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Jun -26, 2018 10:46AM Canepa & Sons
<br />Jos ADDRESS: -32-7.,-2- C - "M 4M2 /4 PERMIT#:
<br />LICENSED CONTRACTORS DECLARATION
<br />No, 1917 P. 3
<br />I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
<br />Professions Code and my license Is in full force and effect. / G
<br />License # Explratlon Date
<br />`
<br />Date apll yy____ Contractor Nt19� ONS /NL•
<br />OWNER -BUILDER DECLARATION
<br />I hereby affirm that I am exempt from the Contractor's License Lew for the following reason (Section 7031.5, BusInesS and Professions
<br />Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance,
<br />also requires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's
<br />License Lew (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt
<br />herefrom and the basis for the alleged exemption. Any violation of Section 7031,5 by any applicant for a permit subjects the applicant
<br />to a civil penalty of not more than five hundred dollars ($500))7
<br />❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not
<br />Intended or offered for sale (Section 7044, Business and Professions Code: The contractor's License Law does not apply to an
<br />owner of property who builds or improves thereon, and who does such work himself or through his own employees, provided that
<br />such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of
<br />completion, the owner-bullder will have the burden of proving that he did not build or improve for the purpose of sale.)
<br />1711, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and
<br />Professions Code (B&PC): The Contractor's License Law does not apply to an owner of property who builds or improves hereon,
<br />and who constructs for such projects with a contraclor(B) licensed pursuant to the Contractor's License Law.)
<br />0 I am exempt under Section , B&PC for this reason
<br />Date:
<br />WORKERS' COMPENSATION DECLARATION
<br />I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers' Compensation Insurance, or a certified copy
<br />thereof (Section 3800, Labor Code).
<br />Expiration Date Company
<br />❑ Certified copy Is hereby furnished
<br />C1 Certified copy is filed with the Environmental Health Department
<br />CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
<br />(ThIS section need not be completed if the permit is for one hundred dollars ($100) or less)
<br />I certify that in the performance of the work for which this permit is issued, I shelf not employ any person In any manner so as to
<br />become subject to the Workers' Compensation Laws of California.
<br />Date:
<br />Applicant
<br />NOTICE TO APPLICANT: If, shot making this Ceniticate of Exemption, you should become subject to the Workers' Compensation
<br />provisions of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked.
<br />CONSTRUCTION LENDING AGENCY
<br />I hereby affirm that there is a conBlruction lending agency for the performance of the work for which this permit is issued (Section 3097,
<br />Civil Code).
<br />Lender's Name
<br />Lender's Address
<br />DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<br />❑ I hereby cerlify that no excavation five (5) or more feet In depth Into which a person is required to descend, will be made in
<br />connection with work authorized by the permit, and that no building structure, scaffolding, falsework, or demolition or dismantling
<br />thereof, will be more then thirty-six (36) feet high. (Chapter 3,2, Group 2, Article 2, Section 341, Title a, California Administrative
<br />Code),
<br />❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safely, as noted
<br />above, unless such person has a parmit to do such work from the division.
<br />❑ Division of Industrial Safety Permit #
<br />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
<br />ordinances and state laws relating to well construction and or sewage system construction, and hereby authorize representatives or this
<br />county to enter upon the above-mentioned property for Inspection purposes.
<br />Date
<br />EHO 43.02-007
<br />648.09
<br />Received Time Jun.26, 2018 10:56AM No -3768
<br />Applicant
<br />LICENSED coNTRACTORB 000URATION
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