Applicant's Signature: Date:
Lender's Name: Lender's Address:
Signature: Date:
Based on the scope of your project, Accessibility requirements may be applicable. For more information, visit the link below:
http://www.dgs.ca.gov/dsa/Programs/programCert/casp/AB3002.aspx
https://www.murr ietaca.gov /departments/engineering/wate r.asp
[ ] I, as the owner of the property, building or improving structures thereon, or appurtenances thereto, will contract with contractor(s) or subcontractor(s) licensed
pursuant to the Contractor's State License Law to construct the project. I will not contract more than four (4) single-family residential structures which are intended or
offered for sale within a calendar year, except that such limitations shall not apply if I contract with a general contractor for the construction (Sec. 7044 (b), Business and
Professions Code).
[ ] I am the homeowner improving my principal place of residence, or appurtenances thereto, and the following conditions exist: (1) the work will be performed prior to
sale, (2) I have resided in the residence for twelve months prior to completion of work, and (3) I have not used this exemption from the Contractor's State License Law on
more than two structures more than once during any three year period (Sec. 7044 (c), Business and Professions Code).
NOTICE TO APPLICANT: Sec. 7031.5 of the Business and Professions Code specifies that each county or city which requires the issuance of a permit as a condition
precedent to the construction, alteration, improvement, demolition or repair of any building or structure shall also require that each applicant for such a permit file a
condition precedent to the issuance of a permit a statement which he or she has prepared and signed stating that the applicant is licensed under the provisions of the
Contractor's State License Law, or , if the applicant is exempt from the provisions of the Contractor's State License Law, the basis for the alleged exemption. Any violations
of Sec. 7031.5 by any applicant for a permit shall be subject to a civil penalty of not more than five hundred dollars ($500).
[ ] I have and will maintain a certificate of consent to self-insure for worker's compensation, as provided in Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
[ ] I 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 worker's
compensation laws of California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
[ ] I have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My worker's compensation insurance carrier and policy number are:
I certify that I have read this application and state the above information is correct, and that I am the property owner, authorized agent of the property owner, or other person
having a legal right, interest, or entitlement to the use of the property that is the subject of this application. I understand that the applicant is responsible for knowing and
complying with the governing policies and regulations applicable to the proposed development or permit. The City is not liable for any damages or loss resulting from the actual
or alleged failure to inform the applicant of any applicable laws or regulations, including before or during final inspections. City approval of a permit application, including all
related plans and documents, is not a grant of approval to violate any applicable policy or regulation, nor does it constitute a waiver by the City to pursue any remedy, which
may be available to enforce and correct violations of the applicable policies and regulations. I authorize representatives of the City to enter the above-identified property for
inspection purposes. I have the authority and grant City staff and advisory bodies the right to make copies of any plans or reports submitted for review and permit processing
for the duration of the project.
OWNER BUILDER DECLARATION
WORKER'S COMPENSATION DECLARATION
CONSTRUCTION LENDING AGENCY
NPDES REQUIREMENTS
APPLICANT'S SIGNATURE
Based on the scope of your project, NPDES requirements may be applicable. For more information, visit the link below:
I hereby affirm that I am exempt from the Contractor's State License Law for one of the following reasons:
I hereby affirm under penalty of perjury one of the following declarations:
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civil Code).
[ ] I am the owner of the property, building or improving structure thereon, or appurtenances thereto, will do the work myself of through my own employees with wages
as their sole compensation. None of the structures, with or without the appurtenances thereto, are intended or offered for sale (sec. 7044 (a), Business and Professions
Code). NOTICE TO APPLICANT: In all actions brought in the Contractor's State License Law, proof of sale or offering for sale of any structure by the owner-builder
within one year after completion of same constitutes a rebuttable presumption affecting the burden of proof that such structure was undertaken for purposes of sale. Proof
of sale or offering for sale five or more structures by the owner-builder within one year after completion generally constitutes a conclusive presumption the structures were
undertaken for purposes of sale (Business and Professions Code).
