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Home My WebLink AboutXR2022-2787 - Permits�t •.mi _im. �.r ..s c..a � Y `'e i ONI E)NIOVIJEE) (INV NOIIIIM30 Of :SNOI110NO3 Td103dS A8 03SS30ONd (eax lol wnw!ulw sewolpul 0009) le!luap!saN;!uN-eouls - 0009-L-N : ouoZ as0 X : auoZ Pooij 9:JeaN'9 :ap!S'9:gp1S oz quoJd : siloegias 6u!pl!ng 0 : 6p18'74'bs 1V1O1 0 ; oftnE) g'bs maN/PePPV Z : sa!Jois;o ON :;46191-16P18 'bs a 6'14 : si!u OON N; E-NYl : sdnoJO,(3uednooO ,bs • � : 6PI9 '8'bs Il/maN/PaPPV ON/ ppv ON : auoZ PJezeH aJ!d : uoponJisuo o edAI 9-A O i `00'0$ : uo!lenlen ua!33nJisuoO ON : sJalilu!Jds aJ!d 6LOZ u01i!P3 aPOO :auo4d :8uo4d ssaJppV £ZOZ/ZZ/9 : andx3 •0 •M : ssaJppV - : Jau6!sa0 9L969M : ON 6o!IOd : Japl!ng/JaumO ONfld 30N"nSNl NOIIVSN3dAOO 31ViS : Ja!JJeO • : 8uo4d aaueinsul uogesuedwo0 ,siomiom 9bLO-L69 (676) : auo4d E99Z6 VO 'HOV39 1N0dM3N ssaJppV ZZOZ/OE/60 : aJldx3 311 sne V llNn '1S HlOE Z09 : ssaJppV Jaau!6u3 4L49b00£19 311 sn9 NOI omUSNOO NVWN3-LNOEE) : lue3!lddy £ZOZ/OE/40 : aJ!dx3 31I O!1 aleis £L0999 : 311 elelS u00 : auo4d 9bLO-169 (6176) : auo4d L£69-£EZ (6b6) : auo4d E99Z6 VO 'HOV391NOdM3N 099Z6 VO 'HOV38 1NOdMEIN ssaJppV V llNn '1S H10£ Z09 : ssaJppV Nl X3SS3 17ZL L : ssaJppV J3ai!43JV N0110f1N1SNOO NVWN3INOEE) : Joi3eJluOO Hi HIGH 3AN13H : JaumO dVO N3M3S'IONI US 6Z£'Z) 3OVHVO ONV WN038 £ °O.1SIX3 OW30 - NdS : uo!lduosa❑ 09101 Nl9 OOOE Nl N : 3sa0 1e6al Nl X3SS3 17U L : ssaJppV 9of SV3NV 11V NI SAV01-1OH 0NV AVONnS NO )INOM ON 0NV SV3NV AlISN30 HOIH NI AVONns NO AVONf11VS NO 3SION 031V13N NouonN1SN00 ON 31V0 30Nvnss1 IVNIOINO W081 SNV3A £ NVH1 131V1 ON lfi8 'NO1103dSN1 OIIVA 1SVI NO 30Nvnssi N31dV sAva 091, 3NIdX3 S11WN3d E : eaJV uogoodsul ZZOZ/oVU : .ON olep penssl 40 LBLZ-ZZOZNX:;I'ulaOd B W00 Ueld 11111111111111111111111111IIIII IIIII111111111111IIII II u01plowa0 - ssel0 >JoM Wn-1d ddS - adAi uo!leu!gwo0 suolloodsu!/no6'eopeopodmau 99Z£-4179 (6b6) :auo4d s1senbe8 uopoedsul w 89ZE-bb9 (6176) :auo4d Jalunoo llwJad 099Z6 Vo'4oeag lJodmaN '9np0 Jajuap o!np 0OL uo!s!nld 6ulp!In9 -luowpedap luawdolana4 !4!unwwop OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that t ant exempt from the Contractors' State License Law for the reason(s) indicated below by the oheckmark(s) I have placed next to 010 applicable item(s) ieclion 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 1D 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) cf Division 3 of the Business and rofessions Code) or that he or she is exempt from licensors and the basis for the alleged exemption. Any violation of Section 7031.E by any applicant fore permit subjects the applicant to a civil penalty of 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 L) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044, .usiness 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 ❑provements 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 nproved for the purpose of sale). 11, 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 pply 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), 3 1 am exempt from licensure under the Contractors' Slate License Law for the following reason .y my signature below I acknowledge that, except for my personal residence in which I must have resided forat least one year prior to completion of the Improvements covered by this permit, I cannot legally ell a structure that I have built as an owner -builder if Ithas not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and 'rofessions Code, is available upon request when this application is submitted or at the following Web site:http:liwww.leginfo.ca.gov(calaw.html. signature of Property Owner or Authorized Agent _ Date ACENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that. I am Ilcensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions $�o6dlis�' �ara(d_my /license is In full force nd effect. License Class License No Date k f afJai/'�'49Gontractor Signature X as — _ VORKERS' COMPENSATION DECLARATION ARNING: FAILURE TO SECURE WOR%ERT COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS t5100;000). iN ADDITION TU ,eE DST OF COMPENSATION, DAMAGES AS PROVIDED FOR fN SECTION 3706 OF THE LA80R CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: J 1 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 thu Labor Code, for In, rGr%mance of the work for which this permit is issued. Policy No. 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" carrier and policy number are: Policy Number Expiration Date of Agent 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 agre If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. / tature of Applicantii�^-�+'�, Data 1�-- hereby 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). enders Name Lender's Address ly 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 county to enter the Above -identified property for inspection purposes. Ia ACTION DATE BY I REGULATIONS ONS OF C 81 LIAN7 � WITH COAEE O�FEDERAL FOR OFFICE USE ONLY PERMIT EXPIRED I I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELLED EPA q PERMIT EMENDED UAQMD PERMIT FINAL CERTIFICATEOF OCCUPANCY ISSUED -IAA ASBESTOS 1101 IFICAfION IS NOT APP€ICABLB TO PROPOSED DEMOLITION SIGNATURE: m tO O tOp i N i N I d i tO0 � m o i LA Lu o O E,3 8 �WQO i ~ UlOfijO O � ZO Q>WmW O-®Ypf• ` N¢ i ® U�NO NOI+r 1�6 jp N O�£Cp mid % mO'OOIIYI� N 0 0 7m Oin �LLJ 9L.99 fi024 0000 0G64 UU. 6999 bOTT 0000 OG6T 220L.