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Jul. 31. 2018 8 : 04AM Canepa & Sons No, 2347 P. 3
<br /> LOB ADDRESS= / / //��./ ,// PERMIT*1
<br /> LICENSED CON/TRACTORS DECLARATION
<br /> I hereby affirm that I em 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# 925749 Expiration Date 7/31/18
<br /> Data Contractor CANEPA AND SONS, INC.
<br /> OWNER-BUILDER DECLARATION
<br /> I hereby affirm that I em exempt from the Contractor's License Law for the following reason(Section 70315,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[het he Is licensed pursuant to the provisions of the Contractor's
<br /> License Law(Chapter 9(commenc[ng 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)):
<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 contrac(or's License Lew 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 buliding or Improvement is sold within one year of
<br /> completion,the owner-builder will have the burden of proving that he did not build or Improve for the purpose of sale.)
<br /> ❑I,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 Contractors License Law does not apply to an owner or property who builds or improves hereon,
<br /> and who constructs for such projects with a conlraclons)licensed pursuant to the Contractors License Law.)
<br /> 111 am exempt under Section , B&PC for this reason
<br /> Date: Owner:
<br /> WORKERS'COMPENSATION DECLARATION
<br /> I hereby affirm that I have a certlftcate of consent to self-insure or a certificate of Workers'Compensation Insurance,or a
<br /> certified copy thereof(Section 3800,Labor Code).
<br /> Expiration Date 7/16/16 Company CALIFORNIA INSURANCE CO.
<br /> 13 Certified copy is hereby furnished
<br /> M 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!$1001 or le5w
<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 Cerlilicate of Exemption,you should become subject to the Workers'Compensation
<br /> provisions of the Labor Code,you must fonhwllh comply with such provisions or this permit shell be deemed revoked.
<br /> CONSTRUCTION LENDING AGENCY
<br /> 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 Name
<br /> Lender'Address
<br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION
<br /> ❑ I hereby certify that no excavation five (5) or more feet in depth Into which a person is required to descend, will be made to
<br /> connection with work authorized by the permit,and that no building structure,scaffolding,falsework,or demolition or dismantling
<br /> thereof,will be more than thirty-six(36)feet high.(Chapter 3.2,Group 2,Article 2,Section 3di,Tlge e, 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 Safety,as noted
<br /> above,unless such person has a permit to do such work from the division.
<br /> ❑Division of Industrial Safety Permitil
<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 slate laws relating to well construction and or sewage system construction,and hereby authorize representatives of this
<br /> county to enter upon the above-mentioned properly for inspection purposes,
<br /> Date Applicant
<br /> EHD 43-07 LICENSED CONTRACTOR DEOLARATION
<br /> 10/507
<br /> Received Time Jul. 31. 2018 8: 24AM No- 3944
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