SU0012393 (2) - Laserfiche WebLink

Home Browse Search

1th JOB ADDRESS: PERMIT #: LICENSED CONTRACTORS DECLARATION thereby affirm that I am licensed under the provisions of Chapter 9 r conimeneing with Section 70011! nt Division Sot the Business and Pmfessions Code. and my license is in full force and effect. License # Exp :Date I Date Contractor OWNER-BUILDER DECLARATION I hereby affirm that 1 aril exempt from thc Contractor's License Law tor the following reason tSce. 7031.5. Business anal Professions Code. Any city or county which recto i res Zr permit to construct, alter, improve, demolish. or report any structure. poor 10 its 15511aa,c, a/50 requires rho applicant for arch iiermit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 71810) of Division 3 of the Business and Professions Code) or that he is exempt hercitom and the basis for the alleged exempt inn. Any violation of Section 7101.5 by any applicant for a permit subjects :he applicant to a civil penalty of nor mire than five hundred dollars (5500)' 0 I. as owner of the prnpcny, or my efnployees with wages as then ,ofe ommensation. will do the work. and the structure is not intended or offered For sal, (Sec. 7(144. Business and Pmfessions Code: The Contractor's License Lax does nor apply loan escort of moonily who builds or improves thereon. and who docs such work himself or through his own employees, provided that such improvements are not intended or altered for salg.. If, however, the building or impnwement is sold within one year of completion. the ow recbuildet will lucr e the burden of proving that he did not build or improve for the purpose of sale.) 13 I, as Owner of the property, am exclusively contracting with licensed cnriractors to construct the project (Sec. 7044, Business and Profession Cede: The Contractor's l icense Law does not apply loan owner of property w ho but.da or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) CI I am exempt under Sec. .8 ifa P.C. fin this mason Date Owner WORKERS' COMPENSATION DECLARAllON I hereby affirm that I have a certificate of consent ro -sel f.insu re, or a certificate of Workers Compensation Insuram.v. or a certified copy themof (See. 31E51, Lab. Ct. Esp. Date Company 0 Certified copy is hereby furnished 0 Certified copy is tiled with rite County Building Inspection Divisors CERTIFICATE ITE EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need nor he completed, if the permit is for one Icandied dollars 15100) or lesal ' I certify that in the performance of the work for which this permit is issitcd. I shall not employ any person in any manner 50 as to become subject lathe I Workers' Compensation Laws of California. i Date. Applicant NOTICE TO APPLICANT: If. after making this Certificate of Exemption. you should become subject to the Workers' Compensation provisions of the , labor Code, you must forthwith comply with such provisions or this permit :hall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the periormance uf the work for which this rscrinit is issued (Sec. IOW. Civ. tender's Name Lender's AddresA • • DIVISION or INDUSTRIA!. SaFF.TI PERMIT CERTIFICATION: CI thereby certify that no excavation rive IS) or more feet in depth IMO 10.:11 a person is required to descend, will he make in 000000000 whir 55ork authnored by alio permit, and that no building strutaure, scaffolding. fakework. or denustiti,m or dismantling thereof. will be more than thirty-six f3(t) feet high. (Chap. 3.2, 5irp 2, Art 2. See 341. Title 8. C.A.C.I. : CI As owner-builder, I Will nix civic"), anyone to du work which v,milt1 iisicire a permit from the Ott is fon of Industrial Safety, as noted above, unless such person has a permit to do such work from the division. Disision of Industrial Permit No. I certify Ii101 I hil5 r read this application and Slate that the above infOrMatir ri IS COffeet. I agree to comply with all city and county ordinances and state law!. relating to well construction and ur sewage system construction. and hereby authongc representatives of this city to enter Lipari the above-mentioned property for inspection purposes. Date Applicant