The URL can be used to link to this page

Home My WebLink AboutH2023-0480 - Permits (3)a� Nd31VO 10 SNOUION00 1tl103dS JaluaO !JodmaN glJON - 0d Ag 03SS30021d : auoZ ash auoZ pool] slloeglaS 6u!pl!ng .0 •bs 1tl1O1 ; 44619H GPIs a6eue0 .0 •bs maN/POPPY : sauolS 10 ON 000 : sdnouo Ioo : 6PI8li ''bs uo!leua;ltl sl!u� to oN dA ; uoll0nilsuo3lo adRy 10 6plg'A'bs I1fmaN/POPPV ON : auoZ PJezeH 011j : sialMuudS aalj ZZOZ : uo!l!P3 apo3 uo!len!eq uo!lonjlsuo3 ON :auo4d :auo4d ssaupptl £ZOZ/OZ/Zl : aj!dx3 •3'M : ssaippV Jau6lsao LOE99990M : ON A0110d : aapling/jaumo 00 SNI V0N3AV sntciiS : aalaje3 610E-Z88 (009) : auo4d : auo4d eoueinsul uo!lesuadwo3 ,sje4joM '3Nlnal 749M VO ssaupptl bZOZ/L£/80 : andx3 01-1 sng j '2JIO >WVd A>iS L9LLL : ssaupptl : lueol!ddtl Joaul6u3 E7L0900E19 : 0!1 sng S3d3HO VNV 9ZOZ/OE/b0 : andx3 011 0!1 alelS bOLE00l : 011 alels uo3 688t-6E6(6176) :auo4d :auo4d 6LOE-Z88(009) :auo4d `HOV39 bL9M VO'3NW:11 899Z6 VO 1NOdMAN ssaupptl A 31S'NI0 N1clVd AXIS L9LLl : ssaupptl : ssauppV 011 Id 1V ANOl00 3H1 : Joumo 1001!40uV ONI 281V8 9NIIV3H H031lNV : J010eJlu03 11Nn (3) NVHl 13n31 90 2J3M01 -3iwi 2iOd 37111 'f1Vd 'S 2J3SN30NOO O/V eJ :I - H03W : uo!ldu0sa0 6 -LOl A19 8L 19L W- N : 3s90 le6al Zld ANOl00 6OZb : ssaupptl qor SV3'dV 11V NI SAVOIIOH ONV AVONnS NO AHOM ON (INV SV3aV WSN30 HOIH NI ),VONns 8o AVO2Jf11VS NO 3SION 03yV132i NOuomJ1SNOO ON 31VO 9ONVl1SSl 1VNI9MO WONj SHV3,k £ NVHl N31tl1 ON ills `NO1133dSNl OI-IVA 1SVl NO 30Nvnssi N31jV SAVa M 3NIdX3 SlIWN3d q : eautl uogoadsul leul j :snlelS 8wuad £ZOZ/ l0/80 :ale0 leul j £ZOZ/LZ/LO : aled ponssl : ON 310840 veld 08ti0-£Z0ZH : Wul3d 9W03 II I�IIII�IIIIIIIII��IIIIIIIII��IIIII I�I�II�II��II�II�I�II�II 18410 - SS210 voM - adAy uolleulgwoC) .�,,xo'i>e Ohio/nob eapeepodmou 888L-SLL (6b6) auo4d Jalunoo liwJad a — - 099Z6 VO '4oeag 1J0dm9N 'anup Jalua'J OlnlO OO L Lllunwwo0 0 1 j uOiSiniO 6uipling-luemieda(i luawd01anap 1O bod 3 y3e9g )Aodm0N 10 A110 I hereby affirm under penalty of perjury that 1 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 stWcturp,, ggnor, 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 tfvith �ijt KTO" of -&vision 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 Tot more than five hundred dollars ($500). L..B.,. suji3ct§ ttlexapplicant to a civil penalty of - ; c I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U 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 mprovements 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). 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 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). 1 am exempt from licensure under the Contractors' Stale License Law for the following reason: 3y my signature below I acknowledge that, except for my personal residence in which 1 must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legall; :ell a structure that I have built as an owner -builder if it has not been constructed in its entirely 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:http:flwww.leginfo.ca.govlcalaw.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 7000) of Division 3 of the Business and Professions Code, and my license is in full force Ind effect. License Class License No Date Contractor Signature NORKERS' COMIDENSATION DECLARATION ✓ARNING: 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 IS100,0001, IN ADDITION TO THE :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 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 th, erformance 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' rance carrier and policy number are: Policy Number of Agent Date JI 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 lava of California, and tat, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ignature of Applicant Date ,ECLARATION REGARDING CONSTRUCTION LENDING AGENCY hereby affirm under penaltyof perjurythat there is a construction lending agency for the performance of the wont for which this permit is issued (Section 3097, Civil Cade). enders Name Lenders Address y 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 city or county to enter the above -identified property for inspection purposes, ignature of Property Owner or Authorized Aoent Dn.,,----...... 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 I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELL£D FG,1 PERMIT FINAL g (W CFASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATEOF ry " , PROPOSED DEMOLITION OCCUPANCYISSUED SIGNATURE: