SU0012412 - Laserfiche WebLink

Home Browse Search

Jos ADDRESS:3 r %PAC.y PEMIT#: LICENSED CONTRACTORS DECLARATION I hereby affirm that 1 am licensed under the provlsions 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 Dates Date Contractor 1 OME 43UILDIER DECLARATION I hereby antrm that I am exempt from the Contractors License Loa for the bilowing reason(Section 7031.5,Business and Professions Code: Any city or county which requires a permit to mnslnicL atter,improve,demottsh,or repair any structure,prior to its issuance, also requires the applicant for such permit to file a signed state nent that he is ficenaed pursuant to the provisions of the Contractors License Law(Chapter 9(Commencing with Section 7000)of Division 3 of the Bus ness and Professions Code)or that he is exempt herefrom and the basis for the alleged exemption. Any violation M Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500)): l O I,as owner of the property,or my employees with wages as their sole compensation, MPSI do the work,and the sMJtL"is not r Intended or offered for sale(Section 7044. Business and Professions Code:The contractor's License law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through hts Own employees,provided that such Improvements are not Intended or offered for sale. It, however, the br8ding or Improvement is said within one year of completion,the owirer-builder will have the burden of proving that he did not build or improve for the purpose of sate.) Q I,as owner of the property,am exclusively oorttracting with licensed contractors to cons=l the project(Section 7044,Business and Professions Code(S&PC)7 The Contactors License Law does not apply to an owner of property who builds or Improves hereon, and who mnstiuets for such projects"M a contractor(s)licensed pursuant to the Con�License taw_) ❑I am exempt oder Section , B&PC for this reason Date: Owner: WORKERS'COMPENSATION DECLARATION t hereby affirm that I have a certificate of consent to self-irtsure or a certificate of Workers'Compensation Insurance,or a Certified copy thereof(Section 3800,labor Corte). i Expiration Date3 I 240 Compenli JACertlfied copy is hereby fumW*ed ❑Certified copy is fited with the Envirorovntal Hearth Department CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE (This section need not be comu[eted if the permit is for one hundred dollars($100)or less) I Certify that in the performance of the Munk for which this permit Is issued,I shall Trot employ any person In any manner so as to become subject to the Workers'Compensation Laws of.Calffomia. Data: Applicant NOTICE TO APPLICANT:If,after making this Certifroate of Exemption,you should become subject to the VUtxkers'Compensation provisions of the Labor Code,you must bdhwtth comply with such provisions or this permft shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construiultion lending agency for the performance of the work for which this permit is issued (Section 3097,Civil Code). Lender's Name Lender Address DIVIMN OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑ 1 hereby certify that no excavation five (5)or more feet in depth intlo which a person to required to descend. will be made in Connection with work authorized by the perrrnL and that no iwldkg structure, scaffeldng,fatsew+odr.or deffK t w or disrnantllnng thereof,Will be mote than tfiirty-six(36)feet high.(Chapter 3.2,Group 2,Article 2.Section 341,Title 8,Catiforrria Administrative Code)_ i7 As owner-buildes,1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety.as noted above,unless such parson has a permit to do such work from the division. ❑Division of Industrial Safety Permit II I Certify that I have read this appbcatEon and state that the above information is Correct I agree to compty with all city and county ordinancm and state laws relating to well construction and or sewage system construction,and hereby authorize representatives of this county to anter upon She abave4nentioned property for inspection purposes. Dom, Applicant EMD aim /t �9 UCVMED CONTRACTOR DECLARATION 10/507 V