SU0012237 - Laserfiche WebLink

Home Browse Search

• JOBACORE.SS: I'(l n 3 Rd PER�rC: LICENSED CONTRACTORS DECLARATION I herabyalfinn Met 1 am licensed uderthe provisions of Chir 9(commencing wfh Section 7009)of Division 3 of the S smess and Professions Code and my Iceree Is in N face and effect. Lk"' 962 E,4,hauonDate F -3��6 actior X Date Contr �� OWNER$ULLDER DECLARATION I hereby affirm that 1 am exempt from the Cortrarmfa License Lew for the fo0owing reason(Section 7031.5,Business and Pmrassiont Code: Arty City or aorrty which Mquras a Permit in mratna altar.improve.demolish.w repair any structure,prior to its issuance, also requires the applicant for such permit b 919 a signed statement that he is foam sed pursuant to to provisions of the Cor4aclola Licsree law(Chaper 9(cominerxirg win Section 7000)of Division 3 of to Business and Professions Code)or Mat he is exempt hemetrom and the basis for the aQVW a empflm Any Notion of Section 7131.5 by any applicant for a Permit stAJects the appicart • to a tlwl penalty of not more than he tarered dolers($.590)): ❑ L as ower of the property.or my employees with wages as their sale compensator,will do the work,and the stihrare is not intended or offered for sale(Section 7044,Business and Professions Code:The tontisctors License Law does not apply to an owner of property we builds or improves thereon,aM who does such work himself a tlwotgh tis sum employees.provided that such irrpro mens are not intended or olfefed for sale. 1, however, the butting w knprowmer[is sold w tin one year of completion,the owner-0uker w0 h a%e the buten of proving that he did rot build or irriparrve for the purpose of sale.) ❑I,as ower at de property.am Al el ely mrltaco g wM licensed contractors to o stnkl Ova prg9c4(Section 7944.Busmaso and P.. ors Code(88PC): The Contractor's license Law dors not apply to an owner of property who builds or improves hereon, and who corstruch for such projects wth a mtracka(s)licensed pusrent to the Contrecbrs Lleervie Lew.) 0 l am exempt under Semon , B3PC for this reason Date' Owner. WORKERS'COMPENSATION DECLARATION I thereby affirm that I haw a Certificate of orient to se!I insure or a Certilicete of Workers'Cornpersatw Irstrarice,or a certified ropy thereof(Section 3809,Labor Code). �i t Expiation Data 7—r —Dort Company O Certified copy is hereby furnished 0 Certified copy is filed with the Ernrirormerdal Ftealh Department CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE (This section rheed not be completed lithe permit is for one hvtlred dollars 1$100)or less) 1 certify that in the perfonrhance,of the work forwfidh this permit is issued,1 shag not employ any person in any manic r so as to,Demme subject to the Workers'Compensators Laws of CaPbrtla. Date: Applicant NOTICE TO APPLICANT: if.after nndog tic Certiaote of Exemption,you shhordd bemnro suyect to the Wod are'Compensation provisions of the Labor Code,you must brdtsith oxrpy%M such provisions or this permit stall be deemed rewked. CONSTRUCTION LENDNG AGENCY 1 hereby trillion that(iwxe is a co st actio;-; dr,-ag--cylor the perfomarce of the work forwhich this permit is issued (Section 3097,Chil Code). Lenders Name Lender Address DRUM OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑ 1 hereby certify det no cormvation fine (5)or more feet in depth Irto wic h a person is required to descend, ova be made in correctors wfM sunk autonmd by the permed,and that no busting strumae,smdokirg,ti sewak or demo65on or dsnarSrg thereof,w1 be more then thirtysbi(38)feet Ngh(Chapter 3.2.Qutp 2,Article 2,Section 341,Title B,Calloria Adminisuatiee Code). ❑As water-0liker,1 will not:erryby anyone M do work which Wald require a permit from To Diuson of I dtaMal Safety,as noted above.unless such person hes a permit to do suwch work from Ma dnisiorh. Division of Industrial Safey Permit a 1 certify dot I Pave mad ftss atpi®em and sura Mat the above information is correct. 1 agree to comply hwth a1 city and county ordinances and slay laws retailing to well construction and or sewage system tmstructioa and hereby authonim represerraaves of this comahy to erder upon the above-maraored property far inspection Purposes. Date Applicant ao'.M1P/ ICQJe®CONTRACTOR OECIAPATION harsos