WP0039928 - Laserfiche WebLink

Home Browse Search

JOeADORESS: _ PERMIT,#; LICENSED CONTRACTORS DECLARATION hereby affirm that I am licensed under me provisions of Chapter 9(commencing with Section 7000)of Ci 3,On 3 of the Busmess and elabCode � 4 2Z PrGns Coddeenndmay/lic_ense is in full force and effect U time,* -? Expiration Date 07 3 Dela Contractor OWNER-BUILDER DECLARATION �v I hereby affirm that I am exempt from the Contractors License Law for the following reason(Section 7031.5.Business and Professions I Code. Any city or county which requires a permit to construct attar,improve,Cerrhdish or repair any structure,prior to its issuaMe also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions d the Contm Me tors License Low(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he;s exempt herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appikerd to a civil penalty of not more than We hundred dollars($500)) i 0 I,as owner of the property,or my employees with wages as their sole compensation will do the work,and the structure is not intended cr offered for sale(Section 7044.Business and Professions Code:The contractors License Law does not apply to an owner of property who builds w Improves re theon,and who does such work himself or through his own employees,provided Mat such improvements are not intended or offered for sale If however,the building or improvement u sold within one year of complelron,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale) I ❑I,as owner of the property,am exclusively contracting with licensed Contractors to Construct the project(Section 7044,Business and Professions Code(BBPC): The Contractor's License Law does not apply to an owner of property who builds or improves hereon, iand who constructs for such projects with a contractor(s)licensed pursuant to the Contractors License Law.) ❑1 am exempt under Section Bd PC in,this reason Data: -- WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a Certificate of consent to sett-insure or a certificate,of Workers Compensation Insurance,or a certified copy thereof(Section 3800,Labor Code) Expiration Date___.. Company___-_____ 0 Certtfied copy is hereby furnished D Certified Copy is filed with the Environmental Health Department i CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE (This section need not be comolet_d if the perm t s for one h un red tlallars i 51 o0 or less I certify that in the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the Workere'Compensation Laws of California. Data; _ Applicant NOTICE TO APPLICANT.9,after making this Cartlficate of Exemption,you should become subject to ere Workers Compensation Provisions of the Labor Code,you must fbrtldh hwcomply with such provisions or this permit shall be deemed revcked CONSTRUCTION LENDING AGENCY 1 hereby affirm that them is a construction lecding agency for the performance(34 the work for which tors permit,s issued;Section 3097, Cwt Code) Larder's Name Lando,'.Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend.will be made in connection l with wi0fk authorized by the permit.and that no building structure,scaffolding falseworkor demollbon or dismantlingbe rare man maty-six(38)feet high (Chapter 3 2,Group 2.Article 2.Section 341 ,Title 8,California Administrative Cthereof wYode) D As owner•twllder,I will not employ anyone to do work which would require a Pe"It from the Division of Industrial Safety,as noted aboveunless such person has a permit b do such work from the division D DMsion of Industrial Salary Permit a I cenffy that I 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 county to enter upon the abdve-menbored property for inspection purposes Data Applicant END 43-02.007 6.2&09 LICENSED CONTRACTORS DECLARATION