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Home My WebLink AboutPV2023-0168 - Permits:SNOI11ONOO IV133dS A8 03SS33ONd IeOuap!saN liun-al6u!S - L-N : auoZ ash X : auoZ P001j 0 :-1e8N 'q :ap!S 'q :ap!S 'OZ :lua j : s3loeglaS 6u!PI!n8 0 : 'u'bs 1tl101 0 : a6en0 11 •bs mON/PaPPV Z : SalJolS 10 ON : 1y619H 6PI8 0 : 6PI8 '14 •bs uo!leiallV : nun ;o oN E-N : sdnoi0 IL3uedn330 0 : 6p18'31'bs Il/mON/PaPPV ON : auoZ pJezeH aJ!j g-A : uo!lonjlsuoOlo adAl OOZ'L$ : uogenlen uollonjlsuo0 ON : sial3luudS aj!j ZZOZ : uO11!P3 OPOO :auoyd :auoyd b0806 VO 'HOV38 ONOI 1S H117L 3 bS6Z : ssaJppV EZOZ/17Z/6 : ajldx3'3•M : ssaippV 3NN08SO OOHHVf : Jau6lsa0 6ZZZZ06 : ON A3110d : japllnepaum0 ON11d 31ViS : JauJUD auoyd aouejnsul uogesuadwo3.sjaMjoM OZM-61Z (EE8) : au04d EOb46 VO'SNVO NVW0J3HS ssajppV bZOZ/SZ/ZO : aj!dx3 oil sna 009'On-10 VNf11N3A EEZSL : ssaJppV J88ul6u3 8Z0000U8 : O!l sn8 NVAd3SAOH VNOS : lueollddV SZOULE/EO : andx3 011 Oil ale1S LEZgM : 31-1 OMS uo3 :auoyd 9Z9S-Z9g(Z99) :auoyd ZZEO-LOZ(ZL8) :auoyd 170906 VO 'HOV38 ONOI E99Z6 VO 'HOV381NOdMIN ssaappV 1S Hlbl 3 1796Z : ssajppV ON S0NIN FOE : ssa'ppV : 1oa1!youV ONI 3ONf10S NVIOS : jo4oeuluo0 8l Al2i3dONd NV1S ANVdWOO 3NIANI : Jaum0 S3If300W ZL 'MN 8E h W31SAS Ad NVIOS NdS : uo!lduosa(i ZL 101 H NIS 6LZL H1 N : asaO le60l ON SONIA ZOE : ssaippV qar SV3HV IIV NI SAV0IIOH 0NV AV0NLIS NO )QJOM ON ONV SV3NV A11SN30 H9IH NI AVOWS NO AVON(11VS NO 3SION 031V13N N0uom]1SNOO ON 31V0 30NVf1SSl 1VNI91NO WONd SNV3A £ NVH1 N31V1 ON 1f18 `NOI103dSNl 01IVA 1SV1 NO 30NvnSSI N31dV SAVO 08L 3NIdX3 S11WN3d g :easy uopoadsul au!IuO - SSM IJOM leu! j :sn;e;S 1!wJad adA( uol eu! wo noyT bZOZ/£L/£0 :aled leu!j djS - 1 3 q O £ZOZ/L L/SO : alep penssl olnlo/nob eoyoeagpodmau w eeEL-e LL (6176) :auoyd jalunoo llwjad u 130140 099Z6 VC) JGIUao (� /� 89�0-£ZOZ/\d •oNOdG Ueid II II IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII uoISInO6uPngyluawyjeda4,uawdolanaC]AIulnwwoo o(;tl 0 ;ILuaa yoea8 podnnaN 10 AIM `&OJ�74? I hereby r penalty o uvn 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 item(s) (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 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 Section 7000) of Division 3 of the Business and 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 of 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 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 the property, 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). ❑ 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 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). ❑ 1 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 improvements covered by this permit, I cannot legally sell 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 Professions Code, is available upon request when this application is submitted or at the following Web site:https:tlleginfo.legislature.ca.gov. LICENSED CONTRACTOR'S DECLARATION I 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 and effect. License Class: C46, C10 License Number: 925231 WORKERS' COMPENSATION DECLARATION WARNING: 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 ($100,000(, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I 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 Labor Code, for the performance of the work for which this permit is issued. Policy Number: 9072729 0 1 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' compensation insurance carrier and policy number are: Carrier: Policy Number: Expiration Date: Name of Agent: Phone* ❑ I 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 agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. CONSTRUCTION LENDING AGENCY DECLARATION I hereby 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). Lender's Name: Lender's Address: By my signature, I certify to each of the following: DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I am the property owner or authorized to act on the property owners behalf. REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 1 have read all the declarations, checked applicable ones, and the information I have provided are correct. I SUBMITTED ASBESTOS NOTIFICATION TO: I have read this application and the information I have provided is correct. ❑ EPA I agree to comply with all applicable city and county ordinances and state laws relating to building construction. ❑ AQMD I authorize representatives of this city or county to enter the above -identified property for inspection purposes. ® Asbestos notification is not applicable to proposed demolition. BONA HOVSEPYAN AuPust. 11 2023 _.5_Qna 1-1ovs�pyan