FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

JOB DDRE55' iJ ulJ 1�5. -/�`' y ' PERMIT*: LICENSED CONTRACTORS 13ECLARATION I hereby affirm that t am licensed under the provisions of chapter a(commencing with Section 7000)of Division 3 of the Business and Professions Code and my license is in full force and affect License Expiration Date 10/31/14 Date 7— �—�/�/ Contractor� Ld1lCrl�w - OWNER43UILDER DECLARATION I hereby affirm that t am exempt from the Contractor's License Law for the following reason(SeeUon 7031.5,Business and Professions Code. Any city or county which requires a permit to construct,Aller,improve,demolish,or repair any structure,prior to its issuance. also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with Section 70o0)of Division 3 of the Business and Professions Code)or that he is exempt herafrom and the basis for the alegod exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appfirant to a civil penalty of not nwre than five hundred dollars($500)): 11 1,as owner of the property,or my employees vAt h wages as their sole compensation,will do the work.and pia structure is net intended or offered for sale(Section 7044,Business and Professions Coda•The contractors Umnse Law does not apply to an owner of property who builds or improves thereon,and vitro does such work himself or through his own employees,provided that such improvements are not Intended or o6ered rot sate. It,hovrever, Ute building or improvement it,sold within one year of completion,the owner-builder wdl have the burden of proving that he did not build or improve for the purpose of sato.) O i,as osmer of the property,am exclusively contrectiny with licensed contractors to construct the project(Section 7044,Business and Professions Code(BLPC)., The Con"clor's License Law does not apply to an owner or property who builds or Improves hereon, and who constricts for such projects with a contractor(s)licensed pursuant to the Conlraetor's License Law.) 131 am exempt under Suction , (3aPC for this reason Date: Owner: WORI(MS'COMPENSA7M DECLARATION I hereby atTum ftt I)lave a certificate of consent to self risure or a cerfificato of Workers'Compensation insurance,or a celled copy thereof(Seton 3800,Labor Code). ExpiradlonDate 1?/15/14 _ C-npany Zurich Am ncap TncurancP Co ®Certified copy is Hereby famished 0 Certified Copy is filed with the Envirorvaental Health DepartrnerA CERTIFICATE OF IEXaMFrRON FROM WORKERS'COU ENSAT)ON INSURANCE ffhis section need not be completed if the permit is for one humxired dollars($100)or less) I certify that in the performance of the work for m4fc l this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'CDntperIsafion Laws of California. Data- Appiicartt NOTICE TO APPLIC.AMr..it,anter making this C.ertificatra of Exemption,you ahouhd be vme subpet m the Workers'Compensation provisions of the Labor Code.you must fordARF t comply with sndr prnvtsions or No permit shill be deemed ravoked- CONSTRUCTION LENDING AGENCY i hereby affirm that there is a construction lending agency for the performance of the work fbrwhich this permit is issued (Section 3097,QW Code). Lender's Name Lendee Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICAMON E3 i hereby cerfiry that no excavation fire(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by the pamiit and that no building structure,scalfolding,fatsework,or demdition or dismantling thereof,writ be more than thirty-six(3G)feet high.(Chapter 3.2.Croup 2,Article 2,Section 341.Title 0,C01fomia Adminisirativo Code). a As owner-bulder,i will not employ anyone to do work which would require a permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the division. 0 Division of Industrial Safely Permit 0 1 certify that 1 have read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state laws relating to well construction and or sewage system construction,and hereby authorize representatives of this eohutty to enter upon the above-mentioned property for inspection purposes. Date Applicant -- LtcENSFci rnxMCTOR DEC1AR&T1ON EM 4307 igr507