HomeMy WebLinkAboutX2018-1746 - Permitswtvx City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
N tj Permit Counter Phone (949)644-3288
3 Inspection Requests Phone (949)644-3255
C w i
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 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
he 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
'rofesslons 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 epTWi'U2Rt to a civil penalty of
iot 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 U portions of the work, and the structure is not intended or offered for sale (Section 7044,
iusiness 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
n 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
d for,:the purpose of sake).
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).
I am exempt.from licensure under the Contractors' State License Law for the following reason:
iy 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 legalh
ell 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, Sectipn 7044 of the Business and
'rofessions Code, is available upon requ hen t applicatio 's submitte or at t I wing W b site: p: /www. leginfo.ca.gov/calaw.htmi. f❑V',9Cjl,
tignature of Property Owner or Authorized Age
.ICENSED CONTRACTOR'S DECLA TION
hereby affirm under penalty of perjury that I am licensed under provisions of/Chapter 9 (com Aencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect. License Class License No Date - Contractor Signature
VORKERS' COMPENSATION DECLARATION
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
;OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 310$ OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm"Cir penalty of perjury one of the following declarations: - -
I have arlfAi 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
ariformance of tMd Work for which this permit is issued. Policy No.
JI,have antl 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' compensatioi
Isurence carridir and policy number are:
:artier ..... Policy Number Expiration Date
j.11the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the wor ers' compensation laws of California, and
Id become subject to the workers' compMatjon provisions of rection 3700 of the Labor Code, I shall forthwith comply with those provisions. e
ral affirm Ilndek penalty of perjury that there is a constriction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Ipar 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 owners 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 nter the bove= ified p operty or inspection purposes.
Signature of Property Owner or Autho
Print Property Owner's or Authorized Agent's N15Lde
ACTION
DATE
8Y
DECIAR ION OF COM IANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED
U I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED
OEPA
PERMIT EXTENDED
QMD
PERMITFINAL
P>BESTOS NOTIFICATION IS NOTAPPLICABLE TO
CERTIFICATE OF
ROPOSEDD�fMOUTIO�
OCCUPANCYISSUED
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