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Joa Ar)GREss: PEAMR 0: LICENSED CONTRACTORS DECLARATION !hereby sff:r chat I am licensed under the pro.n%*m of Chapter 9!convnenung with Section 70001 of Dwtii..On 3 of d+e Business and Professions Code and my hoonse is in IIA farce and effect. License E qq LA 5� :piration Data 30 /7 Date 7-5-y'q 1 Contractor ! d�It Eat+ O \ �+nG• OWNER-BUILD DECLARATION I herby afrsmhat ttam exempt from tine Contractors Licerse Law! rip foaonng reason(Section 7031.5,Business and Prafessions Code Any city or county which requres a porm,t b r rs±n,C, iter, rove,demolish,or repair any structuire,prior to its rmarce, also requ+res the appboant for such permit to fila a signed Statement that he is licensed o„rS:,Jani to the pvdvisgns of the Contractor's License law;Crtapter 9(commencing with Section 70Cb)of Division 3 of the Business and Professions Coae)or that Ino is exempt herefrom and the bas 3 for the alieged exemption. Any vrdabon a'SeCbon 7031 S by any applicant for a perm:1,subjects the apphcartt to a c,,A penalty of not more than fie hundred dollars($500)1 E3 1,as owr:er of the property. or my amploy,aes vitt wages as itiwr side 6dmpinsatx}n, will do the 1kork, and the structure is not intended or otlered for Yale(Section 7:144,Busnesa and Prafess.ons Code:Ttw contractors License Law does rff apply to an owner of property who bulks or improves thereon,and who does such work himself or Lhrougf,tits own empl:ryee5 provided that such improver*nos are not intended or offered for sale. If however,the building or .mproverwt is sold comm one year of completion,the owrf-tx der vwq nave tike tutden of pfavmg that-e(fid not build or impure for the purpose or sale 1 O 1 as owner of ire property am exdus.vety corttra;ing wrh licensee contractors to castrud'Ife p1rit"!Sectio}7044,5-5,ness aria Professions Code IB&PCj The Cortvactrrs LrCenae law does not apply lo an driver d property Mho Inu ids or mprdv�.herect. and who cc�tstruCts for such profecii with a contrecitx(s)icertsed purs;;am to the Contractors License Law j O 1 am exert under Secton B&PC fcr d.is eascr. Date_ Owner WORKERS'COMPENSATION DECLARATION I hereby afrim`that I have a cenlifrcate W conselit to serf-insure oral certificate of';IIokers'C-o_impensaton Insurance.or aLciclrfcd copy tl Expiration A rCompany 1v?i.�4t�a t I Z.rG. �sltiTt r'►)T `0 Cer.iFed caps:s hereby Vn,sred Y�Cerfiod rr)py.s filed with me ErirGnmm en!al Hea&,Deaarerit //�� CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE tT"sr-ton*Yew not be oc pletec if tie Derma's for ane hundred O—Aars,$Iooi or fess( 1 cert..y the'in"performance of the work for which ms:emit is iss,ed I sivill not employ any Deism in any manner so as to berme subfect tc the WorkersCompensation Laws of California Date_ Applicant NOTICE TO APPLICANT:N.after making this Certificate of Exemption,you should become suOtoc!to rhe Workers Corr.pensatlon prov+sions of,tine Labor Code,you must forthwith comply Wth such provisions or this perm,d shall be deemed revoked CONSTRUCTION LENDING AGENCY 1 hereby aflrr,that there 6 a construction lending agency for the performance of ttne work fw which.this peril is issued ISectiOn 3097 C.vt Code) Lender's Name Lender's Address DMSION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION p I hereby certify that no excavation Cre S5;or more feet .n deput into wn.ch a person :s re;used m descend. AA be made .n crnecoon vir'h work authonxed by'he permit,and that no oodcirg stnycttre.scsffoldw%g.falsewcrk_or demoiitmn or dismantling t--fect will be more than 7ur'y-six(36)feet high (Chapter 3.2 Group 2 ".de 2. Section 341 Title 8.California Administrative Coder ❑ As owrw-binder.I will riot(xnplpy anyrne to rc won.wr,C:would require a per4 from the Division of I:,custral Safety.as Holed above,unless such person has a peril to dC work from the c.--son Dwesion of lnd,,szmm Safety Isern+a a _ I certify that I have read this appbcabon and state that;he above:nforrrtetion as correct I agree to comply with a8 city and county efdtnanCes,arra state taws relating to well construction arid or sewage system consirurtticr+.and hereby auttrrmze noomsentabves of m:s cow ty Uo enter upon the atiove-mentioned property for srspo=n purposes Date Applicant E),a 4,-,W-a'? uC8d6DC0KTRACT0Ft$DECILWATipe �zs-vl