101107305 - Permit - Laserfiche WebLink

Home Browse Search

BUILDING. INSPECTOR RECORD SITE.WORK DATE ID/SIG.GOMMENTS OWNER BUILDER DELCARATION I hcrcby allirm undo pmalty of pojury thst I m excmpt from the ContractoF' Licere law for thc following r6qn (Ss.7031.5 Businos md Prof*ion Code): Any City or County which requirs a po'mit to con3ruct, alt6, improvq danolish or repair u! structrc, prior to its issuilcc, slso rcquirG thc applicot for such pemit to file a signed statmot that hc or shc b licmcd pGuel to thc prcvisioN of the Contractor's Licenscd taw (Chapt6 9. Commcing with Sction 7000 of Division 3 of thc Busincslud Prcfcsions Codc) or that he or shc is cxempt thEefiom md thc b6is for the alleged exmpion. Any violation of S6tiotr 7011.5 by ily applicantforapermitsubjetsthc applicettoacivilpâ‚¬naltyofnotmorcthdfivehundreddollus($500). _1. as owner of the propefly, or my cmployecs with wages as their sole compexsation. willdo the work and the strwturc is not intcnded or offered for sale (Sec.7044. Business and hofessions Code: The Contractor's License larv does not apply to an owncr of the proSro'ty rvho builds or improves thereon. and who does such work himself or herself or through his or her own employees. provided that such improvonents are not intendcd or offered for sale. If. howet/er. the building or improvement is sold within one ),ear of cornplaion. the Orrner Buitder will have the hrden of proving thd he or she did not build or improve the property for the purpose of sale). _1. as owner of the property. am cxclusively contracting with licensed contractors to construct thc project (Sec. 7044. Business and hofession 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 Contractor{s) licensed pursuant to the Contractor's Licerse law). -l am exempt under Section-, B. & P.C. for this reason. Date: WORKERS' COMPENSATION DECLARATTON I hereby a(Tirm under penalty of perjury one of the follorving declarations: _l have and will maintain a Certifrcate of Conscnt to Self-lnsure for workers' compersation, as provided for by Section 3700 of thc labor Code. for the performance of the work for which the permit is issued. _l have and rvill maintain workers' cornpensation insurance. as required by Section 3700 of the Labor Code. for the perfonnance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Policy _l cenify that in the performance of the work for which this permit is issued. I shall not so as to becorne subject to the workers' compensation laws of California, and agree that if I employ any person in any manner - should-become subject to the I Labor Code, I shall. forthrvilh with those provisions. and shall an and civil fines up to one hundred thousand dollars ($100.000),the cost ttre Section f)o lo. 3076 of $e LabogCode, 7 lLLlur interest and attorney's fees. I hcreby affirrn under penalty of perjury that I am licensed under provision of Chapter 9 (comrnencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License 3 71 7) L I hmby affm undc pcnalty of pcrjury that thsc b a @n*ructiotr knding agrey for the pcfomcc of thc work for which this pqnh b isucd (Sc. 3097, Civ. C.). Lender's Name: Lcnder's Address: APPLICANT DECLARATION I hereb}, aflinn undcr pcnalty of perjury one of the following declarations: Dernolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Rcquired Letter of Notification _l ccrtiS that the federal regulations regarding asbestos removal are not applicable to this project. _l ccrtify that I have read this information is correct. I agree to cornply with all City and County ordinanccs and State laws relating authorize represertatives of this City and County to above mentioned property for Applicant or Agent Permilee nnme (print): to Z enter upon the Set Backs Forms/Steel/Holdowns ?-q- ct rGl.rcr, qfr Pk &u-rr F? oL- Erection Pads UFER Ground SLAB Floor Su bfloor/Ve nU! n s u latio n Roof Sheathinq Shear Wall Framing !nsu lation/Energy Drywall Ext./!nt. Lath Brown Coat Masonrv Pool Fence T-Bar Handicap Req Deputy Final Report Engineer Final Report Flood Zone Certif rA 0V V pi.r?l.th_a -Ze-A *,ffLitlL/ l / FINAL l6-t t 4-t ( -?rlzGertificate of Occupancy Notes, Remarks, Etc. ('rrrr icl' to L"