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Home My WebLink AboutXR2022-2377 - Permits661, :6ple'31'bslVJOl 0 : a6eJe0 •u •bs maN/PaPPV 9L : 6ple ,31'bs uol;eJa;IV I,l I, : 6PIg •1J'bs 11/maN/PaPPV 00'000'0M : uopenleA uol;owlsuO0 1.616-ZZb (6V6) LZ9Z6 VO 'VS3N V1SOO 90LV'MH19L LVOL 12JVHOIN NOW SBEZ-E9Z (Z99) L0806 VO 'HOV38 JNOI bOZ# 3AV 0I1NV-liV ZOZV AONV INVIZVH`J 1,61,6-ZZb(6176) LZ9Z6 � 'VS3N b': SOO 90 LV 'M 1-1181 IbOI 12iVH3M NOSVP auoyd ssaJppV Jeu6lsaa Z : saIJOIS 10 ON I, : s;lun;o ON ON : auoZ pJeZBH aJlj ON : sJaiMulJdS aJlj £ZOZ/6Z/L : aJldx3 -0'M 981,04L6 : ON 63110d 0 Nn=i+3ONv,dnSNI+N011VSN3dWOO+31V1S : ja1ijeo auoyd aoueJnsul uol;esuadwo0 ,SIGMJOM ssaJppV EZOZ/0E/70 : aJldx3 oil sng Jaaul6u3 Z988900£18 : oll sng EZOZ/OE/90 : aJldx3 oll 01l a;e;S 41,L968 : 011 a;e;S u00 : auoyd LLh6-9EZ (6176) : auoyd LL9Z6 VO'I3f101N VNnsv-i ssaappV 1df10O udi iON 6808Z : ssaJppV ;Oa;JgOJV ONI 1SN00 ONVIIOH 3NIN : JO;3eJlUO3 SNOI110N00IV103dS lseo0 vodmaN - Od X :Ag ❑3SS3OOad : auoZ asn auoZ pool] sMoeq;aS 6ulpling : ig61aH 6PIG £-H : sdnoJO Aouedno30 g-n : uol;onJ;suoO;o adAi 660Z : u0I11p3 apoo auoyd : ssaJppV JapimgpaumO E009-894(14L) :auoyd LZ9Z6 VO'VS3N V1SOO 901,V '1S 1-1181, M 1481. : ssaJppV 1HonVn NMVO :;ueollddV auoyd LOZ98 ZV 'VS3N 1S N31N90 N Obi, : SSOJppV 07 ON3NSVd3HS : JaumO SMOONIM 30NVI1\13 'ANOOIVO Wi J WO1VATO IONI) jS I, I, I, 11V 2ijS : uo1;dposaa 86101 NI8 917bSl al N : OsaO Ie6a-1 ii0 AV8 AEINOIS 4L : ssaJppV qoP SV71 iV IIV NI SAVOIIOH ONV AVONnS NO MOM ON ONV SV36V A1ISN30 HJIH NI AVONIIS Ho AvcHn1VS NO 3SION 031VI321 NOI10f12ilSNO3 ON 31Va 33NVnSSI IVN[DINO WONJ S1JV3A £ NVH12131VI ON ing 'NOIl33dSNl OIIVA 1SVI NO B0NVt1SSl N31jV SAVQ 081, 3211dX3 S11WN3d uO11eJa;IV1uO1PppV - SSLIO AJOM H03W 03I3 dzIS - adA-L u01;eulgwo0 suogoadsul/nob eopeagyiodmau a�an°ai�bJ 9 : eaJV umpedsul SSZE-"9 (6V6) auoyd slsenbaa uogoodsul ZZOZ/LOM : oleo panssl II II II III III IIIIIIIIIIIII 29ZE-bV9 (6b6) :auoyd jaluno0 lwiad �ON�oa40Ueld 6uppyuAl uolsln49luawlieda03awdolaAGolunwwop LLEZ-ZZOZvX;!w18d 8WOO �u9 y3ea8 JjodMON 10 A310 `bode` OWNER -BUILDER I hereby affirm under penalty of perjury that I are exempt Irom the Contractors' State License Law for the reasons) indicated below by the checkinark(s) I have placed next to the applicable lem(s) Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, derno4sh, or repair any structure, prior to its issuance, also requires the applicant for he permit to III& a signed statement that he at she is licensed pursuant to the provisions of the Contractors' Stale License Law (Chapter 9 (commencing with Suction 7000) of I)Msion 3 of the Business and 'rofessions Code) or that he or she is exempt from licensers and the basis for the alleged exemption. Any violation of Section 7031.6 by any applicant fora permit subjects the applicant le a civil penalty of tot more than five hundred dollars ($500). 1 L, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044, 3usiness 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 inprovemenis 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 mproved 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 ipply to an owner of property who builds or Improvesthereon, 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: _ . _,._..__ .......". 3y my signature below I acknowledge that, except for my personal residence in which I must have residod for at least one year prior to completion or the improvements covered by this permit I cannot legally sell a structure that I have built as an owner -builder if it has not boon 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;hUp:/1www.leginfe.ca,gowcalaw.html, >ignature of Property Owner or Authorized Agent Date ACENSED CONTRACTOR'S DECLARATION —�------'-" hereby affirm under penalty of perjury that. I am licensed under provisions of Chapter 9 (commencing with Section F D is'on 3 of the Business and P �pd, �ryd mpfl� se is in full force and effect. License Class License No Datg�'� Contractor Signatu f VORKERS' COMPENSATION DECLARATION fARNING, FAILURE TD SECURE WORKERS' COMPENSATION COVERAGES UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TC ONE HUNDRED THOUSAND DOLLARS ($100,000),.IN AOUITION TO THE :DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LASOR CODE, INTEREST, AND ATTORNEY'S FEES, hereby affirm under penalty of perjury one of the following declarations: 3 1 havtafnd 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, fcrty erfom ee of the work for which this permit is issued. Policy No. eve 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' compeiisatio mce caare,: Ir Policy Number % i�� $ > Expiration Date of Agent certify that, in the performance of the work for which this permit is issued: I shall notemploy any person in any manner so as to become subject to the workers' compensation laws of C3Ufornla and afire t, if I should become so Pact o th orkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply With those provisions ` ^ nature of Applicant _ Ill- Dat p 7iZ CL4FWTION REGA DING CONSTRUCTION ENDING AGENCY �reby affirm under penalty of perjury that there is a construction lending agency for the performance of 1hR work for which this permit is issued. (Section 3097, Civil Code), Ider's Name, Lender's Address my signature bet",, 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 city or count to r o -ide0ayed property for inspection purposes. I nature of Property Owner or Authorized Agent 1 ad Property Print Property Owner's or Authorized Agent's Nam /XL 116dCi/.tr-,Q �✓�5. SOP1Li 7/27— ACTION DATE f BY DFCLARATION Or COMPLIANCE WitH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLF 40 AND AQMD RULE 14iH PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO PEAM___.IT._. CANCELLED y�-r Ep_A PERMIT EXTENDED PFR,tar F1NA1 CERTIFICATE OF U> $FSTOS NOTIFI" IIDN SNOY APPLICABLE TD ED OCCUPANCY ISSUED QfjA(7LIT SIG? 516NAFUR . ��, ��1�1 �(( ��I