In the City of Pinole, acquiring a building permit is a comprehensive process outlined in the Building Permit Application, which mandates applicants to fill in information across several sections. The form is designed to accommodate both commercial and residential projects, requiring details such as job site address, contact name, and the nature of the project, including but not limited to plumbing, electrical, pool, or demolition work. Additionally, it covers environmental considerations by asking if the project will create 10,000 square feet or more of impervious surface, necessitating the completion of a supplemental project impervious area worksheet. Critical to the application are sections on workers' compensation declaration, where applicants affirm their compliance with Section 3700 of the Labor Code, under penalty of perjury. This declaration is vital for the protection of the workers employed on the project and signifies the legal responsibilities of the applicant regarding workers’ compensation insurance or self-insure consent. Moreover, the form also seeks detailed information on the property owner, contractor, architect, and engineer involved in the project, including their contact details and registration numbers. Additionally, applicants must describe the work to be done, emphasizing the need for clarity in the project’s scope and specifications. A stern warning on the failure to secure Workers’ Compensation Coverage highlights the legal consequences, including criminal penalties and civil fines, which underscore the seriousness with which the City of Pinole regards this aspect of the building process. By requiring the applicant's signature, the form ensures that the information provided is accurate and that the applicant agrees to comply with all relevant ordinances, state laws, and to indemnify the city against any liabilities or costs that could arise from the project. This comprehensive approach ensures that all construction work within the city adheres to safety standards, legal requirements, and environmental considerations, safeguarding the interests of the city, its residents, and the workers on the project.
| Question | Answer |
|---|---|
| Form Name | Pinole Building Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | pinole permit online, cityofpinole com building permits, city of pinole building department, pinole building |
City of Pinole: Building Permit Application
APPLICANT: PLEASE COMPLETE SHADED AREAS
Pinole City Hall
2131 Pear Street
Pinole, CA 94564
|
Date: |
|
Commercial |
|
Residential |
Valuation: |
|
|
|
|
|
Received by: |
|
Plan Check # |
|||||||
|
Job Site Address: |
|
|
Contact Name: |
|
|
|
Building |
|
|
Demolition |
|
|
|
NPDES |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
Project creates 10,000 sq. ft. or more |
|
|||||||||
|
|
|
|
|
|
|
|
|
|
Plumbing |
|
|
Pool |
|
|
|
|
||||
|
|
|
|
|
Property Owner |
|
|
|
|
|
|
|
|
of impervious surface. |
|
||||||
|
|
|
|
|
|
|
|
Electrical |
|
|
Fence |
|
|
|
|
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
Complete supplemental project |
|
|||||||
|
|
|
|
|
Tenant |
|
|
|
|||||||||||||
|
|
|
|
|
|
|
|
Mechanical |
|
|
|
|
|
|
|
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Impervious Area Worksheet. |
|
|||||
|
|
|
|
|
Other_________ |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
Owner’s Name |
|
|
|
Owner’s Phone |
|
|
|
Floor Area: |
|
|
|
|
|
REROOFING PERMITS |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||
|
Address |
|
|
|
Home ( |
) |
|
|
|
Garage Area: |
|
|
|
|
Type of Roof |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||
|
City/St/Zip |
|
|
|
Work ( |
) |
|
|
|
Deck Area: |
|
|
|
|
Number of Squares |
|
|||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|||||||
|
Contractor’s Name |
|
|
|
Architect’s Name |
|
|
|
|
|
|
|
|
Engineer’s Name |
|
||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Address |
|
|
|
Address |
|
|
|
|
|
|
|
|
|
Address |
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
City/St/Zip |
|
|
|
City/St/Zip |
|
|
|
|
|
|
|
|
|
City/St/Zip |
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
|
Phone |
|
|
|
Phone |
|
|
|
|
|
|
|
|
|
Phone |
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
Registry # |
|
|
|
|
|
|
|
|
|
Registry # |
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Description of Work
WORKERS’ COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to
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 carrier and policy number are:
CARRIER:____________________________________________________
POLICY #:____________________________________________________
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 provisions of Section 3700 of the Labor Code. I shall forthwith comply with those provisions.
Applicant__________________________________________________
Date __________________________________________________
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 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this agency to enter upon the
Signature _________________________________________________
Date _________________________________________________