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Home My WebLink AboutXC2022-1892 - Permitsluawaseg 10 ON 4ZZ`LL : '41 'bs 1tl1O1 y : sauolS 10 ON 0 : a6eje0'11'bs mON/PPV 0 : si!un 10 ON 0 : 6PIg 11'bs uo!lejallV S3A : swie!V anj 4ZZ' LL : 6PIg 11'bs Il/maN/POPPV ON : auoZ puezeH and 00'000`000`8£$ : uogenluA uogoniisuo0 SEA : s.lapluudS anj : auoyd ssaippV 9ZOZ/L/7 : andx3.O'dyl uau6!sa0 6L0£0£V9o0 : ON A3110d 00 SNI 1V2d303E : ua!uue0 9L9Z-b0£ (9Z9) : auoyd eouemsul uogesuadwoO,sLaliom LUL6 VO'VN3OVSVd HOO-H H19 3AV 3NV1 N 9 L L : ssaJppV 9ZOZ/0£/60 : andx3 01l sng MOl CIA : aaau!6u3 9Z99L00£19 : oil sng 9Z0Z/L£/0L :a.ndx30!l oil a1e1S 8MI.M : Oil a1e1S UO3 0089-6b6 (08b) : auoyd 00M-£98 (6b6) : auoyd VO `179Z98 ZV 31V0S110OS b49Z6 VO '3NIA2Jl 00£ 31S Old 31VOS110OS N 029S : ssaJppV NVMOO Z96LL : ssaippV AVP 0Vid9 N9Sl3N : POINoJV 0ll NOIS0NVI2ACIANS : uoloeuluO3 jalueo UodmON PON - Od X Z-VA V-11 6L0Z :SNOIIIONOO lVIO3dS A9 03SS33ONd : auoZ asn auoZ P001d sMoeq;aS 6u!pl!ng : ly610H 6PI13 :sdnojO Aouednoo0 uo!4onilsuo0lo adAl : uo!1!P3 OPOO auoyd : ssaippV japlmg/iaum0 : auoyd 9Z6b6 VO'V2d30VW 312100 02d HOOK SL : ssaJppV 011 Sn Ha : lueoyddV 00L£-OZL(6b6) :auoyd 999Z6 VO 'HOV39 iiJWM3N 097Z X09 Od : ssaippV 011 ANVdW00 3NIANI : Jaum0 HS bZZLL „3aVM0?JVH NOI1Va01S32d„ JNIOIIng -lVIO?J HAOO M3N : uopduosea L 2]Vd 0£ 0d LZZ )i9 d : osa0 Ie6al HG'd31N301dOdM3N 1,0L L : ssaippV qof SV-RIV llV NI SAVOMH 0NV AVONnS NO N2dOM ON 0NV SV3HV A11SN30 HJIH NI AVOWS Ho AV02dn1VS NO 3SION O31Vl3id NOIi0n d-LSNOO ON 31VO 33NVnSS1 IVNIORIO WONA SHV3J. £ NVH12131V1 ON ins `NOI1O3dSNI OI-1VA 1SVl 80 3ONVnSS12d31dV SAVO 081, 3dIdX3 S11WH3d L: eajV uo!loadsul leulj :sn1e1S 1!wJad 9ZOZ/6 L/SO : aleO leulj SZOZ/90/ZO : ale0 panssl C961,-ZZ0Z3d : ON 113040 veld Z68 �-ZZOZOX ' ;iw.lad 9W00 MON - SSE10 110M Wnld H03W 0313 -adAl uolleulgwo0 0!AI0/A06,eo yoeaquodm@ u 888L-9LL (646) auoyd jalunoo Uwiad 099Z6 VO 'goea9 uodmON 'aAIiO Jaluao OIA13 00L II III IIIII IIIII IIIIIIIIIIIIIIIIII I II IIIII IIII IIIIIIIII uoIsIAIO 6uIP111a - luawyjeda0 luawdolana0 Allunwwoo yoea8 podmON 10 A113 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) 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, 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 'rofessions 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 lot more than five hundred dollars ($500). 3 I, as owner of the property, or my employees with wages as their sole Compensation, will do (_) 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 mproved for the purpose of sale). 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 Ipply 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' Slate 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 legall) ;ell 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 3rofessions Code, is available upon request when this application is submitted or at the following Web site:http:l/wRw.leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date _ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700D) 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 EARNING: 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 4$100.0001. IN ADDITION TO THE :DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37" 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 Labor Code, for th performance 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 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 , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. of Date DECLARATION 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 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 owners 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. 1 authorize representatives of this city or county to enter the above -identified property for inspection purposes. ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE I �nm PERMIT EXPIRED PERMITCANCELLED PERMIT EXTENDED PERMIT FINAL CERTIFICATEOF OCCUPANCY ISSUED 1 U I SUBMITTED ASBESTOS NOTIFICATION TO UASBESTOS NOTIFICATION 15 NOT APPLICABLE TO PROPOSED DEMOLITION Civil Cade). Date