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Mar, 16. 2017 11 : 10AM Canepa & Sons No, 7910 P. 3/6
<br /> Jo9ADoasss: 1?p .5. rc� Traou PERMITM
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 or the Business and
<br /> Professions Code and my license is in full force and effect.
<br /> License# 925749 Expiration Date 7/31/18
<br /> Date Contractor CANEPA AND SONS, INC.
<br /> OWNER-BUILDER DECLARATION
<br /> I hereby affirm(het I am exempt from the Contractor's License Law 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 or Section 7031.5 by any applicant for a permit subjects the applicant
<br /> to a civil penally of not more than five hundred dollars($500));
<br /> ❑ I, as owner of the properly, 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 haw does not apply to an
<br /> owner of properly who builds or improves thereon,and who does sveh work himself or through his own employees,provided that
<br /> such improvements are not intended or offered for sale. Ir, however, the building 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 sele.)
<br /> ❑1,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 Lew does not apply to an owner of property who builds or Improves hereon,
<br /> and who constructs for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
<br /> ❑1 em exempt under Section , BdPC for this reason
<br /> Date,. Owner:
<br /> WORKERS'COMPENSATION DECLARATION
<br /> I hereby affirm that I have a cerfifiCale of consent to self-insure or a certificate of Workers'Compensation Insurance,or a
<br /> certlfied copy thereof(Sec(ion 3800,Labor Code).
<br /> Expiration Date 7/16/17 Company AU INSURANCE SERVICES
<br /> ❑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 ke completed if the permit is for one hundred dollars($100)or less)
<br /> 1 certify(hat 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 Califomia.
<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 /> I hereby affirm Thal 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 /> ❑ 1 hereby certify that no excavation five (S) 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, scarrolding, faisework,or demolition or dismantling
<br /> thereof,will be more than thirty-six(36)feet high. (Chapter 3.2, Group y,Article y, 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 Safety,as noted
<br /> above,unless such person has a permit to do such work from the division.
<br /> ❑Division of Industrial Safety Permit ff
<br /> I cenlfy that 1 have read this application and state that the above Information Is correct, 1 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 of this
<br /> county to enter upon the above-men tion ed property for inspection purposes.
<br /> Date Applicant
<br /> EHD 4307 UCENBED CONTRACTOR DECLARATION
<br /> i dryo7
<br /> Received Time Mar. 16, 2017 11 : 21AM No- 1038
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