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Mar. 6. 2017 6: 18AM Canepa & Sons No. 7851 P. 3/6
<br /> Joa ADDRa9a: 2125 SNYDER LANE, STOCKTON 95215 PERMITM
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby aHlrm 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.
<br /> License# 4257499 Expliatlon Date 7/31/19
<br /> Date (/ 11 COntraCtOf CANEPA AND SONS, INC.
<br /> OWNER-BUILDER DECLARATION
<br /> I hereby affirm that I am exempt from the Contractors License Law for the following reason(Section 7031.5,Business and Professions
<br /> Code: Any city or county which requires a permit to construct,eller,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 me provisions of the Contractors
<br /> License Law(Chapter 9(commencing with Section 7000)of Division 3 of the hualness and Proressiona Code)or that he is exempt
<br /> therefrom 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($500)):
<br /> 0 I, as owner of the property, or my employees with wages as their sole compensation, will do the work. and the structure Is not
<br /> Intended or offered for sale (Section 7044, Business and Professions Code: The contractors License Law does not apply to an
<br /> owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that
<br /> such Improvements are not intended or offered for sale. If. however, the building or improvement is sold within one year or
<br /> completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale.)
<br /> 0 I,as owner of the property,am exclusively contracting with licensed Contractors to construct the project(Section 7044,Business and
<br /> Professions Code(a&PC): The Contractors License Lew does not apply to an owner of property who builds or improves hereon,
<br /> and who constructs for such projects with a contractor($)licensed pursuant to the Convectors License Law.)
<br /> 0 1 em exempt under Section , B&PC for this reason
<br /> Date: Ownar:
<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
<br /> certified copy thereof(Secllon 3800,Labor Code).
<br /> Expiration Date 7/16/17 Compafly AO INSURANCE SERVICES
<br /> ❑Certified copy is hereby furnished
<br /> 0 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 12erm'1 i5 for one hundred dollars($100)or less)
<br /> 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
<br /> as to become subject to the Workers'Compensation Laws of California.
<br /> Date: Applicant
<br /> NOTICE TO APPLICANT: If, after making this Certificate 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 /> 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued
<br /> (Section 3097,Civil Code).
<br /> Lender's Nam
<br /> Lender'Address
<br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<br /> 0 1 hereby ccrEfy that no excavation five (5) or more feel to depth into which a person is required to descend, will be made in
<br /> connection with work authorized by the permit,and (hal no building structure, scaffolding,felsework,or demolition or dismantling
<br /> thereof,will be more than thlnyslX(3e)feet high, (Chapter 3.2,Group 2, Article 2, Section 341, Title 8,California Administrative
<br /> Code).
<br /> 0 As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted
<br /> above,unless such person has a permit to do such work from the division.
<br /> O Division of Industrial Safely Permit x
<br /> I certify that I have read this Application and stale that the above Information is mff cl. I agree to comply with all city and county
<br /> ordinances and stale laws relating to well construction and or sewage system construction,and hereby authorize representatives of this
<br /> county to enter upon the above-mentioned property for Inspection purposes.
<br /> Date Applicant
<br /> EHD 4"7 LICENSED CONTRACTOR DC-C✓.RATION
<br /> 1N&l77
<br /> Received Time Mar, 6, 2017 6 : 28AM No, 0945
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