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Home My WebLink AboutXR2023-1957 - Permits0 : 'u'bs 1V1O1 0 : a6eje0 Y ,bs MON/PaPPV Z : sauolS 10 ON 98Z : 6PI9 'S'bs uopejaJIV : sl!un;o ON 0 : 6PIEI'11'bs Il/m6N/PaPPV ON : auoZ pJezeH alld 00'000'0£$ : uogenleA uo!lonilsuo0 ON : slalmuudS al!d 6606-£99 Wt?6) : auoyd E99Z6 V3'1-13V3812dOdM3N l# AVM OZJVAdIHS WZ : ssaJppV : andx3'0'M ONI Sioc--Ii 18 d1V : lau6!sa0 1dW3X3 : ON Ao!lod S33AOldW3 ON : JOIJJeO auoyd aoueinsul uogesuadwoo ,sja)ldom ssaippV 7ZOZ/LE/80 : andx3 oi-1 sng Jaau!6u3 99E9900£18 : 0!1 sng bZOZ/6E/9O : aj!dx3 0!-I 011 alelS 988E 6Ol : o!1 ale1S uo3 : auoyd 6606-£98 (6b6) : auogd E99Z6 VO `HOV38 12dOdM3N ssajppV l# AVM 02dVAdIHS lOZ : ssa.lppV loal!y AV :SNOIlIaNO3 IV103dS AS 036S ONcl Ielluap!sab lun-al6uls - 3-H : auoZ asn X : auoZ poold q :ap!S '9' 3 auad '0 :lua3 'b :luoJd : slloeglaS 6u!P11ng : ly6!aH 6PIS sdnoj0 Aouednoo0 8-A : uo!lonjlsuo0;o adAl ZZOZ : uo!l!P3 aPoO auoyd : ssaippV :jap6n8/jaumo 6606-E99(6b6) :auoyd E9976 VO'HOV38IiJOdAUN 64 AVM O2dVAdIHS WZ : ssaJppV ONI Sid301U18 d1V : lueo!lddV 908L-699(Ol£) E99Z6 VO'HOV3912dOdM3N OAA2l NVS VIA lOZ 2dl NM1Ol0 ONI Sid301If18 d1V : joloejluo0 AOflf 2J1 NOSNOIO N3H1VEIH ONV18 auogd : ssajppV JauMO dS SSZ 1300W32J A0021H1V8 2d31SVW a=IS : uollduosaa Z6 U461 SiM L06 ?Jl 161, 101 �,i18 L06 2d1 N : osaO 1e6a1 OW32i NVS VIA WZ : ssajppV qof SV3'6V -11V NI SAVOIIOH ONV AVOWS NO MOM ON ONV SV3?JV AlISN30 HSIH NI AVONnS do Avain1VS NO 3SION 031V132J Noiion2d1SNOO ON 31VO 3014VnSSI WNI01HO WONJ SNV3A £ NVHl M31V1 ON ins 'NO1103dSNl OI1VA 1SV1 HO 30NVf1SSl N31-V SAVO 081, 3?JldX3 S11W83d Z : eajV uo!loadsul uo!leJOIIV - sselO NJOAA panssl:snlelS llwJad ddS -adAl uOgewgwoO :ale(] leu!j 0iAi0/A06eoyoeagl,odMau �+ �/£Z0Z/86/LO : ale0 panssl 888E-8LL (6b6) auoyd jalunop liwjad �. 156�_ii�O��A� oN�oa40ueld IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII uOisln46upp94luawliedaaluawdolaeQRlunwwoo oI`lrl�� ;1uJaad 8WOO yoea8 llodmON }o A;iC) hod OWNER -BUILDER DECLARATION 1 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, after, 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 ofthe 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 U 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 impravgs;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 butdeptof the that it was not built or improved for the purpose of sale). w ,: ❑ 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). I 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 legally 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 70" of the Business and Professions Code, Is available upon request when this application is submitted or at the following Web site:http:(lwww.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 Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No Date Contractor Signature WORKERS' COMPENSATION DECLARATION 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 ($10(1,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 070E OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: 111 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 IN jperformance of the work for which this permit is issued. Policy No, 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' rance carrier and policy number are: Policy Number of Agent Date 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 California, and , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. latureofApplicant _ Date_ meby 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). lder'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 1 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 county to enter the above -Identified property for inspection purposes. Date ACTION I DATE j BY DECLARATION OF j REGULATIONS PARTOMPLIANCE WITH CODE OF 61 OF TITLE 40 AND AgMD RUIERt`t FOR OFFICE USE ONLY PERMIT EXPIRED LJ I SUBMITTED ASBESTOS NOTIFICATION TO DUPLICATE PERMIT CANCELLED OEPA PERMIT EXTENDED QM D PERMIT FINAL CERTIFICATE OF OCCUPANCYISSUED 4 �A�/�� ASBESTOS NOTIFICATION I5 NOT APPLICABLE TO PROPOSED DEMOLITION SIGNATURE: