The URL can be used to link to this page

Home My WebLink AboutP2022-0162 - PermitsN :auoZ pJezeH aJlj ON : siahluuds aald ajldx3 .0 'M ON A3110d : jaliie0 aoueunsul uopesuadwo0 ,sje)iJOM aaldx3 0ll sne : oil sna ajldx3 oil oll a;e;g u00 :auogd ssaippV Jo;oei;u00 :A9 (33SS33ONd : auoZ asn auoZ pool] s)laeq;aS bulpling :sdnouO Aouedn000 uol;oni;suo0 }o adR1 uoglp3 91300 C61717-9917 (0l£) : auogd £99Z6 VO'HOV391NOdM3N IS Hlg6 3 LOU : ssaJppV SMIZIVH IIISVA :;ueollddV £611-9917 ME) :auogd £99Z6 VO'HOV381NOdM3N IS HIS 3 1,0£Z : ssauppV SINIZIVH IIISVA : laumo 1!d3N1d/Oe8 Ol 3NII SVO - And : uogdposea osea [goal 1S HIS b0£Z : ssajppV qor SV3NV 7V NI SAVOIIOH ONV AVONnS NO NNOM ON ONV SV3NV AIISN30 HOIH NI AVOWS NO AVONfIIVS NO 3SION 031V13N NOIlOnHISNOO ON 31VO 3ONVnSSI IVNI`JINO WONd SNV3A £ NVHl N31V1 ON Ins `NO1103dSNl OIIVA ISV-1 NO 30NvnSSI N31dtl SAVO 081, 3NIdX3 SIIWN3d l : eeiv uol;oadsu! lll» : a;e0 panss! 16410 : sselo Njom ZZOZ-ZOL6 : ON 83040 ueld 1iwaua ad Buiqnld Z9 4O-ZZOZd II I I III III II I II I II I I II II suogoadsuyn06'e0y0e6quodMeu �`0tl04"g SSZ£-bb9 (6b6):euogd s;sanbaa uogoadsul SeZE-b79 (676) :auogd ja;uno0 llwlad v O oua odm@ anu Ja1ua olA! 099Z6 V0 '4 8>✓ N' O 0 0OOl � u0191ni0 6uip!m3 - luowlJedaO;uawdolana0 R;!unwwoo 9 r �, yoea8 liodmON 10 40 ��'��+x OWNER -BUILDER DECLARATION I hereby affirm under penalty of penury that I am Lxempt tram the Contractors Stare License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable items) Section 7031.5, Business and Professions Code: Any c'Cy or r.ouaty ihct r^qillres aparmit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for is permit to file a signed statement that he or she is licensed pursuant to the provi, crs of the Contractors' Slate License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 'rofassions Code) or that he or she is exempt from ficensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a clvil penalty of of more than five hundred dollars ($500). 7 I, as owner of the property, or my employees with wages as Chair sole cumpersacion, will do L) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, iusiness and Professions Code: The Contractors' State License L.,v doe, not SIDI to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the nprovements are not intended or offered for sale. I', hoAa�er, th 3 huildh,p or Ini jerieM is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not builtor nproved for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044. Business and. Professions Code: The Contractors' State License Law does not D an owner of property who builds or improveslhereon, and w4To contrails for the projects with a licensed Contractor pursuant to the Contractors' State License Law), a. exempt 'ran' "DEL ure under the Contractors' Slate License Law for the fatlowing reason: ITy IF nature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements Covered by this permit, I cannollegall7 ell structure that I have built as an owner -builder if it has noC been DonsCructed in its entirely by licensed contractors. I understand that copy of the applicable law, Section 7044 of the Business and 'rofessi0ns Code, is available upon request when hid �pplic ` n Is submitted or at the fallowing Web site:httpahvww.leginfo.ca.gov/calaw.html. signature of Property Owner or Authorized Agen. V DateZ ICENSED CONTRACTOR'S DECLARA hereby affirm under penalty of perjury that I am licen ed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force nd effect. License Class License No Date Contractor Signature PORKERS' COMPENSATION DECLARATION 'ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL. PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 15100.000). IN ADDITION TO THE DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: I I have and 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 th• erformance of the work for which this permit is issued. Policy No. 11 have 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' compensatior isurance carrier and policy number are: Krrier Policy Number Expiration Date Agent jl a ify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and afire at, if should become subje t to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply With Chose provisions. signature of Applicant -,� Date tECLARATfON REGAR 4. ON8TRUCTION LENDING AGENCY hereby affirm under penalty of penury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, CIA Code). Lenders Name Lenders Address By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this city or countv to enter the above -identified property for inspection purposes. I Signature of Property Owner or Authorized A ens - Print PropertyOwner's or Authorized Agent's Name / �r �� Date ZLZZ ACTION DATE BY NPIECLAWATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED [SUBMITTED ASBESTOS NOTIFICATION TO All required alarms, latches gates and fences which serve as part of a pool/spa barrier, shall be In place prior to approval to fill pool/spa & shall remain in place & be maintained for the life of the pool. PERMIT CANCELLED OEPA - PERMITEMTEND€D QMD PERMIT FINAL ZD'7i If A58E5T05 NOTIFICATION IS NOT APPLICABLE TO CERhRCATP O' PROPOSED DEMOLITION OCCUPANCY ISSUED S SIGNAT IREe