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Home My WebLink AboutH2022-0715 -O.L.I,J:f sdwnd IV3H N ®31181H0dd 3d3WII : #18POW :jain;oelnuuw £ZOZ/9l/9 : aa!dx3 '0 •M .P9dZOV03M9L : ON A3110d ANVdWOO+3ONv2inSNl+3NId+AllO+NIMi : uatlae0 eouemsu! uo!lesuadwo0 ,simpoM £Z0Z/0£/60:aj!dx3 o!I sng 4U6900£1g : d!I sng £ZOZ/0£/b0 : andx3 o!I 09W96 : o!I alels u00 66ZL-M? (Z99) : auogd 90906 VO'HOV3g ONOI 3AV SIM31 lIL79 : ssajppV IVOINVHO3W OIOS : Jo3oeJluoO :SN0IlION00 IV'103dS : Ag 03SS30021d (eaje lol wnwlulw saleo!puI 0009) Ieliuep!saa;lun-al6u!S - 0009-6-a : auoZ asn X : auoZ Poold g aeaa '9 :ap!s 'g :aP!s 'OZ :luwd : sAoeglaS Bu!p!!ng :sdnojE)Azuednoo0 uo!lona3suo0;o adAi ON : auoZ pJeZEH aJ!d MZ : uoll!P3 apo0 :auogd ssajppV jap!!ngpaum0 66ZL-ZZ4(Z99) :auogd 90906 VO'HOV3g JNOI 3AV SIM317LV9 : ssaIppV IVOINVH03W OIOS : lueo!!ddV :auogd £99Z6 VO 'HOV3g laOdM3N 3AV OSIIV 96£ : ssaJppV 2i3M311)1 NOSVf : uaum0 (0940-ZZOZX) 0,0321 SdVO iNV1SIS32! a3dWVLSdnnd 1V3H NO 031181HOi!d S2i3W11. nvzi (6) . M3N (Z) lINn O/V HO3W : uo!ld!losaO L7101 N19 £L66 2i1 N : 3s80 1950l NI NVWVW LZU : ssalppV qof SV32JV IIV NI SAVOIIOH ONV AV0NnS NO MHOM ON ONV SV32JV AlISN30 HJIH NI AVONns 2i0 kvaH 11VS NO 3SION 031VIMJ NOiiom!1SNO3 ON 31VO 30Nvnssi IVNIDIHO INOUJ SNV3A £ NVHI N31V1 ON Llg 'NOIlO3dSNl OI1VA 1SVI UO 30Nvnssi N31dV SAVO 09l• 3MIdX3 S1IWM3d £ : eajV uo!loadsu! ZZOZISwu : alep penss! MON : sse10 AJoM ZZOZ-£040 : ON Mha40 veld 9 U-0-ZZ0ZH ' IM10d 112=121438W suoiloadsu!/no6•eogoeaquodmau -0��n0 �i�y� 99Z£-449 (6176) :auogd slsapbab uogoadsul yw 88Z£-"9 (6116) :auOq , jaluno01!wjad = �i►( 099Z6 VC 'goea9 uodmaN '=7?�G J81ua0 o!n!0 OOl ka II III III II II I II I II I I I III uoisin!0 6u!ppq -luawUedaO luawdolana0 A!unwwo0 C 60 yoeag liodmON 10 AIM OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the resson(s) indicated below by the checkmark(s) I have placed next to the applicable iter. (Section 7031.5, Business and. Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure,prior to its Issuance, also requires the apple,, the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with $action 7000) of Division 3 of the SUSlnese Professions 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 not 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, Business 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 theproperty, provided that the Improvements 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 improved for the purpose of sale).. h as owner or 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 apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors State License Law). EC I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvamentscevered by this permit, I.cannot Iegali! sell a structure that I have built as an owner -builder if ithas not been constructed in its entirety by licensed contractors- I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http://w .leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent _ Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under pena3ty of perjury that I am licensed under provisions of Chapter 9 (commencing with Secf3o 7000 of fvisi n 3 of the Business and Profess' ITCode, aaAmy u - ' a tioree and. effect. License Class License No Dat Contractor Signature NORKERS'COMPENSATION DECLARATION NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNOREO THOUSAND DOLLARS ($100,000), IN ADDITION TO THE :OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: 1 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 L^bor Code, few thi rerformance of the work for which this permit is issued. Policy No. :11 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 wJrk3ls' -ompecsatior nsurance carrier and policy number are: :amier. Policy Number Expiration Date Jame of Agent Phone # :11 certify 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 workers' compensation laws of California, and agrat hat, if I should become subject worke ' compensa ien_xgnsmnsof Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ,,,,�� y/ / ci )ECLR of Applicant .. f"E.=-JX �,�( ,4 ✓a�`G.c 3ECLARATFON REG DIN CONSTRUCTION N ING AGENCY are by affirm under penalty of perjury that there. is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code), Iders Name Lender's Address my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct.. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this city orceunt t '"^��/.,`'fie aboy91-idantifis for inspection purposes. nature of Property Owner or Authorized Agent. _ / us;� / �//,ff/(� Print Propertv Owner's or Authorized Anent's Nam ) ti ��/��///"' ACTION DATE. By I bECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART'61 OF TITLE 40 AND AOMD RULE 1403 PERMIT£XPIRED I Ii L1 I SUBMITTED ASBESTOS NOTIFICATION TO PERN11T EXTENDED UAQMD PERMIT FINAL D ASBESTOS NOTIFICATION 15 NOT APPLICABLE TO CERTIFICATE OF PROPOSED DEMOLITION OCCUPANCY 15SUED ( I ctrRIATUDC,