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Home My WebLink AboutXR2023-0328 - Permits:SN011IONO3IV103dS Ag 03SS30OUd legueplssb 3!uN-aoulS - l-2i : auoz asN X : auoz P001d 9 :leaa 'q :ap s 'ti :aP!S bZ :;uad : sMoeq;aS 6u1PI!ng 0 '74'bs IV101 :;46!aH 6PIg 0 : a6eie0 •;;'bs maN/POPPV : sauo;S 10 ON n : sdnou0 Aouednoo0 6plg'S'bs uo!;eia;lV : s;lunjo ON 9-A : uol;onu4suo0;o adAl 0 : 6p1g'31'bs Il/mON/POPPV ON : auoZ PJezeH aald 00'9U0`8$ : uol;enlep uogon�;suo0 ON : sialmuudS aj1d ZZOZ : nO13!p3 opoo 1949-0b£(9Z9) :auoyd :auoyd Z9L16 VO'012JV1NO ssaappV : ajldx3 •0'M M J NOISSIW M 0909 : ssajpPV uau6lsaO : ON A3110d 011 S31ii13dO2Jd VfOO : jaPling/jaum0 : jauje0 auoyd aoueinsul uogesuadwo0 ,sJ93110M l9VS-Ob£ (9Z9) : auoyd Z9LL6 VO'Ol'dV1NO ssajppV : ojidx3 oil sng Oii NOISSM M 0909 : ssaJppV uaaul6u3 : 0!I sng 011 S3Ilb3dodd VfOO :;ueo!lddy ajldx3 0!l 0ll a;e;S : 01l O;e;S u00 : auoyd 69b9-Ob£ (9Z9) : auoyd auoyd Z9L16 VO 'OPJV1NO ssalppV : ssaippV ❑2I NOISSIW M 0909 : ssajPPV :;oa;!40iV : Jo;oej;uo0 011 SlUAdOad VPOO : Jeum0 (1N3W332iJV/M l/d NO AIlVIl2iVd) dl 9'ZLl X HOIH ,9llVM>1OOlg NdS : uo!;d!J0sa0 bZ 101 8£ A -IS S1H0I3H 1i10dM3N Ol OOV 1S&J 'dl V : osaO le6al 3AV NoiH3l-inzi 009 : ssaippV qor SV3i V lIV NI SAVOIIOH ONV AVONnS NO MOM ON ONV SV32IV AlISN30 HSIH NI AVONns b0 AVO2ifLLVS NO 3SION 031V132J NOIiomJ1SNOO ON 31Va 33NVf1SS1 IVNIJINO WONJ SMV3A £ NVHl 2131V-1 ON ll;g 'NO1103dSNl OIIVA 1SV-1 1:10 3ONVf;SSI N31dV SAVO 086 3UIdX3 SlIWN3d J84;0 - sselo Njom - adR1 uol;eu!gwoO suogoadsut/Ao6'eayoeagyodMau �O,,,, £ : eajv uo130adsul 99Z£-17b9(6116) auoyd slsanbaN uogoadsul �k n £ZOZI£0/ZO a;e0 panssl 89Z£-tb9 (6176) :auogd ialunop 3!wjad u 4ZOZ 6£l6:ON�l0ay0Ueld 9 z£ 0 8 z 0 z 2j x uols!n46upp gyluawliedap]uawdoanaOR!onwwop e'jry` 8Z£U-£ZUZ2iX : IRUJOd 8W0o II 11111111111111111111111111111111111111111111111111111111 yoeea laodmON 10 43 boa MO? DECLARATION I 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) 1 have placed next to the applicable items) '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 :he 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 iot more than five hundred dollars ($500). 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, 3usiness 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 mprovements 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 red for the purpose of sale). 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 tp ly 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: 3y 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 legall7 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 Irofessions Code, is available upon request whe this it- at n is Innitt at the following Web site:http:llwww.leginfo.ca.gov/calaw.htmi. signature of Property Owner or Authorized Agen! ) /J�(,_ Date ZA 1 Z,_ -ICENSED CONTRACTOR'S DECLARATION v ° % hereby affirm under penalty of perjury that I am censed 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 Ind effect. License Class License No Date Contractor Signature NORKERS' COMPENSATION DECLARATION rARNING: 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 (4100.now, IN AuarrioN 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: 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 the Lahor Code, fnr th erformance 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' connpensatiorJl Fence carrier and policy number are: I 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 Califomia, , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions, ignature of Applicant Date_ IECLARATION REGARDING CONSTRUCTION LENDING AGENCY 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 Lenders Address y 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 apd state laws relating to building construction. q I authorize representatives of this city or county to ant t a, v�ldentif j pro inspection purposes. p,/ I ignalure of Property Owner or Authorized Agent i r print Prooertv Owner's or Authorized Anent's Nam..O I�' h )43 7 it 2; ACTION DATE BY DECLARATION OF COM)%LIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO PERMITCANCELL£D DEPA PERMIT EXTENDED QM D PERMIT FINAL / 2 ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF PROPOSED DEMOLITION OCCUPANCY ISSUED clr.Men mv.