WP0038761 - Laserfiche WebLink

Home Browse Search

JOB ADDRESS: 80c Zr I _SKI IJJ ICJ PERMIT#: i LIC ENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under the pr vislons of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code and my license is in full f6ro and effect. License425749 Expiration Date 7/31/2020 e# Date 1 7 C Inactor CANEPA AND SONS, INC. I OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Con actors License Law for the following reason (Section 7031.5, Business and Professions Code: Any city or county which requires al p rmit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to Ile a signed statement that he is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with S ion 7000) of Division 3 of the Business and Professions Code) or that he is exempt herefrom and the basis for the alleged exemp on. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred ollars ($500)): 13I, as owner of the property, or my emplo es with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 704 Business and Professions Code: The contractor's License Law does not apply to an owner of property who builds or improves hereon, and who does such work himself or through his own employees, provided that such improvements are not intended or the ffered for sale. If, however, the building or improvement is sold within one year of completion, owner-builderwill have the burden of proving that he did not build or improve for the purpose of sale.) O I I, as owner of the property, am exclusively ntracting with licensed contractors to construct the project (Section 7044, Business and Professions Code (B&PC): The Contraeto s License Law does not apply to an owner of property who builds or improves hereon, and who constructs for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Section B&PC for this reason Date: lOwner WO KERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of conse thereof (Section 3800, Labor Code). rit to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy Expiration Date 7/16/2019 mpany CALIFORNIA INSURANCE COMPANY ❑ Certified copy is hereby furnished ❑ Certified copy is filed with the Environmenta Health Department CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE This section need not be completed if the P e1rr ilt is for one hundred dollars 100 or less fvhich this permit is issued, I shall not employ any person in any manner so as to I certify that in the performance of the work for become subject to the Workers' Compensation Laws of Califomia. Date: A plicant Certificate of Exemption, you should become subject to the Workers' Compensation NOTICE TO APPLICANT: If, after making �hi provisions of the Labor Code, you must fort il h comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction len, di ig agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address i DMSION OF INDUSTRIAL SAFETY PERMIT 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 De thereof, will be more than thirty-six (36) it, and that no building structure, scaffolding, faisework, or demolition or dismantling t high. (Chapter 3.2, Group 2, Article 2, Section 341, Title 8, California Administrative Ife Code), ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit tI o such work from the division. ❑ Division of Industrial Safety Permit # ! I certify that I have read this application and tate that the above information is correct, I agree to comply with all city and county ordinances and state laws relating to well cons ction and or sewage system construction, and hereby authorize representatives of this county to enter upon the above-mentioned pm erty for inspection purposes. Date Applicant EHD 43-02-007 6-26-09 LICENSED CONTRACTORS DECLARATION