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s Joe ADDREss: 5700 E.Nik Rad Mameca.CA PERM LICENSED CONTRACTORS DECLARATION i her"affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of ft Business and Professions Code and my lien P full forceeffect Litxnae a � L) S� piratbn Dab Date S 1 Contractor e' L FWR Cb OWNER-BUILDER DLARATIO I hereby afrifm that 1 am exempt from the Contractors License Law for the twang reason(Section 7031 5.Business and Professions Code Any city or county which requires a permil to construct.alter,i .demolish,or repair any WAticlure.prior to els issuance, also requires the applicant for such pearl to file a signed staternerd that he is licensed pursuard to ilii prov Siors of the ContraCtor s License Law(Chapter 9(commencing wttli Section 7000)of Division 3 of the Busaness and Professions Code)or that he is exempt herefrom and the basis for the alleged exempttdn.. Any vrotation of Section 7031 5 by any apptncant for a permat subhects the applicant to a civil penalty of not mom than five hundred dollars($500)y ❑ I,as owner of the property, or my employees with wages as their sole compensation.wilt do the work,and the structure is not intended or offered for sate(Seaan 70x4,Business and professions Cud*:The contractor's License Law does not apply to an owner of property who builds a improve•thereon,and who does such work himself or throuc,fn his own employees,provided that such tmprovements aro not intended ox offered for sate If. however,the Wilding or imptoverient Is sold waUvn ore year of complebon thtt owner-builder wilt have the burden of proving that he did nu»btu or uTV(cve for the purpose of sate) ❑1 as owner of the property am exclusN"contracting with kcensied contractors to construct the protect(Section 7044,Busness and Professions Code(B PC)- The Contactors License Law does nit apply to an owrW of property who biafds or improves hereon. and wfid constructs for such prufacts with a contractorgs)licensed pursuant to the Contractors License Law) ❑1 am exempt under Section BdPC for this reason Date: Ownsir - - WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to W-insure or a certificate Of Waiceni thereof(Section 3800.Labor Codec. Compensatarn Insurance.Or a ce+lNfed Copy Expiration DateL ! Company : fc�a �j c�T«/e •,c. J f, l rrct�• fur. 13 Cerafed copry,s hereby furrkshed VCenfted copy is filed with the Envvonmentai Health Department CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE 1111+2 section need not tie comNeted if Via permt s for one hundred dollars 17Q?) or less) I certify that in the performance of the work for~.this permit is issued,I shad not atripic y arry person m any manner so as to becwrie sublact to the Workers'Compensation Laws of California Date: Applicant NOTICE TO APPLICANT. If,after making the Certificate of Exempbon,you should became select to the Workers'Compensation provisia-s of the Labor Code,you must forthwith cdm(Yy wain such provisions of this permit shad be deemed revoked- CONSTRUCTION LENDING AGENCY I hereby affirm Chet there is a construction lending agency for the performance of the work for which this permit is issued;Section 3097 Cow Code) L.sndees Name Lender's Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ❑ I hereby ce"that no excavation ttve(5)or mane feet In depth into wfucin a person is required to Oescend. wAn be made in connection w th work autho med by the permit,and that no building structure.scaftoking.falsework,ox demolAlon or dismantling thereat.wwil be more than thirty-sic(36)feet high (Chapter 3 2 Group 2.Article 2.Section 341.Title 8,California Administrative Codey ❑ AS owner-builder,I wctl not employ anyone to do work which wvess°d require a pertrrt from he Dean M Industrial Safety.as notal above.unless such person has a perrtud to do such work from the drviscm ❑Division of Industrial Safety Permit a I certify that I have read ttxs application and state that the above mAormai,on is carecl- I agree to wriply wrath as city and County ordinances and state taws relating to wee conVAXJkrn and or sewage system constriction.and hereby audnorue representatives of this county to enter upon the above-mentioned property for inspect on purDO$ s Dila __ Applicant END 4:fff:Do? i.IC04 ED CONTRACTORS DECLARATION 6.26-0'9