6309 E LA PALMA AVE�;__§jE I MEC I PLM IPermit Number: BLD2020-05412
Issued: 12/16/2020
INSPECTION REQUEST LINE: (714)765 -4626Quarter Section: 195
Site Address: 6309 ELA PALMA AVE (Yorba Park)
Legal Description: LANDS OF SAMUEL KRAEMER LOT POR OF
OWNER -BUILDER DECLARATION:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's License State Law for the following reason(s) indicated below by the
checkmark(s) I have placed next to the applicable item(s) (Sec. 7031.5 Business and Professions Code: any city or county which requires a permit to
construct, alter, 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).
--I, as owner of property, or my employees with wages as their sole compensation, will do (_) all or(_) portions of the work, and the structure is not intended or offered for sale (Sec. 7044 Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal efforts, builds or improves the property, 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).
__ I, as the owner of the property, am exclusively contracting with licensed Contractors to construct the project (Sec. 7044 Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractor's State License Law).
__ I am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below I ackonowledge 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 legally 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.html.
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 Date
WORKER'S COMPENSATION DECLARATION:
WARNING: FAILURE TO SE CURE WORKERS' COMP E NSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN E MPLOYER TO CRIMINAL P ENALTI ES AND CIVIL FIN ES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO TH E COST OF COMP ENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OR THE LABOR CO DE , INTE REST, AND ATTORN EY'S FE ES.
I hereby affirm under penalty of perjury one of the following declarations:
__ I have and will maintain a certificate of consent to self-insure for worker's compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued.
� 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 are:
Carrier: FED ERAL INSURANCE Policy No.: 5430965202 Expiration Date: 313112021
Name of Agent: _____________ _ Phone No.: __________ _
__ 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 the 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
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Signature of Applicant Date
V
Temporary p
location
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Address: 6309 ELA PALMA AVE
Zone:T
Required Proposed
Front
Residential Site Plan
Planning Services Division
APPROVED
:::ack BY: _Sophia Tatlyan _____ (STA)
Setback DATE: 12/10/2020 __ _
Rear Description/Notes:ok for new address for
t-s_et_b_ac_k --+----+-----i temp power pole for construction inMax. Lot
coverage association with -OC Loop El Cajon Bikeway --�+-----+------t Max. Project -Job # 290781. __
Bldg Plans comply with Title 18 of the A.M.C. (Zoning). Height Plan Review Fee Required $ _105.00_
I XPIRED I NSPECTIO N NOT COMPLETED
Building Division
APPROVED
BY: ( )-------
DATE: ______ _
Case No. _________ _
Notes: ------------
The issuance of this permit does not approve violation
of any of the Building Codes of the City. The Holder of
this permit proceeds at his own risk.