SR0082226 SSNL - Laserfiche WebLink

Home Browse Search

y ' 2,8a� �' •rrltli(i Q� •IQ PERMIT A: FJOMSADDRESS: LICENSED CONTRACTORS DECLARATION hereby affirr^that i am licensed under the provisions of Chapter 9(commencing unit)Section 1000)of Division 3 of the Business and Professions code and my license is in fuel force and effect Ucenae S �y1 Z3 Expiration Date Date r�7Zre�rly0113 Contractor faEey `' PVWA Rmp OWNER-BUILDER DECLARATION �I 1 hereby affirm that I am exempt from the Contractors License Law for the tonownng reason(Section 7031 5 Business and Professions Code Any city or county which requires a perm,!10 construct after Improve demolish,or repair any structure,prior to Its issuance also requires the applicant for such permit to file a signed statement that he IS licensed pursuant to the provisions Of the Contractor's License Law(Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code)of !hal he IS exempt herefrom and the basis for the alleged exemption Any violation of Section 1031 5 by any app!,cant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500)) I as owner of the property. or my employees with wages as their sole compensation will do the work and the structure Is not intended or offered for sale (Section 7044. Business and Professions Code the contractors License Law does not apply to an owner of property who builds or Improves Ihereon and who does such work hislfof through his ownt n employees yw thin pone y er of such Improvements are not intended or offered for saleWilding completion,the owner-budder will have the burden of proving that he did no!build Or improve(of the purpose of sale) 1 ❑1,as owner of the property,am exclusively contracting whin licensed contractors to construct the project(Section 7044,Business and Profesa)ons Code(B&PC) The Contractor's License Law does no,apply to an owner of property who builds of Improves hereon_ and who constructs for such projects with a conlraelor(s)licensed pursuant to the Contraclat'S License Law) I]1 am exempt under Section B&PC for this reason -- Date- Owner — WORKERS'COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self-Insure or a ceritflcate of Workers'Compensation Insurance or a testified copy thereof(Section 3800.Labor C05e) Expiration Date Company_ __ —.._--- O Certified copy is hereby furnished C)Certified copy is filed with the Environmental Health Department CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE (This section need not be completed If the perrnil Is for one hundred dollars 1$100)or less) I certify that In the performance of(he work for which Inls permit Is tssued I shall not employ any person In any manner so f as to become sub!ecl to the Workers'Compensation Laws of California Date: _ Applicant ___-__ I NOTICE TO APPLICANT If, atter making this Certificate of Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for whicrl this permit Is issued (Section 3097 Civil Code) Lender's Name Lender Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ch a person ll be e In C1 connection with that author Zed by the permit,and that no budding structure scaffoldings falsewordt descend, f I hereby certify k, or demolition or dismantling thereof.will be more than thirty-six (36)feet high (Chapter 3 2.Group 2 Article 2 Section 341. Trite 8 California Administrative Code) ❑As owner-budder I unit 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 10 d0 such work Irpm the d,vlsion O Division of Industrial Safety Pernut is 1 certify that I have read this application and state that the above Information .s correct i agree to comply With sit city and county ordinances and state laws relating to well construction and or sewage ps stem construction,and hereby authorize representatives of this County to enter upon the above-mentioned property D . Date Applicant LICENSED CONTRACTOR DECLARATION �tb 4}07 nusun