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Joe A:)oaEss: 95`11 Fest Lane,Stockton,CA 95_216 PEPJ&TS: LICENSED CONTRACTORS DECLARATION hereby a'firm that!am licensed under the provisions of Chapter 9(commencing with Section 7000)of Dvision 3 of the Business and Professions Code and my license is in full force and effect License# `— Expiration Date Contractor OWNER-BUILDER DECLARATION hereby affirm that I am exempt from Ne Contractor's License Law for the fo':owing reason(Section 7031 5,Bus ress anc Professions Code Any city or county which requires a permit 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 Contractor's License Law(Chapter 9(commencing with Section 7000)of Division,3 of the Business and Professions Code)or that he is exempt heretrom and the basis for the alleged exemption Any violation of Sectton 7031 5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500)) ❑1, as owner of the property, or my employees wth wages as their sole compensation, rill do the work, and the structure is not intended dr offered for sate(Section 7044, Business and Professions Code The contractor's License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or through his own sTpicyees.provided that such improvements are not intended or offered for sale If however the buiAing or impreveme Id wit in one yea; of completon,the owner-budder wall have the burden of proving that he did not build or improve for tbf� se of sale ❑1.as owner of the property,am exclusively contracting with licensed contractors to constru ect(Section 7044,Bus'ness antl Professions Code(88PC) The Contractor's License Law does not app to an ow r perry who builds or improves hereon aril who constructs for such project with a contractor(s)licensed pursuant41h75}i ors License Law) ❑I am exempt Lraer Section 88PC for this reason V a Date: __ Owner ��-- GG - -- --- --- - WOR//K'��F 6-M^e�V }tT7ON DECLARATION I he eoy affirm that I have a certificate of ij5lA:db self-�r it r a certdcaie cf'Norkers Compensation Insurance or a certified copy thereof(Section 3800,Labor Code) w./ c- Expiration Date Company_- ❑Cenfied copy is he [3r k Rfhad Certified copy is 5 h the Environmental fieal:h Department CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE 'Th12 Se(;'ien reed not be completed if the permit is for one hundred dOaars(5100)o essl Cettrty that In Lie performance of the work for which thisrmit is issued.I shall not em o y an Pe RI Y Y Gerson in any manner ao a$to DeCOme Subject to Inc Workers'COmpen SatiOn Laws of California. Date:. Applicant _ NOTICE TO APPLICANT If,after making this Certificate of Exemption,you shouid become subject :o the;Ncrkers Compensation provisions of the Labor Code you must forthwith comply with such provisions or this permit shall be deemed revoked CONSTRUCTION LENDING AGENCY I hereby affrn that there is a construction lending agency for tate performance of the work for which this permit is issued(Section 3097 Civil Code, Lender's Name Lender's Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERT)F'.CATION ❑ I hereby cendy that no excavation five (5) or more feet in depth into whirs a person is required to descend, will be made n connection with woauthonZed by the permit and that no building structure scaffolding,1a15eworK or demolition or dtsmartli rk ng thereof, will be more then thirty-six(35)feet high (Chapter 32.Group 2 Artcle 2 Section 341 Title 8 California Acirrvnistrative Code) ❑ As owner-builder,t cal,not employ anyone to do work which would require a permit from the Division of!rdustrial Safety,as noted above.unless such person rias a permit to do such work from the division ❑Division of Industral Safety Perrot it I certify trial l have read this application and state that the above information is correct 1 agree to comply with all city antl county ordinances and state laws retailing to well construction and or sewage system construction and hereby authorize representatives of this county to enter upor the above-mentioned DroRerty for nspecuon purposes Date _._ Applicant EMD 4-102.007 LICENSE^CON-RACTORS DECLARATION !-26-09