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Home My WebLink AboutF2023-0275 - Permits,St,\ —V)�—J1�1 a� �`) 0 : .0 •bs IVIO1 0 : aBejeO'g'bs maN/PaPPtl BPI9 '8 'bs u0148JO41V 0 : BP19'll'bs Il/maN/PaPPtl 00'00£'6$ : uogenleA uo!lonLlsuoO ° OLL9-7L6 (7LL) : auogd LZ9Z6 V0'VM0 : ssa�pptl ` O OOl9 'm312!39WV1 SLOL : SSOJPa0 ONI NO'13310Nd DHIJ OOS03 :auoyd ssaapptl :Jaau!Bu3 Oil alelS :auoyd ssaipptl 9 : sauolS !O ON : smun to ON ON : 9UOZ piezeH aLld S31. : sjalAu!jdS and VZOZ/L/L : 9ndx3'0'M 9L6LZOZS02ilm : ON Aollod ANVdW00 30W:jnSNl NVORAINV 30V : La11JeO aouejnsu! uo!lesuadwoo ,sia)pOM £Z0Z/l£/L0 : 9ndx3 ail sng £LLZZ00019 : o!-I sng £ZOZ/0£/60 : aj!dx3 oil LML9 : 01-1 alel8 uo0 0LL9-bL6(17U) :auoyd LZM VO'V3ii9 0 OOl9'ON 1?J39WVl SLOL : ssa�pptl ONI N01133106d 32JIJ OOS03 . �olowluo0 SNOI110N00 IV103dS : ,ke O3SS300Nd jalua0 UodmaN 001710019 - 3d : auoZ asn X : auoZ poo!d s3!oeglaS Bu!ppng : lq&aH BPI9 g :sdnojO Rouedn000 V-1 : uo!lonilsuOO to adRl ZZOZ : uo!3!p3 apOO auoyd : ssajpptl iapl!ngpaumO 0LL9-bL6 (PLL) : auoyd LZBM V3'V32 El : ssaipptl 0 Jol9'O'd JA39Wb`l9LOL ueollddtl ONI N0113310Nd 3HU OOS00 3 LSZ L-6LZ (6b6) 099Z6 VO'HOV3912iOdWIN L0631S 3AV OOV0OAV "7L 01l t ON SOON .17900-£ZOZ3X. (SOV3H CO Sd31)iNlHdS 3i93 MOO Z HVd LL Od £6L )19 d : 3sa0 !ellal foV rt 3AV OOVOOAV LOVL auoyd ssaApptl : Jeumo :uogduosa0 ssaipptl qof SV 31V0 V NI SAVSI IVNIOINO WO n SNO) £OM ON N31tl1 ON 1n91 N30 HEASNl IIVA lSVI'do 9ONtl SS a31 v s"a 091.ON H NI 3NIdX3 SlIW213d luawanojdw! lueual - ssel0 IpOM -adRluogeulgwo3 d�pdoa��y 01A!o/A06 eogoeagVodmau 3N1j : eeiv uoPoadsu! 999L-9LL (6b6) auogd ia!unoo llwiad 6ZOZ/90I90 : aled penssl IIIIIIIIIIIIII 09966 V3 'goeag UodmaN 'anud Jalua3 o1n13 OOL uoisiniaswp na LuIA -Ilmi0d 8WOO l�3LGS�odmaN10 AM3 CLzO-EzOZ' O L,YYn1114tsulLDER DECLARATION f hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s) (Section 7031.5, Business and Professions Code: Any city or county That requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State. License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure and the basis for the alleged Exemption. Any violation Of Section 7031:6 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 111, as owner of the property, or my employees with wages as their sole compensation; will do L) all of or L_) Portions of the work; and the structure Is not intended or offered for sale (Section 70", Business and Professions Code: The Contractors' Slate License Law does not apply improved for the purpose of sale). to an owner Of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not Intended or offered for sate. if, however, the building or improvement is sold within one year Of completion, the Owner -Builder wdf have the burden of proving that it was not built or 5111, as Owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Coder The Contractors' State License Law does not ap y to an owner or property who builds or improves: thereon; and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). I em exempt from licensureunder the Contractors' State License Law for the following reason: 3y my signature below I acknowledge that, Except for my personal residence in which I must have resided for at least one year prior to completer will a structure that t have built as an owner builder if it has notbeen constructed in its entirety by licensed contractors. I understand t t a copy 'Tof rssions Code, is available upon request when this application is submitted or at the following Web site:http:he llwww,lEginto.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent. .ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with cD a 7000) off DivesiL3_pf the Sue and effect. License Class License No 33 VORKERS' COMPENSATION DECLARATION C` IARIGNO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT�b AND CIVIL FINES DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION STDS OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, hereby affirm under penalty of perjury one of the following declarations: 71 ,m,ao W."Ieu uy MIS permit, I'. cannot law, Section 7044 Of the Business and �s and Prof e Codti� en icerise is In full force Signature VE HUNDRED THOUSAND DOLLARS (SiDpsSV}, No AUorrio, 1 O THE have will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, For e of the work for which this permit Is issued. Policy No, ve and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit. is Issued. My workers, comoensai Ind Price carrier and policy number are: of Agent Policy Number Date JI canify that, in me Performance Of the work for which this Phone # hat, if I should become su ' to the work Permit Is-issuetl, Fshail not employ any person in any manner so as to become subject to the workers' rompensatlon laws o` Caffonia, pensatlon provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. signature of Applic )ECLARAT10PiREGARDING CONSTRUCTION LENDING AGENCY s_ hereby affirm under nalry, of perjury that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 7, Civil Code). ender's Name Lenders Address ,y my signature below—,' certify to each of the following: I am the property owner or aulttoriZed 10 act on the property owner's behalf. 1 have read this application and the information I.have provided is correct. I agree to comply with all applicable city and coun ordinances and state laws relating to building construction. I authorize representatives of this city or ny to B ha atiov arEllj d „erty I12nature of Property Owner or Authofjz Apnl Its - - -' •, far inspection purposes. Print Prooertu n, n..m..:...,..._ UKLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE REGULATIONS PART 61 OF TITLE 40 AND AQMO RULE lYd u A58EST05 NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION