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Home My WebLink AboutE2023-0412 - PermitsJ0--'A'SI ZESO-EZOZAM J :SNOIII(3NOO 1VIDAdS :.kg 03SS33ONd 96p!y podmaN - Od X OL :jeaa `g :ap!S'g :ap!S'OL :luad : sdno90 R3uedn3o0 ON : auoZ piezeH aJ!d bZOZ/L/9 : aj!dx3'O •M 09ZV906 : ON Ao!lod : auoZ asN auoZ poold s){oeglaS 6u!pling uogonjlsuoO;o adAi : uolJIp3 apoo : auo4d ssajppV ONfld 33WV jnSNl NOIIVSN3dNOO 31V1S : ja1JJB3 : japl!ng/jaum0 aoueansul uo!;esuadwoo ,sja5poM £ZOZ/LE/90:aj!dx3 oil sng 6ZZ L-L6b (6b6) : 0uo4d EZ96LOOEl9 : o!l sng 9OLZ6 VO 'A311VA NIV1Nnoj LL '3dOHM3N 09ZLL : ssaJppV bZOZ/LE/ZL : au!dx3 011 O OIAVO Si2:M J :;ueo!IddV 99VLV0 L : Oil ale;S uoO t,ELZ-L9Z (OL£) : auo4d : auo4d 60EL6 VO'NNVd VDONVO 8090E X09 Od : ssajppV VO'HOV39I'dOdM3N 13NNOS 6L : ssaJppV ONI NoiionUSNOO 3NII 0121 : JoPeJluo0 131 S3NVF : Jaum0 Hi IINI100 009 NI I3NVd (N) 030OV 0313 : uo!ld!josa0 9101 N19 0499E 211 N : osa0 Ie68l 13NNOS 6L : ssaippV qof SV32iV 11V NI SAV0110H 0NV AVONnS NO 1R OM ON 0NV SV3NV A11SN30 HOIH NI AVONf1S ?JO AV021f11VS NO 3SION (131V1321 NOi-Lon8lSNOO ON 31V0 30NVnSSi IVNIE)INO NONd S2JV3A E NVHi N31V-1 ON ins'NOU3AdSNl UIVA iSVI NO 30NVf1SS1 H31JV SAVO 08L 3HIdX3 SIINN3d 9: eejV uogoadsul £ZOZ/LL/SO : ale(] ponssl Jag30 : sselo 4jom IoaZUT I!d ' ON yO Ueld },E Z � -;IwII IIIIII IIII II II IIII I IIII II IIII �ad �eou;oal3 01AI0/A0eoyoeagjJodm@u 6' n0+i - �b - 999L-9LL (666) :auo4d jalunoo 1!wjad is T 099M VO'4oeag UodmaN'anu4 Jaluap o!A!O 00L u g < uoISIAI4 6u!plmg - luawUedap luawdol9AeQ R3!unwwop�O yoea8 podmON 10 AID od�3� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' Stale 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 7031.5 by any applicant 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 U all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply 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 sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved 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 apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By my signature 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 cannot legalb sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http:i/w .leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectiorryy70&�¢,,of)D, io 3 of the Business and Pr fession�Codee,, and my I' 1 is irkfull force and effect. License Class License No DateContractor Signatu / WORKERS' COMPENSATION DECLARATION �� _�j,% WARNING: 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 WD0,0001, IN ADDITION TO THE COST 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: 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 '.abc, Code, to. it: 'reIr�for ante of the work for which this permit is issued. Policy No. eft a 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 worker.' compensavor irSt-urance c ter ntl alit u Iber e: v `y c �/ zanier � C y � Policy Number 176 S / 7" S O 2 Expiration Date ✓/1-Z Jame of Agent Phone # ]I certify 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 Ca1'Ifornia, and agre net, If 1 should become subjeillf to the workers' c lion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �/� / signature of Applicant ]� SSE / Dat S / 1C11 wo wTlnwl 13.1-AkIn1u1 rnuerol IPTInW I runlur wreMry _ lieby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code) Ider's Name Lenders Address 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 rdinances and sla!fAaws relating to building construction. j� I authorize representatives of this city or countyt r the aabove-i Lf d prgparty for inspection purposes. \1 nature of Prooartv Owner or Authorized Agent _ Pnnt Property Owner's or Authorized Agent's Nam etf�I� ACTION I DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL RFGULATIONS PART 61 OF TITLE 40 AND AOMD RUIF 1403 PERMITEXPlRED LJ I SUBMITTED ASBESTOS NOTIFICATION TO [JEPA L.UiUMD PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL ❑ ASBEIT05 NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF .Z�.Z3 ,,..,, G�zJ PROPOSED DEMOLITION OCCUPANCY ISSUED //// SIGNATURE: FOR OFFICE USE ONLY d1lIanz5