COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

CONTRACTOR / OWNER-BUILDER DECLARATIONS ot required for Special Purpose Commercial Modular 1 LICENSED CONTRACTORS DECLARATION \ I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cod and my license is In full force and effect. License Class Lic. No. Exp. Date Contra or Date 2. OWNE -BUILDER DE LARAT1ON I heresy affirm under penalty of perjury that I am exempt from the Contractors' License La for the following reason: (Sec. 7031.5, usiness and Professions Code: Any city or county which requires a permit to construct, • ter, improve, demolish, or repair any structure, prior to its issuance, also requires the a licant for such permit to file a signed statement that he or she is licensed num f to the provisions of the Contractors' license Low Chapter 9 (commet ions Code) or that he I All approved permits and any :mption. Any violation icant to a civil penalty associated plans/documents shall be [ compen: [posted in a conspicuous place on-site as their sole cl for sale. Failure to comply may result in a (Sec. 70, .aw does not apply to required re-inspection. ho does such work hin ed that such improvemenrs are nor Irifencicu ur CJI ICI CU ILA 31../1.. it, f ft/ vvc v cr , ,ise building or improvement is said withi1r one year of completion, the owner-builder will have the burden of proving that he o she did not build or improve for the purpose of sale.). [ I I. as owner of ter property, am exclusively contracting with licensed contractors to construct the priject (Sec. 7044, Business and Professi ns Code: The Contractors' License Law does not apply to an owner of properly who blsjlds or improves thereon, and who contracts for such projects with a contractor(s) licen ed pursuant to the Contractors' license Law.). [ 1 I am exempt under Sec. B. & P.C. for this reason: Owner Date 3. WORKERS' COMPENSATION DECLARA •N I hereby affirm under penalty of perju one of the following declarations: [ I I have and will maintain a certi ate of consent to self-insure for workers' compensation, as provided for by Sec •n 3700 of the Labor Code. for the performance of the work for which this perml is issued. ( ] I have and will maintain workers' c mpensation insurance, as required by Section 3700 of the Labor Code, for the perfor •nce of the work for which this permit is issued. My workers' compensation insurance ca -er and policy number are: Cartier Policy Number [ ] I certify that in the performance of the wo , for which this permit is issued. I shall not employ any person in any manner so as o become subject to workers' compensation lows of California. and agree that if 1 sh uld become subject to workers' compensation provisions of Section 3700 of the Labor ode, I shall forthwith comply with those provisions. Applicant Date WARNING: FAILURE TO SECURE WORKERS' COMPENSATION AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITIO COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37 INTEREST, AND ATTORNEY'S FEES. OVERAGE IS UNLAWFUL, D CIVIL FINES UP TO ONE TO THE COST OF OF THE LABOR CODE, CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construc on lending agency for the performance of the work for which this permit Is Issued ection 3097, Civil Code). Lender's Name Lender's Address CERTIFICATION I certify that I have read this application and state that the above information is correct. I agree to comply with Oil city and county ordinances and state laws relaling to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for Inspection purposes. Signature of Applicant or Agent Dole FICO 415 (Rev. 07/2013) 0. For Inspection Call: Steve Downer (209) 769-6873 State of California Business. Transportation and Housing Agency TMENT OF HOUSING AND COMMUNITY DEVELOPMENT Division of Codes and Standards FICD 415 APPLICATION FOR 0 Alternate Approval U Technical Services k)S 144, Pe I • ..kt, DENt I sp •Ction To Obtain Insignia SECTION 1 - UNIT INFORMATION I, We are requesting services for the following unit (5): (Check Appropriate Box) . Manufactured Home/Mobilehome U Multifamily Manufactured Home 0 Commercial Modular (Occupancy Group I ''...01511 2. 4 7 l 1 7 (ocl 30, DTN / Permit No. Fee -214F, .1 Special Purpose Commercial Modular Decal Number i Date I 12,01,.: t iZ7 n I; joy n 4 Serial Number(s) / VIN Number la b lc r . 9 ,i4. AA No.. 1 4 b 'x 3_10._51gir Manufact rer Name / Model Name c rvy d RT TOIL,13N-121'e RT BY Year of Manufacture /121.i19' Insignia / HUD Label Number(s) SECTION 2 - OWNER / APPLICANT INFORMATION Owner ' %Ai A" awl J1/ A it Address ii /-5 / 1 Arit7 j / e • /2 City ,te# County Zip 5 ,'2- Location Address 8/7 1 'ec of ___,_yil / Park Name (If Applicable) 7\) /A Park ID# N! A.. Applicant 711'&ite Matgrir- Address City County Zip Telephone - Applicant 44/.0247 V Homeowner SECTION 3 - CONTRACTOR, ARCHITECT OR ENGINEER INFORMATION Contractor's Name (If Different than Applicant) Address Architect / Engineer Name Registration No Address ,SECTION 4 - DESCRIPTION OF WORK / ACTIVITY AND VALUATION Describe the proposed work / activity in detail. Attach additional pages if necessary. Where structural alterations or additions are proposed, complete plans, specifications, details. and calculations are required to be attached to this form. Provide the make and model of any appliance to be installed and provide complete electrical calculations for any etectrical alter lions or additih ns. 14. b 01,4_ At .i/1.‘? . Indicate the Total Cost of the Work to be Performed SECTION 5. IGNATURE AND CERTIFICATION I / We here al e application for the services designated above. 0.... Signature Date "DEPARTMENT USE ONLY Permit Expiration Date 7! -2- 7/ Z-02...-(„j (see reverse side) Z. --/ /1040 0-APPROVED 0 CONDITIONS (see reverse side) 0 DISAPPROVED Issued By: 65-- .4 Dole: /./ S"..... 2..._- 2---7 - .2-('-' i Closed / Signature of District Representative Dote DISTRIBUTION: YELLOW - DEPARTMENT WHITE - AREA OFFICE PINK - OWNER/APPLICANT