SU0011858 - Laserfiche WebLink

Home Browse Search

4 JOB ADDRESS: - PERMff I LICENSED CONTRACTORS DECLARATION II hereby affirm that I am licensed under the provisions of Chapter')(commencing with Section 7000)of Division 3 of the Business and Professions Code, f and my license is in full force and effect. License a Exp.:Datc I Date Coiuraetur OWNER-BUILDER DECLARATION I I I herebv affirm that I am exempt from the Contractor's License Lau for the following reason(Sec.703[.5.Business and Professions Code;Any city at county which requires a perlait to construct,alter,improve.demalish,ur rcpatr any structure,prior to its issuance.also m4uires the applicanr for such permit O file a signed statement that he is licensed pursuant to the provisions of the Contractor's Licence Law(Chapter 9(commencing with Section 7000)of file 3 of the Business and Professions Code)at that he is exempt hcrcfrom and the basis for the alleged exemption. Any violation of Sectlnn 7031.5 by t any applicant for a peradt subjects the applicant to a civil penalty of ma mea a than five hundred dollars MOM): ❑I.as owner of the property,or my employees with wages as their sole cnmpensati(n,will do the work,and thr.structure is not intended or offered for sale (Sec.7044.Business and Professions Code;The Contractor's Licen4 Ldw•(lies ria apply to an owner of property who builds or improves thereon,and wilo does such work himself or through his own employees.provided that such improvements are not intended or offered fur sale. if.however,the building or improvement Is sold within one year of con:oletion,the owner-builder will have the burden of proving that he did net build or improve for the purpose of t sale.) ❑1.as owner of the properly,am exclusively contracting with licensed contractors to construct the.project(Sec.7044.Business and Profession Code:The l Contractors License Law docs not apply to an owner of property who hud,ls Of improves thereun,and who contracts for such projects with a conrractm(s) I ` licensed pursuant to the Contractor's License Law.) l � Cl I am cxempt under Sec. ,B&P.C.for Lhic reason i I � f � I Date Owner I 1 WORKERS'COMPENSATiON DECLARATION i 1 hereby affirm[hat I have a certificate of consent to self-insure.or a cendieat:a W ovketi Compensation Insurance.or a certified copy thereof(See.38(10. t Lab.C). i t I Exp.Dare ^Company _-- i O Certified copy is tuachy furbished O Certified copy is filed with the County building Inspection Divisicn CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE j t (This>cction need not be crowleted.if die permit is fie one hundred da{lan t$1 N))or less) I f certify that in the performance of the work for which this pe nut is issued.1 gall not employ any person in any nuvmcr so as to become subject lot be ' Workers'Compensation Laws or California, ' Dare_ Applicant I NOTICE TO APPLICANT:If,after making this Certificate of Exemption.you should become suoject to the Workers'Campensauon provisions of the i ILaborC.ode,you must forthwith comply will,such provisions or this permit shall be dermccl revoked I CONSTRUC,rI0w LENDING AGENCY I 1 hereby affirm that there is a construction lending agency foxibc performance vi the work for which this permit is issued(Sec.3097,Civ.C). j Lender's Name I Lender's Address f I DIVISION OF INDUSTRIAL SAFF:fY PERMrf CERTIFICATION: i 113 f hereby certify that no excavation five(5)or more feel in depth into whv;h a person is required to descend,will be mwks in connection with work I� autho(izcd by the permit,and that no building structure,scaffolding,falsewrrA,nr demolition or dismantling thereof.will be more then thirty-six(36)feet high. (Chap.3.2.Grp 2,Art 2,Sec 341,Tide 8.C.A.C.). ` a As owner-builder.I will not employ anyone to do work which would MIL1.1; i perms from the Division of Industrial SeLrVy,;k�mated above,unless such ` person has a pent no do such work From tha on inion. O Division of Industrial Permit No. - I certify that I:ave read ihie applicatiaa"state that the ahoce information a coned. 1 agree to comply with all city and county ordinances and state laws ` relating to--?I construction and or sewage vysrem construction,and hereby amhucze representatives of this city m enter upon the aboye-mentioned property VI for inspection purposes. Date Applicant '