WP0041703 - Laserfiche WebLink

Home Browse Search

PERMIT #: JOB ADDRESS: I hereby affirm that I am licensed Professions Code and my licens NSED CONTRACTORS DECLARATION is'ons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and and effect. ExpiOion Dat ZAckle E.6110\ .1 e0 )01 LIC nder the pr is in full forc 99 1-151 Contactor c4 /3012 / Tim • OWNER-BUILDER DECLARATION I hereby affirm that I am exempt Code: Any city or county whic also requires the applicant for s License Law (Chapter 9 (comm herefrom and the basis for the to a civil penalty of not more tha 0 I, as owner of the property, intended or offered for sale owner of property who build such improvements are not completion, the owner-builde 0 I, as owner of the property, a Professions Code (B&PC): and who constructs for such 0 I am exempt under Section tractor's License Law for the following reason (Section 7031.5, Business and Professions ,rm t to construct, alter, improve, demolish, or rePair any structure, prior to its issuance, rile a signed statement that he is licensed pursuant to the provisions of the Contractor's t on 7000) of Division 3 of the Business and Professions Code) or that he is exempt . Any violation of Section 7031.5 by any appl cant for a permit subjects the applicant lars ($500)): r my emploee with wages as their sole compensation, wit do the work, and the structure is not Section 7044, usiness and Professions Code: The contractor's License Law does not apply to an or improves Ith reon, and who does such work himself or thrPugh his own employees, provided that intended or bif red for sale. If, however, the building or improvement is sold within one year of will have the lbu den of proving that he did not build or improv I for the purpose of sale.) exclusively o racting with licensed contractors to construct he project (Section 7044, Business and he Contractcir's License Law does not apply to an owner of property who builds or improves hereon, rojects with c ntractor(s) licensed pursuant to the Contractors License Law.) B&PC for this reason rom the Con requires a p ch permit to ncing with S leged exemp ior five hundred ,do License # Date lw WOK icate of cons nt e). ied 1 Environment er Date: I hereby affirm that I have a cert thereof (Section 3800, Labor C Expiration Date ((t I 01 0 Certified copy is hereby furni tikCertified copy is filed with th CERTIFIC iThis section need not be comp I certify that in the performance become subject to the Workers' Date: NOTICE TO APPLICANT: If, 9 provisions of the Labor Code, y ensation Insurance, or a certified copy ertificate of Exemption, you should become subject to the Workers' Compensation comply with such provisions or this permit shall be deemed revoked. TE OF EX M TION FROM WORKERS' COMPENSATION INSURANCE ted if the ernit is for one hundred dollars ($100) or less) f the work fo w ich this permit is issued, I shall not employ any person in any manner so as to ompensatio L ws of California. F licant er making tilts u must forthviiith RS' COMPENSATION DECLARATION to self-insure or a certificate of Workers' Com pany JA; Ati If Ea* (laricA ealth Department II I hereby affirm that there is a c Civil Code). Lender's Name Lender's Address NSTRUCTION LENDING AGENCY agency for the performance of the work for w ich this permit is issued (Section 3097, ,C struction lendin !VISION 0 0 I hereby certify that no ex vation five ) connection with work autho *zed by the per DUSTRIAL SAFETY PERMIT CERTIFI?ATION r more feet in depth into which a person is required to descend, will be made in it, and that no building structure, scaffolding, falsework, or demolition or dismantling