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Home My WebLink AboutH2022-0511 - PermitsIVAONJJV QNV M31A''4>T 3.Y410iid5NI Qimd 011JflfElil;b SdVqnd 1V3H NO ` ®31181HOdd S83NII :SNOI114NOO1V1O3dS jj �JCJ :,kg (13SS30OUd (]N3)q33/A 3H1 NO , lel;uapls9a;lun-aI6u1S - 1,-N : auoz ash X'lj 8 ,3V : auoz pool] 17:aplg'17:8plS'g:;uoJj'91,:;uo{j :s)joeq;ag6u1pl1ng 3SION NOf.Lof1a1SN0O ON sdnaO AouednooO 090-AAX8ZOS #IaPOW : uol;anu}suoO }o adR1 XONN31 : iam;oe}nueW ON : auoz puezeH aulj 61,0Z : u0141133 apOO £ZOZ/1,/17 : ai1dx3'o'm : auogd 1,ZZg9000OM9A'd : ON A3110d : ssaippy 00 SNI 2i31A32Jd 1S3a3A3 : jalligo : uappSpaumO eoueinsul uopusuad woo ,sua)ijom -� C—% es e £Z0Z/60/g0:aa1dx3 01l sng 9L8L-5£L (81,9) : auOgd .'.ls'�a i I 1,ZZ179000OMgA?J : 01'1 sng Z9£L6 VO '3OV111A 3HV11S3M 210 V lV9 Vl 9ZZ1,£ : ssailppV £Z0Z/1,£/0I, : ejidx3 31-1 VN1O3A Nag :;ue0llddy OL1,66L : 01-1 a;e;S uOO LLLL-LLL (V U) : auogd : auogd ,Z8Z6 VO'V3210 HOblB 3 091,E : ssajppV Z9Z98 Zb"31VOS11O0S 1N13NO0 L13ONIO 3 Z8901 : ssaippV O1H SNOId AVHO 3O1A2i3S : J010e1;uOO 11f1VNg 130 : AaumO Sdhnd 1V3H NO O31I81HOUd SN3WIl.1f1O 3ONVH0 OM HO3A : uol;duOsea 9q 10-1 N18 1,60t 211 N : asaO leba-1 S3AOO VOMV0 9q : sseippV qof SV3UV 11V NI S1,VO11OH ONV AVONnS NO YiiOM ON 0NV SVMJV AiISN30 HJIH NI AVONf1S NO l.V0bf11VS NO 3SION 031V132J NOIlomUSNOO ON 31VO 3ONVf1SSI-IVNIEJINO WO11d SMV2A £ NVH12i31V1 ON ilia 'NO11O3dSNl O11VA 1SV-I NO 3314Vf1SSl u31jV SAVO 081, 3NIdX3 S11WN3d uejV u0l;aadsul suol;aadsul/no6'eogoeogpodMau d`�aoepyJ ZZOZIZZ160 : a;ep penssl 99Z£-gg9(6q6) :auogd s;senbaTJ uogoadsul uag;O : sse1O MIOm 89Z£-b119 (6b6) auogd ja;unoo;lwied 4 : II I II I I III II I II I II I I I III 099Z6 VO'goea8 odMaN'aAlJ(j Jalua0 olnl0 00ON �IOa4O veld �o uo!slnld 6uPinB #uewd as Aliunwwoo M-UMu ;Iw�ad �e�iuey�aW qoea-8 liodmaN;0 A;!3 T` OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the ContractorsState License Law for the reason(s) indicated Section 7031.5, Business and Professions Code: Any city or county flat requires a permit to construct, alter. improve, demolish, to permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (( 'rofessions Code) or that he or she is exempt from ficensure and the basis for the alleged exemption. Any violation of Section 7C of more than five hundred dollars ($500).. "1 I, as owner of the property,or my employees with wages as their sole compensation, will do U all of or U portions of the we .usiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through empe nprovements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion nproved for the purpose of sale). 1 L as owner of the property, am exclusively contracting with licensed Contractors to construct the project {Section 7044. Busir poly to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor purse 7 I am exempt from licensure, under the Contractors' Slate License Law for the following reason ly my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year p ell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I underSP: 'rofessions Code, is available upon request when this application is submitted or at the following Web site:httOI,1wwVI.leginfo.ca, �Ignature 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 Section no effect. License Class License. No Da COMPENSATION DECLARATION ING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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: ave and will maintain a certificate of consent to self -insure for workers compensation, issued by the Director of dance 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 pe ice carrier and policy number are: Policy Number of Agent Blow by the clteckmark(s) I have placed next to the applicable item(s) )r repair any structure, prior to its Issuance, also requires the applicant for napter 9 (commencing with Section 7000) of Division 3 of the Business and 11.5 by any applicant for a permit subjects the applicant to a civil penalty of k, and the structure is not intended or offered for sale (Section 7044, ees' or personal effort, builds or improves the property, provided that the the Owner -Builder will have the burden of proving that it was not built or and Professions Code: The Contractors' State License Law does not to the Contractors' State License Law). to completion of the improvements covered by this permit, I cannot that a copy of the applicable law, Section 7044 of the Business and Da he Business and Pugfaillsions In license is in full force Contractor Sig CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (Sf R0.000), IN ADDRION TO THE Relations as provided for by Section 3700 of the Labor Code, for of the work for which this permit is Issued. My workers' Dale certify that, in the performance of the work for which this permit is issued, I shall n y any person in any manner so as o become subject to the workers' compensyCion laws of California, and agre L If I should become subject to the wPpensation provisions o .. on 3700 of the Labor Code, I shall. forthwith COm, ly with those provisions. nature of Applicant Da iZ 7 ✓CLARATION REGA DING CO NG AGENCY;reby affirm under penalty an a construction lending agency for the performance of the work for which this ennit is Issued (Section 309 Code). ides s Name Lender's Address my signature below, KEili 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. agree to comply with all applicable city and county ordinances a I authorize representatives of this city or county t enter the ab-Identifl nature of Property Owner or Authorized Apart ws rel uilding construction. openly for inspection purposes. Print Property Owner's or Authoriz ` d ADent's Nal>T Irl g ,f A �'✓V v ��7 / `��3 7 1 V 1 �1CL.1/ Date AJ Gil ACTION DATE BY �OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY ':. RFGULATIONS PART 61 OF TITLE 40 AND AOMD RULE 1403 PERMIT EXPIREDLJ�I SUBMITTED^ ^ASBESTOS NOTIFICATION TO EpLI A ION IS NOT APPLICABLE TO PERMI7CANCELLED PERNVT EXTENDED ERML �Z- � S FICATE OF CERTIFICATE V PROPOSED DEMOLITION OCCUPANCY ISSUED I SIGNATURE: