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Joe ADDRESS: PERMT #: LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under Me provisions of Chapter 9 (oonxrwx*p with Sacbon 7000) of Duvision 3 of the Business and Profassbrs Cada and eery license a In KA force and .fled. License 71019-14) Expiration Date 9. 3 -If Dab 0 • z 1' / —2 Contractor {, _-- �� DP7 K W, co OWNER -BUILDER DECLARATION I hereby affirm Meat I am exempt from the Contractors License Law for the RAowkV reason (Section 7031.5, Business and Prohssans Code Any city or oou* which requires a pemd to construct alter, improve, demolish, or repair any stnxixxe, prior lo Ib isswnos also requires to applicant for etch permit to ft ■ signed shaMnent Mel he Y licereed pursuant lo the provisions of the CormacWs License Law (Chaplar 9 (commencing with Section 7000) kN Division 3 of the Business and Professions Coda) or that he is axempt hwefrom and to bash for the aliaged exampfbn. Any vioWbon of Section 7031.5 by any appiicanh for ■ permit subjects the applicant to a civil penalty of not mom than five hundred dollars D I, as owner d to property, or my empioyese with wages as Meir sole compensation, will do the work, and to strxcbxe is not intended or offered for sale (Section 7044, Business and Prolassbns Code' The contractors License Law does not appy to an owrw of property wto hxuida or Improves Verson, and who dose such work himself or through his own errpk"es, Provided that such improvements are not hbrxted or offered for sale. if, however, the buildrhg or ITprovenent Is sold within one year of completion, the owner-buNder wit hew the burden of proving that he did not build or Improve for Cr purpose of sate.) D I, as owner of the property, am sxcku+vey contracting With Iursed contractors to construct the project (Section 7044, Business and Professions Coda (S&PC) The Contracsoes License Law does not apply io an owns of property who builds or improves hereon, and who constructs for such projects with a contracior(s) kwoed pun"" to the Contractors License Law.) D 1 sm exempt under Section _ , Ba PC for this reason Do": Owner WORKERS' COMPENSATION DECLARATION I hereby affirm rich I have a owbffcate of consent to se"w rs or a cwb ate of MKk�ers' Compensation Inauraroe, or a oerbfied copy 1 ereof (Section 3100, Coda) �! m1 `ow�C � A� wlG 11j( Expiration Date j Company l[Lty O Canhfied copy is hereby hrrvshed D Certfiad copy w Mild with the EnWorxrwhhl Health DepartrnerM CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be comofeted N the wrrA is for one hundred dollars 13100) or less) I m" Met in to Wb mwnce of to work for which Chis permit is issued, I sial not employ any person In any warner so as to become subjeri b to Vkcksrs' Cmnpen sabot Laws of CaWlomha. Data: AppNeant NOTICE TO APPLICANT: If, after nuking this Certificate of Exemption, you should become subled b the Workers' Conpereabon provisions of the Labor Code, you must fothwith comply with such provisions or this parotin shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affimh that there a a corstrucbon boding agency for the pertomonca of Ihe work for which thea pernrt is issued (Secbon 3097, CM Coda). Lender's Name L.ermloes Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION D 1 hereby certify tel no excavation Ave (5) or more feet in depth info which a person Is required to descend, *1 be mads In connection with work autxxized by the permit, and that no bu*" structure, axynolding, hlsework, or demolition or dhrtorttllhg thereof, wd be more ishan d*ty-sick (3E) feet high. (Chapter 3.2. Croup 2. Article 2, Section 341, TAI* S, CaMomia Admin istratrw Code). D As ownsr4xWder, I will not employ anyone to do work w t4ch would require a permit from the Divbion of Indu "W Safety, as noted i above, u mse esuch person has a permit bo do such work from to division. D Division of Iidu atrial So" Permit i I certify that I have reed this application and state that Vle above Information Is correct I agree io comply with s1 city and county ordkwnces and stale laws relating to wag construction and or sewage system construction. and hereby autanze represenh vse of o wity blef enupon the Labove-rnsr d property for inspection pkrposes. / ) L�aJ Daft Applicant END 43-02-007 UCENSED CONiRACTCRS DECLARATION s•2e4me