The URL can be used to link to this page

Home My WebLink AboutP2023-0110 - Permits: .0 •bs IV1OI 96ejeO •H ,bs maN/pappy : 6PI8 'U ,bs uogeja31V 6p1s'l►'bs Il/maN/pappy : uo!len!eA uo!lonj;suo0 :SNOI110N00 IVI03dS As O3SS300Nd (eaje lol wnwlulw saleo!pul 0009) leguaplsay llun-a!6ulS - 0009-E-a : auoZ asn X : auoZ p0013 g :jead '9 :ap!S '9 :ep!S 'g :luw j : sl!oeglaS 6u!Pllns sauo;S;o ON : s;!un;o ON ON : auoZ PJezeH and ON : sja!l!u!jdS an j : lg6!aH 6PI8 sdnoOO Rauedn000 uo!lonj;suoO;o adRl ZZOZ u0131p3 apo0 :auoyd :auogd ssajppV £ZOZ/9/ZE : aj!dx3'0 •M : ssaiPpV Jau6!sa0 Z91766 E6 : ON A31I0d : Lap!!ngpaum0 ONfl3 3ONV2if1SNl NOIIVSN3dAO0 31VIS : JaIJJe0 auogd eoueansu! uogesuadwoo ,sja)ijom 9060-Sb6 (646) : auogd 9Z9Z6 V0'VS3W V1SOO ssajppV bZOZ/E£/EO : andx3 oil sng E-O 3nV AVMaIV 98l£ : ssa'PpV Jaau!6u3 698£900£18 : 3!l sng S2]OlOV2IINOO 0311Nn : lue3!!ddV bZOZ/OS/90 : aj!dx3 31I :oil alelS 9006t76 :oil alels u00 auoyd 9060-Sb6(646) :auoyd 9060-S76(6b6) :auogd 9Z9Z6 VO'VS3W VIS00 099Z6 VO'HOV381?JOdM3N ssajppV E-0 3AV AVMLIIV 98L£ : ssajppV 1S VIIVHV 90ZZ : ssaJppV l38l!g3jv SldOlOV2JINOO 0311Nn : jo;oejluo0 2il AIIWVj MVHS 3H1 HI O OVWVN MVHS : JaumO 3 I J1 1® l fi(648Z-IZOZX) ONVJSI 0891X3 iJOd 3NIJ SV`J JlV1SN1 gWflld : uo!;d!L3saO 1 V�y��ia' I 60l 1Ole SOL17 Hi N : asaO !e6al VN 1S VIIV 90ZZ : ssauppV qop s e SV38V 7V NI SAVOIIOH ONV AVONnS NO MOM ON ONV SV32]V A11SN30 HOIH NI AVONns 2jo AVONf11VS NO 3SION O31V132j N0110f18iSN00 ON 31VO 30NVf1SSl IVNIDIHO WON3 SHV3J. £ NVHI N31tl1 ON ills `N01173dSNl nI-1VA lSVI NO 30NVf1SSl N31dV SAVO M 3MIdX3 S11WU3d q : eajV umpedsul panssl:snlelS l!wJad :alea !eu! j £ZOZ160/£0 : ales panss! LZOZ-NVZ : ON 313ag0 Ueld 0 L �0-£ZOZd ';!LUI0d SWOP IIIliiiiillliililiillliillliillliilillll1Ilillilllllliilill illlll jag30 - sselO > joM - adAi uolleu!gwo0 0!n!o/A06' eo gaeaqu odma u 888E-81L (6b6) auogd JalunO01!wJad 09936 VO ' goeag UOdmaN 'anua Jalua0 01np OO E uO!S!Ala 6uppng-luaw!�edaa luewdo!anaa 6l!unwwo0 yoeag podmON 10 AMO OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the ContractorsSlate License Law for the reason(s) indicated below by the checkmaFk(s) I have placed next to the applicable items) 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 applicant for Te permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Irofessions 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 of more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, lusiness 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 nprovements 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 nproved for the purpose of sale). 7 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 pply 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). I am exempt from licensure under the Contractors' State License Law for the following reason. ly my signature below I acknowledge that, except for my personal residence in which I must have resided for at lead one year prior to completion of the improvements covered by this permit, I cannot legalll all a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and 'rofessions Code, Is available upon request when this application is submitted or at the following Web site:http:l/www.leginfo.ca.gov/calaw.htmi. signature of Property Owner or Authorized Agent Date .ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions Of Chapter 9 (commencing with Section 7000) of Division 3 Of the Business and Professions Code, and my license is in full force nd effect. License Class License No Date Contractor Signature VORKERS' COMPENSATION DECLARATION 'ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 16100,0001, IN ADDITION TO THE OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 5706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: I 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 Labor Code, for th erformance of the work for which this permit is issued. Policy No. 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' rance carrier and policy number are: Policy Number Expiration Date of Agent 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 , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. of Date CLARATION REGARDING CONSTRUCTION LENDING AGENCY -reby 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 ider's Name Lenders Address my signature below, 1 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 or county to enter the above -identified property for inspection purposes. nature of Property Owner or Authorized Agent Print Property Owner's or Authorized ADent's Name DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 610E TITLE 40 AND AQMD RULE PERMITEXPIRED , ❑ I SUBMITTED ASBESTOS NOTIFICATION TO PFRMITrANrFIIcn i i I I I-A PERMIT EXTENDED PERMIT FINAL CERTIFICATE OF OCCUPANCYISSUED U ASBESTOS NOTIFICATION 15 NOT APPLICAe_E TO PROPOSED DEMOLITION SIGNATURE: Civil Code).