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Joe ADORM: PeWfT s: LICENSED CONTRACTORS DECLARATION 1 hereby affrm that l am licensed oder the provdions of Cnsptex 9(coitxnwe, ng with Sedion 7006)of Division 3 of the&rarress and Professions Code and my license' affect Lkanso art Expiration Dad. Date Conbacior f OWNER$UILDER DECLARATION I hereby affirm that 1 am exempt tram lite Contiaannr`s License Law for the 1011owkvg reason(Section 7631.5. and Prolassions Code, Any Cly or county which requires a permit to constnx&eller.improve,demoksh,or tepw any strucWte.prar to its issuance, also requ fts the appYcanl for such pernat to tae a S910d statamerd that he is licensed pursuant to the provmorm of the ConncWs License Law iChapter 9(mmmen"wNh SeMn 7006)of Division 3 of the Business and Professions Code)or mat he is exempt hereffom and the basis for the aloged exemption Any violation of Secbon 7f131.5 by any applicant for a permit sub)ects the applicant to a civil penalty of not more than five hundred dollars(5500)): O I, as oivrer of the property,or my eernpioyeers with wages as their sob compensation, owl do&,a work. and the structure is not intended or offered far sale iSection 7044, Business and Pr:olassions Code: The contractor's License Law does not apply to an owner of property who bunds or i r4voves 8wereon,and who dors such work himself or through his corn employees.provided the$ such improvements are not intended or offered for sale. d, howewv. the budding or mpruvemen7 is sold within one year of Completion,the owner-buddar well have the burden of proving that he rind not tong or improve fur the purpose of sale-) O 1,as owner of the property,am sudusively contracting with beerised OCAgracsprs d Construct the project iseefion 7044,Business aro Professions Code(BBPC): The Contractor's L.rceanse Law does not apply to an owrrtet of propeay who bLAds or irnprwBs hereon, W4 who constructs W such protects wrath a mritraclor(s)Goensed pursuant to the Contractors t.1Can9e Law,j 01 am exempt winder Section B&PC for flys reason . Date: Owner WORKERS'COMPENSATION DECLARATION I hereby affirm Mai I have a ovildicate of consent to self-irtsure or a car6Cate of`✓oTkers'Com;wswu hon Insurance.or a ceettf$ect copy thereof(S"bon 3$00.Labor Cotte) Expiration Date CoakpanY D Certified copy is hw"fumished `Q Cembed copy rs filed wtm the EmrfrorvneMaf Health Dewt;rt$ant i CERTiFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE fThts 2mim need not be oomaNted d the permit is for one hundred dollars i$100i cr less l I I cc"that in the perlomtance of the work for which this permit is issued.I strati not employ any person m any manner so as to beco+nx subject to the Workers'Comvensatiar,Laws of Cafiforma. Dale: Applicant j NOTICE TO APPLICANT:it, atter making this Certilicaw at Exemption,you should become subject to the Workers'Compensatmn I provisi m of t re Labor Code,you must forthwith comply wttrt:inch mvisgns of this perml shall be doomed revoked CONSTRUCTION LENDING AGENCY I hereby affirm mat mere is a wriStrumen lending ageahey to the p rFormance of the wart for wtich this pemrit is issued(Section 3097. CM Code) Lendee's Name Landoes Address OPASION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION O 1 hereby cerfity that no excavation five(5)or more feet in depth into w.w-$ a parson is required to descend, vA be made in connection vfth work aLOw ind by the permit. Arad that no bu sti-idure,scaffolding,talsewark,or demolrtiosh or disarranging thereof.wit be more than thirty-six i3e)fent high.(CRapter 3.2.Group 2 ,Article 2. Section 341 Title 9,Calffomia Administrative Coft i 0 A4 owner-budder.I wd1 not employ anyone to do work wlvcb would require a permit from the Dwcanon of Industrial Safety.as noted above,unless such person has a pem7dt to do such work from the diwhaion. O Dmsfori of Wustttel Safety Permit a 1 certify that I have read this appic3bon and state that the above informalion is correct_ I agree to comply w4h all aly and county ordinances and state laws relating to well construction and or se mage system constrn on,and hereby authorize representatrves of this county to enter upon the above r terrooned property for inspemiri pox s_ Date Applicant Erb 43.32-yi? LICESSED CONTRACTORS DEC AAAT*N 6-,[849