WP0037979 - Laserfiche WebLink

Home Browse Search

JOB ADDRESS: PERMIT: LICENSED CONTRACTORS DECLARATION I hereby affirm that I am liarosd oder IM provisions of Chapler 9 (coo, in ea vc* with Section 7000) of Divisor S of the suskess and Professor* Cada and! my bows. Is In krl brow and effect. Lieanee t Cr.7 —? h7 o 7 ' ExplaYdon Date Day PL/ 23 / j R ConetracWr Guar L.xtr OWNER -BUILDER DECLARATION I hereby arthn riot I am exempt from the Conbsclor's License law for the following reason (Section 7031.5, Buawma and Prolessbns Code Any city or county which requkes a pewit b construct, allay, frnprove, demolish, or repair any struchxe prior to Its heuance abo requires the applicant for such permit b itis a signed staiernsnt that he Is licensed pursuant to the provisions of the Corltracbn's License Law (ChepW 9 (comrsndrg with Section 7000) of Division 3 of the Business and Prowaions Code) or Met he Is w«Tp( hwekom and the basis for the alleged wwroon. Any violet on of Section 7031.5 by any apphcard br ■ permit subjects the applicant to a oW penalty of not more Man five hundred dollars ($500)) 0 I. as owner of the prop", or my employees wft wages as their mole compensation, will do the work and the stnrdurs Is not Mended or offered for axle (Section 7041, Buairmm and Prolasaion a Coda The confraCtors License Law does not apply b an owner of prop" who txriltla or Improves Marson, and who does such wont himself or trough his own ertpbyees, prov ded Mat such Improvements are not hianded or onereC for sale. If, however, the buklig or Irmo vertwri is sold within one yen of completion, the o wrer4xAlder will neve the burden of proving that he did not build or knprove W the purpose of sale.) 0 l: a owner of the property, am axckuively oonbaWng with licensed contractors b construct to project (Section 7044. Business and Prolsesbue Code (B&PC) The Contractor's License Law does not apply b an owner of property wit bLAds or improves hereon and who constructs lot kith projects with a corrtracbr(s) licensed ptYarrnt b the Cor*scWs License Law.) 0 1 am exempt under Section . BiPC for this reason Day: WORKERS' COMPENSATION DECLARATION I hereby &M(m That I have a certlflcas of consent to sell -insure or a certificate cf W orken' Compernation Insurance, or a cerbfied copy thereof (Section 3500,Lr C7" Expir*lon Dabs �0 company ��-V TI T'T► �1rlCQ {� 0 Certified copy is hereby krmished 0 Cer05ad copy is Wed with to Envvonnwht Heath Departrw,t CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section reed not be comolehed M the oerrA is br one hifdred dolens ($1 DO) or las) I crtiy Mat in Ms perfarrwha of the worst for which rile permit is leered, I shall not empby any person in any rremr so as to beeor a &A*sd b the Workers' Compensation Laws of CaMomia. Date: Applicant NOTICE TO APPLICANT: If, aller making this Certdfcate of Exemption, you should becorne subjed b to Wbrkws' Compersabbn provisions of the Labor Code. you must forthwith Campy with such provisions or this permit sial be deerad revoked CONSTRUCTION LENDING AGENCY I hereby nffirm that two is a constriction lending agency for the perlornrte of the wok br which thts permit is Isund (Ssdion 3097, Civil Code), Larder's Nam* Lender's Address DWISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION 0 1 hereby oeAiy that no excavation five (5) or more last in depth inti which a person is required b descend will be mads in con necalon with work surthorized by the pewit and that no buildrg stnukna scsfbkk g falsewodc. or dernokbon or disrrrntng tared will be more than ftty-sot (3E) last high. (Chapter 3.2, Group 2, Article 2, Section 341, Title 5 Caklomis Adrinishatve Coda). 0 As ownr4xaldw, I will not employ anyone b do work which world require a pemrd from. the DNWon cif Induatral Safety as roMd above, vias such parson has a pwrrA to do such work from the division- 0 ivision 0 Division of kmduatriel Sally Permit # I certify that I have read this applialbn anal ate that On above i lortnabbn Is torted I apse b tornpfy with al city and county 01 chi Whoa and stale levee nskMing b wsl construction anal or ow~ eyssm costructbn, and hereby audxwme rspreowgu4ves of tis County to shear upon the above-ffm*oned property for inspection purposes. Day _ _ AppWark — -- FMD 43.02-W LX fEHW D CONTRAC70RO DECtMATm01A s-2"