101107346 - Permit (2) - Laserfiche WebLink

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BUILDING. INSPECTOR RECORD SITE-WORK DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hueby alfirm unds pmalty of perjury thd I m qmpt from thc Contracto6' LiccN Law for thc following reen (Se.7031,5 Busin6s ud Prof6sion Codc): Any City or County which rcquire a pcrmit to @nstruct, allq, improve, dqnolish or rcpofu my structuq prior to its issumcc, also rcquire thc eplicilt for such psrmit to filc a signed statmot thst lE or shc b lictrcd plBant to thc prcvisioE of the Contmctor's Liccmcd liw (Chaptq 9, Commcncing with Sation 7000 of Division 3 of thc Buinru ud Profsions Code) or that hc or she is cx@pt thqcfrom ud thc bssis for the allegcd exmsion. Any violation of Sdion 7031.5 by ily applicantforapemitsubjststhc applicanttoacivilpcnaltyofnotmorcthmfivchundrcddollm($500). -1. as owncr of the property, or my employees with wages as their sole compcnsation, will do the work and the structure is not intended or offered for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the progrerty who builds or improves thcreon. and who does such work himself or herself or through his or her own employees. provided that such improvonents are not intâ‚¬nded or offered for sale. I[, however. the building or improvemcnt is sold wilhin one year of cornplaion, the Orvner Builder will have the burden of proving tha he or she did not build or improve the propoty for the purpose of sale). -1. as owner of the prcpcrty. am cxclusively contracting with licensed contractors to construct thc project (Sec. 7U4, Business and Profcssbn 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) licaued pursuant to the Contractor's License law). -IamexemptunderSection-,B.&P'C.forthisreason.Date:-- WORKERS' COMPENSATION DECLARATION I hereby alTirm under penalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-lnsure for workers' cornpensation, as provided for by Section 3700 of thc Labor Code. for the perfonnance of the work for which the pernrit is issued. -l have and will maintain workers' compcnsation insurance. as required by Section 3700 of the l.abor Code, for thc performance of the work for this pcnnit is compcnsation insurance carrier and policy number are: a. o Policy _l certify that in the perforrnance of the work for which this permit is issued, I shall not employ any pcrson in any manner should become subject to theso :ls to becorne subject to the workers'compensation and agree that if I rvorkcrs'provisions of Section 3700 of the Labor I shall.those provisions. WARNING:to secure workers' compensation unlawful.to criminal peiultics and civil fines up to hundred dollars ($100.000). and attorney's fees. to the cost of damages as provided for the Section a I hereby affirm under of the Business and penaltyof perjurythat I arn 9 (cornrnencing with Section 7000) of Division ! Code. and rny license is in full t- License 1/ I hereby affrrm under pcnalty of perjury that thcre is a issued (Sec. 3097, Civ. C.). lending the performance of the work for which this perrnit is Lender's Name: I-ender's Address: APPLICANT DECLARATION I hotby aflinn under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Fedcral Regulations (Title 40, Part6) .--Requ ired l-rtter o f Notilication _l certi& that the federalregulations asbestos removal are not applicable to this project. the aklve information is correct. I agrec to comply rrepresentativs of this City with all City and County and above nrcntioned property for inspection Applicnnt or Agenl Pcrnrilee nanre and hcreby authorize b enter Set Backs Forms/Steel/Holdowns Erection Pads UFER Ground SLAB Floor Su bfloor/Venul ns u Iatio n Roof Sheathinq Shear Wall Framinq lnsulation/Energy Drnrvall Ext./lnt. Lath Brown Coat Jvlasonrv Pool Fence T-Bar Handicap Req. Deputy Final Report Engineer Final Report Flood Zone Certif. rl ,/t FINAL U 1 7 DIVII,Z5 t Certificate of Occupancy 'l I I Notes, Remarks, Etc. _> - Da(c:3 //