Laserfiche WebLink
t' <br /> Joe ADDRESS: PE*w 0: <br /> LICENSED CONTRACTORS DECLARATION <br /> I hereby aRrm Heat I am licensed under the Provsurs of Chapter 9 horn menrang wth Section 7000,cf Dry-s:an 3 of the B;rsiriess and <br /> Professions Code and my license o in frill for and affect <br /> uct:nse a 9 y.i ExPI once 4 f 3e )7 <br /> Date zS Contractor �i c C vert a L++C <br /> A <br /> OWNER-BUILDER DEC TION <br /> 1 he•aby affirm H at I am exempt from he Contractor's License Law fit the fcdow 1g reason.fSecton 7331.5 BLs,ness a,-c PrMessiors <br /> Cada. Any city orcount'twttiM requires a permit to construct.alter. improve. rsh or repair any structure prior to ns issuance. <br /> also mires the appricart for sucn permit to file a sigrsd statement:that he is licensed pursuant to the pra.•stors of t!*Contractors <br /> Lwer:SF Law i0hapter 5+cammencrng watt Sector 70001 of Divtscn 3 of the Business and Professions Cooel or that rte is exempt <br /> herefrom and the bases for the abegea exemption. Any rolabon or Sea"703!5 oy arty applicant ic*a perms sut?ec:s the appti wt <br /> to a true penalty of not more than five hunerec dollars IS500)) <br /> O 1 as Owner at the property,or my employees with wages as their sale con-:persaTicin wN do the worstand the stnfC%se is not <br /> imertded or offered for safe(Section 7044,Bus^ess and Professions Code.The contractor's License Law does not apply to an <br /> owner of property w+ho buids or improves thereon and*Rld does such work himself or thivp h4 own employees,provided that <br /> such improvementS are not intended or offered for sale. M. however. the Wking or improvement is sold wrthn one year of <br /> completion.the ewrer-tkAder will hart the burden Of prmng that he did not build of img)rove for the purpose of sale-',, <br /> 0 1 az awmW of the property,am eiclusrvely cohtraamg with licensed contractors to construct trie protect(Seebon 7044.f3us^ess and <br /> P otestions Code tB&PCI The Contrsceors License Law does not apply to an owner o-praPe. f whha th.ulds a imarOv A herecr, <br /> and NhIc aXtSIPAt for suds PrOlectS Wth a contraCtor(si licensed pursuant to the Con"clor's License Law. <br /> 0 1 am exempt under Sectcn _ 88PC far mrs reascn <br /> Dab: <br /> Owner <br /> WORKERS'COMPENSATION DECLARATION <br /> I nereby a-#"that 1 nave a certfic to of Consent Id self-inure OF a cern+ ate of Wok ers'Coenpensanor,Insurance or a certified cups <br /> thereof(Sectio„3W0 Labor Co et. _ <br /> Expiation Dau L /I C.Pany oG y t�•� ttCD� J h l nC. <br /> 0 Certified campy s hereby furnished <br /> %Certfiea copy is tied w4h the Ervrorrrental heath Department <br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE <br /> ^,is secgor neec no!be comlAgled if the Permit 4 for ore hundred ONLars 151001 orf i <br /> I certify that in me performance of the work for wtvch nrs peanut i4:Saud I shag not ernploy arty person in any manner sc as to <br /> 9ecome,sub ect to the Wdrktent'Compensation Laws of Cakfomna <br /> Darr Applicant <br /> NOTICE TO APPLICANT.If,after making this Cert oiyle of Exemption.you should bezme subtect to the Workers Cornpansabon <br /> proviswns of the Labor Cade.yeu must forthwith compfy with such provisions ce this perm 1 shall be deemed revoked. <br /> CONSTRUCTION LENDING AGENCY <br /> I hereby affirm tnat there is a construction lendr",g agerxy for Me performance of the wok for win cn this permit,s slued(Section 3097 <br /> CA Coder. <br /> Lender's Nana <br /> Lander'*Address <br /> DIYISFON OF INDUSTRIAL SAFETY PERMIT CERTIFICATION <br /> 101 hereby certify that no excavation`ire t5i cr+snore legit in depth into which a person is required to descend, .wa be made in <br /> cone tkin with work authorized by the permit,and that no bwldwg stfuMre.scaffolding,falsework.or demolition or dismarymg <br /> Vier",wed be more than.thirty-six(36)feet nign tCnapter 32. Group 2./wide 2.Secton 347,Title 0.Cal-fomm Adminlstrabve <br /> Code). <br /> 0 As owner-0u tder I wall rot employ anyone to do work wnich woukt require a permit from the CiV SKV CA Industrial Safery,as ported <br /> above,urdess&:ch person pas a pamt t to do such work from the division. <br /> CI Division"Industrial Safety Permit is _ <br /> I certify that 1 nave res?Tho application and state that nee above information is cathect I agree to Comply with all cty and county <br /> cedinandea and state laws relating to Ned constnxbt:n and or sew>ige system construction.artd hereby auM4me reprewlatives"mis <br /> county to enter uooh she above-memrcned Vito"for irspection purposes. <br /> Oaer Appikant <br /> E>iC�1:KpJ]Ct LICENSED CONTWTOR&DECLAkATION <br /> 636-]5 <br />