FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

-'C-6rk P�lralr# JOB -DRESS' tlCEN3®COft17RACTORS DECLARATION I hereby affirm That I am ticensedunder the provisions d Chapter 9(commencing with Section 7000)of Division 3 of the Bushes and Professions Code and my License is in tub fore*and effect• Expiration date 10/31/14 License# !2 f 2!t�� ✓l`, ,J Date 7— -W Corttractor O W W-11 3MMER DECLARAn oN the .5,RPSineas and ofessions I hereby afivm that 1 am exempt from the Contractor's License LnyJ imP ro t that he is _ °�• r any wing,reason,(Secloon structure,p 1a,to itsrissuancs• Coder. Any city or county vrhicB cequtres a permit to construct. also requires the applicant for such per Slue a signed�pma 3 of the Buaine�ssand Professions Code)or that he is mcempt License Lair(Chapter'9(esrrerrtendn0 violation islOrl Sectiai 7031.5 try any applicant for a Perm"subjects the applicant befetfern and the basis for the alleged exemption- Ant' to a civil penally of not more than five hundred dotiars($500}}: a t.as owner of the property.or MY emPloY�v dh wages as Dre'v sofa compansatbn.rrs�ions Code:The.03a do the work,and the structure is not 10 an Intended or egered who 6 ads or�pr7044. r�thereon and'rrthorodoes such work him l orrthre"Gh hhWs nown e+nP Y�se Law does QProvkfad that sumer of property or Improvement is sv`d within one year of sadl Win.the OiVn are not intended or offered for sate. that he dtd not build imPiove for rho purpare or solo-) corrrpleGan.the oWnHf burldcr ural have the burden of proving project(Section Tows.Husirxss and 131,as owner of the property.am emdusively cont2cft With licensed rxmhact(om�10 n owner of property ct( e trio r7 44.Buri herao d Professioru Code(BBPC): The OorfMadoYs License tali does not apply and who constructs ror such t�jeH 94th a c0mr-cta(s)licensed pursuant to the Contras or s iasYnse t aW) M tam exempt under Section 13SPC for this reason Owner. Daw WORKERV MTIN DECL.ARAMN I tttueby atfim BVI I have a certificate of consent to ff=re or a cer66cate of Wotitets'Compensation insurance,or a ca wd copy*&reof(Section 3840,Labof Cadet E%0rramL3atte 1215/14 r4mw Zuric a Celiified CDpy is heivby Slurxstted 13 C NtW c M is Med wilh to En tttmretttaj t1mM Depattmefd CXTUTFtCATEof mam" H FROM 1'YQRKERS'ppj(itPENSAmon INSuRANCE (Mis section need not be eon Ieted if the peanit is for one r int t is iissueedd,1 aha not Ie�Y any Peron in any manner so (shy afar to Lite perfarmanoa of the work for wtvdt this permr� as to becorYt akpr rxto the Wofker';Comet r of Carcfomia. Data' Apprit�rtY Compensation u arrould he-"na b_A tv the ked-rs' None-t=ro iarra.sesir+r"n.aetcr..+nrrs�y+his t'-eTtHi�+v�' p o,�''�or uais se^^a.ha0 w a.�.rnrd*r�okea- vnedtb*labor Gad*.you Must rorth—uh ��pr7 CMS-MUCf'(ON LEJMMG AGENCY i ltefebY affa n dkd timet is a construction leri kV agency for Ste perfo»nar>ce of the mark for which this permit is issued (Section 3097,Civil Code). Lendee,$Rattle L.endee Adm& CERTIFICATION DIVISION OF IND113IRIAt-SAFETY pl:R�'f �made kr that no•xcevation five('`) n1a°H tact in dePS+into v)hirlr a person is regwrzd to descend.ural ❑1 herebyiconnection �Yx with warts salhortzed by the permrC and drat no b edug Io'JjWfe,scatlolding,talsewor c.at demolition or dismanoin9 Mereaf,win be more than thrrtysix(36)fel high.(ChapW 3.2.Group 2,Article 2.Srs4°rr 3�9.Titic H.Callfomia Adminisbativa fie)• fro a permli from qre t7ivision of industrial Safety,as rioted El As owner4midder.I wig not employ anyone to do work wtirdr vrvt$d requ abova6 unless sur h person has a penmt to do such work from the dlrrsion. 13 Division of Industrial Safety Permit 7rtwish ail city 2nd county system oonstmcron.end hereby authorize representativesof this I certify that t have read tt$c application and state that the abova ir>:amaGon is correti 1 agree iv wet sista laves retaltng to watt rronstnrdi on and or sewage ofd-manses and of ins}rect " �X]tlrtly to enter upon the above property Applicant Date_ UCpf3M MKTRACMft DECURA•i" EM 41sT wrso�