SU0012433 - Laserfiche WebLink

Home Browse Search

30B ADllKESS: _ PERMIT#: _-_. i LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed under die provisions of Chapter 9 icnmmencing with Section 7000)of Division 3 of the Rusineas and Prefessions Code. and my liceme i>in full force and effect. License N -_ Exp.:Date Date Conhactor OWNER-R11ILDER DECLARATION L hereby affirm that f am exempt from the Contractor's License Law(or the(ottowing mausan(Sec.7031.5.Business and Professions Code: Any city or county which requires a permit to construct,alter,improve,demolish,or rerair any structure.prior to its issuance,also requires the applicant for such permit to rile a signed stamment that he is licensed pursuant to the provisions of the Contractor's License IAw(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he is exemnr heref roto and the basis for the alleged exemptioo-Any violation of Section 70M.5 by any applicant for a permit subjects'he applicant to a civil penally of not more than five hundred dollars($5(01): ❑I.as owner of the property,or my employees with wages as their sole compensation,wit:do the work,and the structure is not intended or offered for sale (Sec.7044,Business and Professions Code:The Contractor's License l ave does not apply to an owner of pmpeny who builds or improves thereon,and wha does such work himself or through his own employees,provided that such improvements are not intended or offered for sale. If,however,the building or improvement is sold within one year of cort pledon,the owner-builder will have ncc burden of proving that he did not hurld or improve for the purpose of sale.) i O I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec.7(44,Business and Profession Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,acrd who contracts for such projects with a contrIM01(5) licensed pursuant to the Contractor's License Law.) El f am exempt under Sec. B At PC for 0115 reason Dau Owner WORKERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self-insure,or u coni Beate of Workers'Compensation Insurance,or a certified copy lherent(See 31300. fab-Q. Rap.Dale Company_ _ O Certified copy is hereby furnished O Certified copy is filed with the Coenty Building Inspection Div isir o CERTIFICATE OF EUMPTIO•FROM WORKURS'COMPENSATION INSURANCE (This section need not be completed•if the permit is for one hundred dollars($100)or less) I certify that in the performance of the work for which this permit is isssed.I shall not emp:oy any person in any manner so as to Mauna subject tot he Workers'Compensation Laws of California. Date_— ^Applicant _ iNOTICE TO APPLICANT:If,after making this Certificate of Exemprinn,you should become suhieer to the Workers'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRICTION[.ENDING AGENCY i hereby affirm that there is a construction leading agency for The performance of the work for which this permit ib issued(Sec.3097,Cor.C). Len&ir's Name Lender's Address DIVISION OF INDUSTRIAL.SAFETY PERMIT CERTIFICATION: 0 1 hereby certify that no excavation rive(5)or more feet in depth into whicb a person is required to descend•will be make in connection with work authorized by the permit,and that no building structure.scaffolding,falsework.or demolition or dismantling thereof,will be more than thirty-six(36)foci high. (Chap.3.2.Grp 2,Art 2,Sec 341.Title g,C.A.0-). ❑As owner-builder,I will not employ anyone to do work which would require u permit from the Division of industrial Safety,as noted above,unless such person has a permit to do such work from the.division. O Division of Indus rial Permit No. I certify thn(I have read this application and slate that the above information is correct. I agree to comply with all city and county ordinances and elute laws relating Lowell construction and or sewage system construction,and hereby autheirirc representatives of this city to enter upon the ubove-rta ntioned property for inspection purpnses.