WP0040233 - Laserfiche WebLink

Home Browse Search

2 JOB ADDRESS: 3c) I q I t eG(yje rd$ Ave, PERMIT#: LICENSED CONTRACTORS DECLARATION I hereby affirm that i am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code and my license is in full force and effect. License# Expiration Date Date Contractor OWNER-BUILDER DECL,RATION I hereby affirm that 1 am exempt from the Contractor's License Law for the fol owing reason(Section 7031.5,Business and Professions Code: Any City or county which requires a permit to construct,alter,impro ,demolish,or repair any structure,prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License law(Chapter 9(commencing with Section 7000)of Division 3 of tl)e Business and Professions Code)or that he is exempt herefrom and the basis for the alleged exemption. Any violation of Section72rrpensation, 1.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500))es❑I, as owner of the property, or my employees with wagas their sole will do the work,and the structure is not intended or offered for sale(Section 7044,Business and Professions Code.The contractor's License Law does rot apply to an owner of property who builds or improves thereon,and who 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 completion,the owner-huildar will have the burden of proving that he did nl't build or improve for the purpose of sale.) 111,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 app to an owner of property who builds or improves hereon, and who constructs for such projects with a contractor(s)licensed pursuart to the Contractors License Law.) ❑1 am exempt under Section BBPC for this reason Date: Owner WORKERS'COMPENSATION DECLARATION I hereby affirm tha;I have a certificate of consent to self-insure ora certificate of Workers'Compensation Insurance,ora certified copy thereof(Section 3800,Labor Code). Expiration Date Company ❑Certified copy is hereby fumished ❑Certified copy is filed with the Environmental Health Department CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE rThis section need not be completed if the permit is for one hundred dollars(S100)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 Workers'Compensation Laws of California. 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 provislons'or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this pen-nit is issued(Section 3097, Civii Code). Lender's Name Lender's Address DIVISION OF INDUSTRIAL SAFETY PF RMIT CERTIFICATION ❑ 1 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 with work authorized by the permit,and hat no building structure,scaffolding,ralsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chapter 32,Group I,Article 2,Section 341,Title 8,California Administrative Code). ❑As owner-builder,i will not employ anyone to do work which would requite a permit from the Divlslen of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. ❑Division of Industrial Safety Permit# I certify 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 weil constriction and or sewage system construction,and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. Date Applicant f_ CHD 45-02-C,07 DCENSID CONTRACTORS DECLARATION 6-26-09