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Home My WebLink AboutH2024-0749 - Permits:SNOI114N00IV103dS As a3SS30ONd puelsl eogleg 'leguaplsay;lun-oml - is-N : auoZ ash L-OV : auoZ Poolj g aeaa '£ :ep!s 'E :aplS '9 :luaH : speq;aS 6ulplmg 0 : 'U ,bs 1V101 0 : a6uie0 •g bs maN/ppV : salJolS Jo ON )LI619H 6PI9 0 : 6PI9'8'bs uogeaa;lV : s;luN;o ON : sdnou0 t3uednoo0 0 : 6PI9 'l)'bs Il/maN/PappV ON : auoZ pJezeH an j : uogonilsuo0;o ad/;l 00'0$ : uogenleA uol;3npsuo0 ON : siaplupdS au!d ZZOZ : u0!;!p3 apo0 :8uo4d :au04d ssaippV : a4!dx3 '3 •M : ssaippV Jau6lsaa : ON t;ollod : japlingpaum0 : jauje0 : auo4d aoueansul uol4esuadwo0 ,sjalla0m : auo4d 9EBM VO'uoljalln3 ssaappV : andx3 oil sng RmH lepadwl 3 99Z : ssalppV Jaaul6u3 : oil sng uaajO jolRel :;ueollddV 9ZOZ/0£/90 : ajldx3 01-1 01I ale;S LL8bLL : 011 a;e;S uo0 : auo4d 06ZO-Z617 (646) : auo4d : au34d ssaippv : ssajppv : ssaipPV :;oa;l43jV nV uolul : Jo;oej4u00 : hump >jomlonp ON 'uogeool awes ul lasolo ul aoewn; slog Jo ;no a6uLg0 : uol;duosea Ll 101 8 Nag l o3S enS3iJ ONV�SI VOMVg 2Jl V : osaa le6al 3AV 31VJV ELZ : ssajppV qof SV3I iV -nV NI SAVOMH ONV I.VONl1S NO MOM ON ONV SV3NV A-LISN30 HJIH NI kVONnS 210 AVObf11VS NO 3SION 031V138 NOIlon1 ]-LSN00 ON 31tla 30NVl1SSl IVNI9INO WONd SNV3A £ NVHl MMV1 ON ills 'NO1103dSNl anvA 1SVI NO 3ONV11SS1 N31dV SAVa 096 3NIdX3 SllWN3d Z : eauV uogoadsul Ieu1 j :snlelS PLWOd SZOZ/£040:0M] leulj bZ0Z/6L/LL : alea panssl ON 43040 veld 6VLO-VZOZH : 31wJad SWOP IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII1111111111111111111111lilllll I W3 - aldw!S - sselo >joM - ad�j uolleulgwoO ofAto/Ao6 eogoeagl,odmau 999L-8LL (6176) :auo4d jalunoo llwjad 099M VO'4oeag uodmaN 'anpp J91u00 oIAIO OOL uolslAiO 6ulppng - luawpeda0 luawdolana0 Ll!unwwoo Lpea8 podmON 10 A413 '�aoy rye. gyp. �bodn3? OWNER -BUILDER 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 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 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). ❑ 1, 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 improves the properly, 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). ❑ 1, 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 ap 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). I am exempt from licensure under the Contractors' Slate 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 legalli 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://www.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 COMPENSATION DECLARATION 'ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND $HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,D00), IN ADDITION TO THE OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTONNEY'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 Labor Code, forth( 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' 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 Califomia, 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. Signature of Applicant Date_ DECLARATION REGARDING CONSTRUCTION LENDING AGENCY I 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). Lenders Name Lenders Address By 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. Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name Date ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED I I I U I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT EXTEfvDED 1 LJAQMD PERMITRNAL Q A5BE5TO5 NOTIFICATION 15 NOT APPLICABLE TO CERTlFlCATE OF /f - 7 , 65 PROPOSED DEMOLITION OCCUPANCYISSUED SIGNATURE: