I hereby affirm under penalty of perjury that I will accurately complete the attached form listing the names and addresses of all subcontractors or specialty contractors performing work or services related to this permit and return the completed form to the Business License section of the City Treasury Division for approval before requesting final approval of the work. I also hereby affirm under penalty of perjury that at the time I make any subcontract (written or oral) for the performance of any work by a subcontractor or specialty contractor, and which work is to be performed within the City, I will verify that such subcontractor or specialty contractor has obtained the required contractor's City license from the City and will not permit any such contractor to perform any of the work contemplated in any such subcontract (written or oral) unless and until such required contractor's license has been first obtained.
NOTICE: FINAL APPROVAL FOR THIS PERMIT SHALL NOT BE GIVEN UNTIL ALL SUBCONTRACTORS OR SPECIALTY CONTRACTORS HAVE OBTAINED ALL NECESSARY CITY LICENSES AS VERIFED BY THE CITY TREASURY DIVISION
I hereby affirm under penalty of perjury one of the following declarations:
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code (and this license is in full force and effect) as follows:
Workers' Compensation Insurance Information
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 ($100,000), 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 affirm under penalty of perjury that the work being proposed is not on the same property where a historical building, district or landmark exists.
I hereby affirm under penalty of perjury that I have read the information shown above on this permit including the declarations and that the above and any attached information that I have submitted in order to obtain this permit are true and correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of the City of Santa Monica to enter upon the above-mentioned property for inspection purposes.