Emeryville Building Permit

Leave This Blank:

INSPECTION REQUEST

Building (510)596-4315
Fire (510)596-3759

LEGAL DESCRIPTION
DESCRIPTION OF WORK
CONTACT INFORMATION
Owner:
Contractor:
Architect / Engineer
BUILDING PERMIT
PERMIT FEES
OWNER/BUILDING INFORMATION
LICENSED CONTRACTOR’S & WORKER’S COMPENSATION DECLARATION
I hereby affirm that I am under the provisions of Chapter 9 (commencing with Sec.
7000) of Division 3 of the Business and Professions Code (B. & P.C.) and my license
is in full force and effect.
I hereby affirm that I have a certificate of consent to self-insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.).
CERTIFICATE OF EXEMPTION FROM WORKER’S COMPENSATION INSURANCE
(This section need not be completed if the permit is for a project valued at one hundred
dollars ($100) or less). 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 Workers’ Compensation Laws of California.
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you
should become subject to the Workers’ Compensation provisions of the Labor Code,
you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
OWNER/BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor’s License Law (C.L.L.) for the following reason (Sec. 7031.5, B. & P.C.) Any City which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the C.L.L.(Chapter 9 commencing with Section 7000 of Division 3, B. & P.C.) or that he/she is exempt there from 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 or not more than five hundred dollars ($500).
HAZARDOUS MATERIALS
NOTICE: A building permit will expire if work is not started in 60 days or if work is suspended for more than 180 days or if no inspection is scheduled for more than 180 days .
Do not conceal or cover any construction until the work is inspected and the inspection
recorded on the job copy of your permit. All inspection requests are required 24 hours in
advance of the inspection. All work performed under this permit must conform to the plans and specifications filed by the owner or his authorized agent with the building department
as the same have been approved and conditioned by the department. A building permit does not constitute an approval or waiver of any violation of the above provisions, nor of any state law or local ordinances, regulation or requirement. Separate permit required from the city engineer for construction or obstruction affecting any street sidewalk.