WP0042857 - Laserfiche WebLink

Home Browse Search

JOB ADDrams: PHt1ir hk LICENSED CONTRACTORS DECLARATION 1 hereby affirm that I am licensed Professions Code and under the pravmons of Cater 9 (O mmem 9 � Section 7000) of Division 3 of the Business and my license is in full force and effect License# ✓� E) Date ` 00 — 2.�2.1 Date co„�r�or N �^� OWNER-BUILDER DECLARATION I he" affirm that 1 an exempt from the Canracors License Law for the blowing reason (Section 7031.5. Business nerd Professions Code- Any city Or county which reWi- a permit to construct, after irnprnve. demdish, or repair any stnrctrae, prior to its issr--, alsO FOWIties TO aPPkant for Such permit to Me a signed statement that he is licensed Pursuant to the provisions of the Contiacxors License law (Chapter 9 (conunerw`ng with Section 7000) of Division 3 of the Busahess and pr0%s9ionss Code) or that he is exeritpt h4r6hom and to basis for Tho aleged ax mpt6m Any v66bon or Se coon 7031.5 by arty «Ppr�cm t roc am to a civil penalty of not mare than five hundred dol= ($.500)): pe,rr t the El I, as owner of the property. or my employees with wages as their sole compensation, will do the wodr, and the strucLue is not intended or offered for sale (SOMM 7044, Business and Professions Code: The contractor's License taw does not appy m an owner of P""rry who bolds or inpuoves thereon, and who does such work himself (K through his own employees. provided that such irryravem@nts are not Intended or offered for sale. If. however, the building or anprovement is said within one year of completion, the 0wner4xnl ter win have the burden of provatg that he aid not build or improve for the purpose of sale.) D I, ro owner of the(B&Pproperty, am exclusively contracting with licensed contractors lo cwmt'ruct the project (Section 7044, Busirmms and Professions (ode (BSPC)_ The Contractors Licernse taw does not apply to an owner of property who btrlds rr i nproves hereon. and who constructs for such projects with a COC wen s(s) fice�ed prasueM m the Contractors perryLk-se Law.) ❑ I am exempt under Section BBPC for this reason Date- Owner - WORK RS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of Consent to st'iF-insure or a certificate of Workers Compensation Insurance, of a certified copy thereof (Section 3800, tabor Code). Exp aWn Date Company-- O Certified copy is hereby firrnished (3 Certified copy is iced with the Environmental Health Department CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE Mrs section (teed not be completed if the permit is for one hundred dollars ($100) or less) I certify that in the peribimance of the work for which this permit is issued. 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of Califomia Date. Appftl M NOTICE TO APPLICANT. If after making this Ce ti6cate of Exemption, you should becorne subject to the WorkersCompensation Provisions of the Labor Code. you must forthwith comply with such provisions of this permit shall be deemed mvoked_ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code), Lender's Name Lender's Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑ 1 hereby certify that no excavation five (5) or more reit in depth IntO which a person is required to descend, win be made to connection with work autitormed by the pefrmt and that no building structiM sraf iolduhg, fasevark. or demoNion or dis ianffing thereof, w0 be more than thirty-Sic (36) feet high- (Chapter 32 Group Z Article Z Section 341. Trde S. California Admirdstiaiive Code] As owner4xAder, I vwll not employ anyone to do work which would require a permit from the Division of industrial Safely, as noted above. unless Sufch person has a permit to do such work from the division O Division of Industrial Satety Permit # I cartuy that I have read this application and state that the above information is correct I agree to comply with all city and cafnty ordinances and State laws nJatir towel construction and or sewage system construction. and hereby audw "repmse tatives of nim c»unty to enter upon the above-mentioned property for inspection purposes Date Applicant EHD43-02-007 6-26-oe LICE SM COMPACTORS DEMARwnon s-zs