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Home My WebLink AboutPV2022-0410 - PermitsZ l : l;emo DI ddS : ae!oS;o adAj 00'000'0£$ : uopen!eA uo!;on„suo0 0600-Z17Z (646) : auogd 909Z6 VO '3NIA211 SNOI110NO0IVI03dS :Ae passa30Ad Gl` (eaje;oi wnwlu!w sa;eolpu! 0009) !e!luap!saa 1!un-a!6u!S - 0009-1-2i : auoZ asn X : auoZ poold 9 aeabj 9 :ep!S '9:ap!S'1Z :;uojd : speq;aS 6u!p!ma sa!io;S to ON :;g6!aH 6p19 : s;!un to ON n'£-N : sdnou0 Aouednoo0 ON : auoZ puezeH aa!d 9-A : uo!lonj;suo0lo adAl 63J. : siah!updS auld MZ : uoRlp3 apoO OOZ3M'3AV NJVNNOA 991.91 : ssa�ppV £ZOZ19Z/L : au!dx3'O'M S2i301In9 NnS VVb' : jau6!sea b089016 : ON A011od ONnd 30NvdnSNI NOIIVSN3dW00 31V1S : ualJUO 9LL6-4£9 (Ol£) : ouogd aaueunsu! uopusuad woo ,sua)liom ld 'OONVl210 EZ0Z/0£/i, : aj!dx3 all sna 6L8ZE 4Z;'OA19 1VS2i3ANn VZ66 : ssaapptl OAO1 N112iVW : a88u!6u3 3!l a;els :auogd sseippV ;oa;!gojv L£60900E19 17ZOZ/L£/L0 ZL09L6 0600-Z17Z(646) 909Z6 VO'3NIAU OOZ '3AV NAMVNNOA 99L9 L S2i3011n9 NnS VVV : oil sna ai!dx3 oil 31l a;e;S U00 :auogd : ssaippV Jo;3eJ;u00 :auogd : sseippV :jappnapaum0 0600-ZbZ(6176) :auogd 909Z6 VO '3NIANI 00Z'3AV N3WaVNNOA 99L91 : ssaJppV S2i3011n9 NnS VVV :;ue3!!ddV auogd i719M VO '3NIA& OZZ31S H01Id OZ9Ll : ssaIppV 0-11 H181, 94l : Jeumo (LLL4-6lOZX)'S83ZIWlldO'8 S3lnOOW (OE) /M W31SAS 2jV OS OIIVIOAOlOHd 031NnOW d002i MN 00'Zl llV1SNl2idS : uo!ld!josa❑ 6L 101 Nl9 VE99 81 N : 3s00 Ie60l 2i0 133N 9014 : ssaippV qor -sheppoH io sAepunS uo �Jom ON 'w-d 00:9 0;'iu'e 00 9 Aepjn;eS pue w,d 0E:9 01'w'e OO L Aepljd -/epuoW :sjnoH uogongsuo0 'N01103dSNI OIIVA 1SVI 2dO 93NVnSSI u31dV SAVO M 3NIdX3 SIIW2iad 9: uejV uo!;3adsul suo!;09dsu!/n06'eogoeagUodmau voe EZOZ/60/EO : a;e0 panss! 996E1779 (676) :auogd slsanbaa uo!;0adsu! uogeaal!V : sse!O NuoM 99ZE-bb9 (6b6) :auogd jalunop;!wjad a 4? q 416Z'ZZOZOd : ON 113a4O Ueld 099Z6 Vo 'goeaa pOdmQN 'aAU(I Jaluap o!A!p 00L < e t a e z Z e Z n d uo!s!nia 6ulpl!na-wy�ea8 4odMaNAo �C�i� �bodrx 3�'VO 0 M-ZZOZAd ` IIWIGd IL'IOS ��IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury, that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable itemis) Dijon 7031.5, Business and Professions Code: Any city or county that requires a permit fo construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requ ras the applicant for porm€t to file a signed statement that he or sheds licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and fessions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a. permit subjects the applicant to a civil penalty of more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, iness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or Improves the property, provided that the rovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or roved for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not ly to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuantto the Contractors' State License Law), U I am exempt from ticensure under the Contractors' State License Law for the following reason' _ . _—._._._ By my signature below f acknowledge that, except for my personal residence in which I must have resided for at feast one year prior to completion of the impro set! a structure that I havo builtas an owner -builder if it has not been constructed in its entirety by licensed contractors, I understand that a copy of the appticat Professions Code, is available upon request when this application Is submitted or at the following Web site:http:L'vm .leginfo.ca.govlcalaw.html.. Signature of Property Owner or Authorized Agent LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury�yy that I am licensed under provisions of C„�tagter 9 (commencing with Section 70p0 of 'svision 3 of the Business and Pro and effect License Class l.fD License No 79D1V Date 3)-If 'L'7 Contractor Signature WORKERS' COMPENSATION DECLARATION'. NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIOL FINES UP TO ONE HUNDRE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, hereby affirm under penalty of perjury one of the following declarations: ments covered by this permit, I cannot legs law. Section 7044 of the Business and _ ate _ ;sions ode,. an my IicenSe is in full forer H77LLARS t5100.0001, IN ADDITION iO TN have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Lacur Code, for, thgl mane of the work for which this permit Is issued. Policy No. Ilii have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensa!ioq� ranee carrier and policy number are: 1e of Agent certify that, in the performance of the work for if I should become subject to the workers' co Policy Number Date ermit is issued., I shall not employ any person in any manner so as to become subject to the workers' compensation laws cf Califoinia, and provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicant CLARATION REGARDING CONSTRUCTION L ' G AGEN ireby affirm under penalty of perjury that there is a struction idars Name my signature below, I certify to each of the following: I am the property owner or authorized to act on the property ov I have read this application and the information I have provider I agree to comply with all applicable city and county ordinance: I authorize representatives of this city or county to enter the ab nature of Property Owner or Authorized Aaant ACTION PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCY ISSUED Date. !�Ifh,3 _ lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code), Lenders Address behalf. laws relating to building construction. ad property for inspection purposes. Print Property Owner BY 3 DECLARATION-F-MMPUANCE WITH CODE OF FEDEI REGULATiONSP R461 OF TITLE 40 AND AQMD RULE 1403 II SUBMITTED ASBESTOS NOTIFICATION TO . __ EPA LJAQMD "1 ( ASBES'fUSNOTIFICATiON SN i PPLICABLE TO FOR OFFICE USE ONLY