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HomeMy WebLinkAboutX2019-0645 - PermitsI hereby affirm under penalty of perjury that I am exempt from the Con =onsn Mrs ) 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 thate, 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 a pr L ense 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 forthiolation 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 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 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 Im 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 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). 0 lam 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 legal) 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:hltp://www.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date 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 o the Busing and Profes5gas.Code, and my license is in full force and effect. Licenre"ass License No -.gate 1 ( ntractor i ture �(AIIIIION WORKERS'COMPENSATION DECLARATIONWARNINO:fAILUREYTO-SE®URE WORKERS'COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDREDTHOUSANTO THE CBST OF dbMPENSAT10y, J0AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I Diarebt gffirm under penalty of perjury one of the following declarations: 0 1 have and wig 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 IN NgrmWce of IN %14for which this permit is issued. Policy No. m a d wi�l"aWain 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 for nco ca rrienand.poiicy number are: Carrier\ . Policy Number Expiration Date that, in the ormance 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 ,...1 b .RA a„ hie�f fn fLu rkam- comnsamaga^ aun signs of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. / _-.. nature of Apf1ji ant - CLARATIO CARDING C STR N LENDIN GENCY Ireby affirm under penalty of perjury that the tion lending agency for the performance of the work for which this permit is issued Ider's 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��l9ity or county to �teHc2lb Move-ida ' 'p.' 4pady-for inspection purposes. nature of Prooertv Owner or AutlldT;ized Agent \ PrMLProperty Owner's or Authorized Agent'slNarc ACTION DAT BY DECLARA- OMPUANC WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PAR ITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED EPA PERMIT EMENDED QMD PERMITFINAL -7 �� h� ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF {/ PROPOSED DEMOLITION OCCUPANCYISSUED SIGNATURE: Civil Code).