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Joe ADORtss: j, i7^ - — V PERMIT#:-- I hareb LICENSED CONTRACTORS DECLARATION =by affi m that I am l caned under the provisions of chapter 9(commerlanB with Section 700p License )of D' 'sion 3 o the B siness and Date U PiratfonD _l Contractor rt' I herebyaM OWNER-BUILDER DECLARATION nn that I am exempt from the CorWactoYs License Law for the following reason Code: Any city or county which requires a Permit to co Lice requires the applicant for such Pemit to file a si (Section 7031.5,Business and Pmfessions License Law Cha nshVCt•atter,improve,demolish,or repair any stiudure,prior to its herefrom and( pier a(°Ommencng with Section 7000 slatament Inst he Is licensed urs uant m a civil bays for the alleged exam )°f Division 3 of the Business and Pofess ors f Oviaons of the �ctoes Pena If more than five hundred dollars gsOpation of Section 7031 5 6 an Cotle)or that he is eek ❑I,as owner of the )) Y Y applicant for a permit subjects the applicant interged oro PrOp"'or my employees with we as their sole Dorn !fared for saleor Int(Section 70gq, Business and Professions Code:Tis m ye 11 do the owner of Property who builds or improves thereon,and who does suchhimself Werk and the such improvements are not intended or offered for sale. I( however, contractors License Law does no refire Is not completion,the Ovmer-buildar will have the burden of proving Inst he did not build or int r through his own employees,provided that the building or improvement k aold within ane year of ❑I,as owner of the property,am exclusively contracting vnth Ilcansed co Pr°ve for the Professions Code(BBPC: PuuPoae o/sale.) acrd who co044 8 ns ) The Conlmcfors License Law does nota ply to an owneconr oftthe project(Secroon 7 Tracts for such projects mth a mmractor(s)licensed u W PertY who builds or rovesnhereon ❑1 am exempt under Section pursuant to the Contractors Licenae Law,) BBPC for this reason Date; Owner: WORKERS'COMPENSATION DECLARATION I hereby affirm that I h Ve certiflcate of consent to s insure or a certified Copy thereof S on 800,Labor Cotle). cote of Wo ars'Compensation Insurance,or a 271 Expiration Date I Company i ifed copy's reby famished Certified copy's filed With the Environmental Health Department � CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE his section need not be Mm0leted if the 3ermit is for one hundred dollars 100 0 less I certify that in the,xrfOnTQo0e of the work for which this permit is issued I shall not employ any person in any manner so as to become subed to the Workers'Compensation Laws of California. Date: Applicant NOTICE TO APPLICANT If.after making this Certificate of Exemption,you should become subject to theµbikers,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 (Section 3097,Civil Code) Lender's Name Lender'Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑1 hereby oertrfy that v exwation five (5)or more feet in depth into which a person is required to descend, will be made in connection withwcz a_!_ d by the permit,and that no bulling structure,scaffolding,falsewurk or demolition or dismantling thereof,will be frlpeix(36)feet high.(Chapter 32,Group 2,Artide 2,Section 311,Title e,Caliromia Admimatrzava Code). ❑As owner-builder,I wil not employ anyone to do work wNch would require a pe om Division of Industrial Safety,as noted above,unless such person las a Permit to do such work horn the division. ❑Division of Industrial Safety Permit 0 I certify that I have read this application and slate that the above information mtrect. I elite. comply with all dry d county Ordinances and slate l ws relating to well construction and or sewage system ,a y a 1110Y repro as of county county m makupon a va_mentioned properly for inspection purposes. Date 1 t' Applicant EHD 13-07 uCEIJ5E0 CONTRFCron DECIARATgN 1015107