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Home My WebLink AboutE2022-0669 - Permitsil;. do t3adSn, U DuAl i iaararas ®IN3Il-:IAA -9HI NO 3SI®N N®uonHiSNOO ON SdNnd 1b3H NO 431191HOdd Sd3WI1 N/£,y : sdnoa0 /Iouedno30 ON : auoZ pJeZBH aaid £ZOZ/l/b : ejidx3'0'M IN 6ZZb9000QM9NN ON,(ollod 0��..i�l 00 SNI N31A3Nd 1SM13A3 eouemsul uoI;esuadwo0 ,sja)jjoM £ZOZ/60/b0:ajidx3 oil sne 6ZZ790000M2NN : oil sne £ZOZ/l£/Ol : ajldx3 all OL666L : oil a;e;S u00 LLLL-LLL(4lL) :auo4d lZBZ6 VO'V3be HODS 3 09l£ : ssauppy O1H SNOIdAVH3 301AN3S : ao;oeJ;uo0 :SNOI110N00 IV103dS As 03SS300'dd Iel;uaplsaa;luN-9oulS - �-a : auoZ asn X Ild 8 '3V : auoZ Poold 17:aplS'17:aP1S'9:Iuad'9l:;uad :s)loeq;aS6ulppne : not;onj;suoo is adfl 6LOZ :uoI;IP3OP03 :auo4d ssajppV aapllnepaum0 9L8L-9EL (M) : auo4d Z9£L6 VO '3JVllIA 3>iV11S3M i30 VAVs VI SZZ6£ : ssejppV VNIO3A N3e :;ueollddV Z9ZS9 ZV'31VOS1100S Ial3N00 dBC)N10 3 Z990L 11f1Vi3e 130 9b i0l NlS L LO4 NI N : osa0 108-1 1f10 39NVH3 O/V NOd 0313 S3AO3 VOSIV9 94 :auo4d ssaippV : Joum0 : uoi;dposap ssejppV qoP SV3NV 7V NI SAVOIIOH ONV AVONnS NO NNOM ON (INV SV3NV A11SN30 HOIH NI AVONns No AV(DtInIVS NO 3SION 031V1323 NOI1onNiSN00 ON 31V0 30Nvnssi IVNIJINO WONJ SHV3J. £ NVH.L N31V1 ON ills `NO1103dSNl OI1VA 1SVI NO 30Nvnssi N31dV SAVO 081 3NIdX3 S11W83d eajV uol;oadsul ZZOZ/ZZ/60: a;ea panssl Ja4;0 : sse10 )jjoM : ON Moa4O ueld 6990-ZZOZ3 ';iuuad IBOIJ13813 suogoedsul/Ao6 eopeepodmau d`anoa��bJ 99Z£-4b9(6b6) auo4d s;senbab uo6oedsul �a 99Z£-b49 (6b6) auo4d ja;uno0;iwjaci U . II I I II II II II I I I I III uolsln 4 6u g 41uaw, eda4 uawdo anaa uJUGO lnwwo0 O yoea8 liodmON I Aj!3 `�'od�a`' OWNER -BUILDER 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 items) clion 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior Io Its Issuance, also requires the applicant for permit to file a signed slatomcnt 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 lessions 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 fora permit subjects the applicant to a civil penalty of 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 vac k, and the structure is not intended or offered for sale (Section 7044, ;iness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through emplo ees' or personal effort, builds or improves the property, provided that the 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 roved for the purpose of sale). - I, as owner of the property, am exclusively contracting with licensed Contractors to conslmcli'. the project (Section 7044, Bushss and Professions Code: The Contractors' State License Law does not ly to an owner of property who bullds or improves thereon, and who contracts for the projects with a licensed Contractor PUISL ant to the Contractors' State License Law). J I am exempt from licensure under the Contractors' State License Law for The following reason: , f, ,- _ - ..,......__. _.,.._.__ _m.. _., I y 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 legs ell 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 Irci ions Code, is available upon request when this application is submitted or at the following Web site: httpliww'w.feginfo.ca. ov/calaw.html,. signature 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 W afjliy{r' gjl3 of the Business an essio • C din nse istCt; in full force nd effect. License Class _ License No Dat GG ,T?; Confracior Si COMPENSATION DECLARATION IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, hereby affirm under penalty of perjury one of the following declarations: I hav ,and will maintain o cerlifoste of consent to self -insure for workers' compensation, issued by the Director of Inc r nce of the work for which this permit is issued. Policy No. Kave and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the perfor ys ce carrier and policy number area ,artier Policy Number CIVIL FINES UP TO ONE HUNOREOTf19USAND DOLLARS ($100,000), IN AOonION TO THE Relations as provided for by Section 3700 of the Labor Code, for of the work for which this permit is issued. My workers' Date to of Agent I Phone ff certify that, in the performance of the wor which this Is issued, I shall not employ any person in any manner so as o become subject to the workers' compensation laws of California, and agre if I should become subject to the wor rs•' comp an provisions of Section 3700of the Labor Code, I shall forthwith corn, flywitti those provisions. leture of ApplicantL �W :LARATION RErARDOING, CON ON LENDING AGENCY hereby affirm under penaIty`1gLP9TTFTthat there is a construction lending agency for the performance of the work for which this onder's Name Lender's Address ly any signature below, I Certify to each of the following: I am the property owner or authorized to act on the property owner shelf. I have read this application and the information I have provided' correct. I agree to comply with all applicable city and county ordinances and s laws rig to building construction. I authorize representatives of this city or ccunter the above -idle t�i ,e property for inspection purposes. or Aumorizec H Yrint rro erry uwner s or Aumoriz DATE ' LA ON OF COMPLIANCE WITH CODE OF FEDERAL '', FOR OFFICE USE e LATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT CANCELLED UE PA PERMITEXTENDED r._ 0AQMO PERMITFINAL _ jZ-� _ _ ,J� CTASBESIDS NOTIFICATION 15 NOT APPLICABLE TO CERTIFICATE OF ( PROPOSED DEMOLITION OCCUPANCYIS.iUED i SIGNATURE: is issued'. (Section 3097, Civil Code). VI