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Contractor Information
Contractor's Company Name
Contractor's State License Number
Contractor's First Name
Contractor's Last Name
Street or P.O. Box
City, State, Zip
Business Phone Number
City Business License Number
E-mail Address
Fax Number (if available)
Credit Card Information
Credit Card 1: MasterCard Visa
Card Number
Name As It Appears On Card
Expiration Date
Credit Card 2: MasterCard Visa
Card Number
Name As It Appears On Card
Expiration Date
The following employees have my permission to use the credit card(s) listed above to obtain permits in the name of my company:
Employee's Name (print)
Employee's Signature
_______________________________________
Employee's Name (print)
Employee's Signature
_______________________________________
Employee's Name (print)
Employee's Signature
_______________________________________
Employee's Name (print)
Employee's Signature
_______________________________________
Acknowledgments
This online permitting process is provided to our regular customers which maintain an active city business license and workers' compensation insurance (if required) and who have an accounts receivable or credit card information on file with the City of Long Beach Development Services Department.
I declare that I have read this application and that the information I have given is true and correct.
I agree to comply with all local ordinances and state laws relating to building construction, and I make this statement under penalty of law.
For inspection purposes, I authorize representatives of the City of Long Beach to enter properties whereupon work bound by this agreement has been permitted.
Permits will expire by limitation if work is not started within 180 days from the date the permit was issued or if work is abandoned for more than 180 days. Do not conceal or cover any construction until the work is inspected and approved. All inspection requests are required at least 24 hours in advance of the inspection by calling our inspection request line at (562)570-6105.
Such privilege shall remain in effect until canceled by the City of Long Beach or revoked in writing by the licensed contractor.
Licensed Contractor's Declaration
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professional Code, and my license is in full force and effect.
License Class _______________ License No. ______________________
Date _______________ Contractor _______________________________
Owner-Builder Declaration
I hereby affirm that I am exempt from the Contractors License Law for the following reason (Sec. 7031 California Business and Professional Code: 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 is a licensed contractor pursuant to the provisions of the Contractors License Law (Ch. 9 commencing with Sec. 7000 of Div.3 of the B. & P. C.) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Sec. 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500.00.):
I, as owner of the property, or my employees with wages as their sole compensation, will do the work and the structure is not intended or offered for sale (Sec. 7044, B. & P. C.: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvements is sold within one year of completion, the owner-builder will have burden of proving that he did not build or improve for the purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, B. & P.C.: The Contractors License Law does not apply to an owner of contracts for such projects with a contractor(s) license pursuant to the Contractors License Law.).
I am exempt under Sec. ____________________ , B. & P.C. for this reason:
Date _________________ Owner ______________________________________
WORKERS' COMPENSATION DECLARATION
WORKERS' COMPENSATION DECLARATION
I 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' compensation insurance and policy are:
(This section need not be completed if the permit is for 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, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Date ___________________ Applicant __________________________________
WARNING: 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, IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby state that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3907, Civ. C.).
Lender's Name
_________________________________
Lender's Address
_________________________________
_________________________________
_________________________________
I certify that I have read this application and state that the above information is correct. I agree to comply with all city and state laws relating to the building construction, and hereby authorize representatives of this city to enter upon the above mentioned property for inspection purposes.
-IMPORTANT- Application is hereby made to the Superintendent of Building and Safety for a permit subject to the conditions and restrictions set forth above.
Each person upon whose behalf this application is made and each person at whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to and shall indemnify and hold harmless the City of Long Beach its officers, agents and employees from any liability arising out of the issuance of any permit from this application.
Any permit issued as a result of this application becomes null and void if work is not commenced within ONE HUNDRED EIGHTY (180) DAYS from date of issuance of such permit.
