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Home My WebLink AboutXR2023-0326 - PermitsSNOI1ION00 1VI33dS A9 03SS300Nd SIM MaIA jogjeH - Od : auoz asn X : auoz Poold sjoeq;aS 6u!ppng 0 -;l •bs 1tl101 0 : o6ejeO ,;l ,bs MaN/PaPPV Z : sauo3S to ON 14618H 6PIg 6PIg 13 ,bs uogeja;IV Z : s;lun to ON Z-b : sdna0 /ouednnoo 0 6PIg';1'bs Il/MaN/PaPPV ON : auoz pJezeH and 8-A : uo!;onilswo 10 adAl 00'000,Z6$ : uo!;enleq uoponi;suo0 ON : sial)luudS and ZZOZ uo1RP3 aPoO :auogd auo4d ssaippy 7Z0Z/8/l : andx3 .O'M : ssajppV Jauolsad L1116£6 : ON Ao!lod : japl!ngliaumo ONnd 3ONV23nSNl NOIIVSN3d1N00 31V1S : J81JJe0 O£1L-9ZZ (646) : auo4d aouejnsul uollesuadwoo,simpoM £800-90Z (blL) : auo4d 6Z9Z6 VO'1NIOd VNVO 998Z6 VO'30NVL10 0# AMH 1SVO3 OIdIOVd L9lb£ : ssaJppV £Z0Z/lE/01 : aa!dx3 0!1 sng 3AV V8M-IVd 3 L06I, : ssaJppV 031 3N23n8 : Jaaul6u3 OZ86L00£18 011 sna ONI 'NOuonHiSNOO 0130'dVW OINlONV : lueo!lddV £ZOZ/0£/90 : aaldx3 o!1 011 alelS 1609901, : 011 a;e;S uo0 :8uo4d E800-90Z(41L) :auogd :auo4d 998Z6 VO '3JNVHO 099Z6 VO'HOV38-LNOdM3N ssaippV 3AV V23AW1Vd 3 L061 : ssaippV bL# 3113HOON Vl 1Z : ssaJPpV ONI :Iivr)nAn� :;0a1!40�V 'NOIlOn231SN00 013O23VW OINlONV : J010e4uo0 LI303n23)4 S3WVf : uaum0 A030 old ONZ 9NUSIX3 NO S11V8 ONVH 30V1d3H - HJIN : uogdu0sao dV NO 031VOO1 io3rO0 Jd d0 9911Nn Z1101 8986 Hi 99 Nn Z1101 N{ 8 8986 H1 N : osao 1e6a1 3113HOON V-1 1Z : ssajppV qor SV3NV 11V NI SAVOIIOH ONV AVONnS NO MOM ON ONV SV32iV A11SN30 HJIH NI AVONnS do AV023n1VS NO 3SION 031V1323 NOuonNiSNO0 ON 31V0 30NVnSSI 1VNIEJ180 WONd SHV3A E NVH12131V1 ON lna `NOI103dSNl OIIVA 1SV1 NO 30NvnSSI N31JV SAVO M 3NIdX3 S11WN3d J0410 - ssel0 AJoM ddW - adAl uoileu!go0 g : eajV uo!;oadsul �d o CZOZ/fo/Zo : oleo ponssl 029 1-9 1/ 16b61 auogd jaluno0 iwiad u io doN100 4 0UeId 4 uolsno6ui9luawpedaojuawdoanao lionwo0 0 9ZC0-4Z0% X;RUJOd 8WOD IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIa yoeeS podmON 10 40 `boenn�a OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the ContractorsState 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 io 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 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, justness 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 npfoved for the purpose of sale). 1, 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' Stale 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 least 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 Irofessions Code, is available upon request when this application Is submitted or at the following Web site:http:l/www.leginfo.ca.govlcalaw.html. ilgnature 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 end effect. License Class License No Date Contractor Signature COMPENSATION DECLARATION ING: 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 (E100,000), IN ADDITION TO THE OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 07" OF THE LABOR CODE, INTEREST, AND ATTORNEY'$ 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 'ormance 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' compensa trance carrier and policy number are: Policy Number of Agent Date 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 I, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply With those provisions. nature of Applicant Date_ _ CLARATION REGARDING CONSTRUCTION LENDING AGENCY oeby 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). lder s Name Lenders 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 stale laws relating to building construction. 1 authorize representatives of this city or county to enter the above-identlfied property for inspection purposes. Owner's or Authorized Aaent's Name Date ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTI FICATEON TO PERMITCANCIFUED OEPA PERMITEXTENDED QME) PERMIT FINAL CE0FICATE OF �.pr�.� Q�L LT �J ASBESTOS NOTIFICATION 15 NOT APPLICABLE TO POSEDEMOLITION OCCUPANCYISSUED SIGNATURE: UPLICA M E