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Joe ADDREss: 1699 Balla Lego VVay,Manteca,CA 95337 PERMIT#: LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code and my license is in full force and effect License#720940 Expiration Date 4130(14 Date 8115f13 Contractor V&W Drilimp Inc OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason(Section 7031.5,Business and Professions Code: Any city or county which requires a pennit to construct,alter,improve,demolish,or repair any structure,prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and professions Code)or that he is exempt herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500)): ❑I,as owner of the property, or my employees with wages as their sole compensation, will do the work,and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The contractor's License Lew does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own employees,provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale.) C3 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code(B&PC): The Contractor's License Law does not apply to an owner of property who builds or improves hereon, and who constructs for such projects with a contractor(s)licensed pursuant 10 the Contractors License Law.) ❑l am exempt under Section , B&PC for this reason Date: 8/15113 Owner: WORKERS'COMPENSATION DECLARATION I hereby affirmtthathere I have a certificate of consentCode to eglf-iflsur ce 'Bate of Workers'Compensation Insurance,or a certified copy thereof l( actio 380 Labor Code). ( '/d( /YItA1r /1Jh/uJL Expiration Date v Z Company\ ❑Certified copy is hereby furnished ertified copy is fled with the Environmental Health Department CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars($100)or less) I certify that In the performance of the work for which this permit is issued,I shall not employ any person in any mannerso as to become subject to the Workers'Compensation Laws of California. Date: Applicant NOTICE TO APPLICANT: If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you mustforthwith 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 ❑ I hereby certify that no excavation five (5)or more feet in depth into which a person is raquired to descend, will be made in connection with work authorized by the permt,and that no building structure,scaffolding,faksework,or demolition or dismantling thereof,will be more than thirty-six(35)feet high.(Chapter 3.2,Group 2,Article 2,Section 341,Title 8,Califomia Administrative Code), ❑As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Indu at Safety,as no d above,unless such person has a permit b do such work from the division. ❑Division of Industrial Safety Permit# I certify that I have read this application and state that the above information is cosec agree to p th all city and unity ordinances nd slat laws relating to veil construct and or sewage system ns do and ereb utho' a presentatives of this county to rn e�ove-mentioned property for inspection purposes. Date Applicant it EHD 439] LICENSM CONTRACTOR DECLARATION 10507