown Coat Masonrv Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif. FINAL /0'a ,z I fr (!/a n/r ru9 a,r/ Certificate of Occupancy Notes, Remarks, Etc. f\^.^. ,