|
Joa ADoRESS: PERMIT#:
<br /> LICENSED CONTRACTORS DECLARATION
<br /> I hereby affirm that I am licensed under the provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Busincsa and
<br /> Proresslons Code and my license is In full force and effect.
<br /> License# Explrat)on Date
<br /> Date Contractor
<br /> OWNER-BUILDER DECLARATION
<br /> I hereby affirm u,nt I Am etxempt from the Contractors License Law for the following reason(&action 7031,5,BuSjnrA&and Professions
<br /> Code: Any city or county which requires a permit to construct,after,improve,demolish,or repair any structure,prior to its issuance,
<br /> also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractors
<br /> License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Businessand Professions Code)or that he is exempt
<br /> herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant
<br /> to a civil penalty of not more than five hundred dollars($500));
<br /> 0 I,as owner of the property,or my employees with wages as their sole compensation,will do the work,and the structure is not
<br /> intended or offered for sale(Section 7044,Business and Professions Code:The contractors License Law does not apply to an
<br /> owner of property who builds or improves thereon,and who does such Work himself of through his own employees,provided that
<br /> such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of
<br /> completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale.)
<br /> ❑I,as owner of the property,am axdusively contracting with licensed Contractors to construct the project(Section 7044,Business and
<br /> Professions Code%I1,C); The.Contmotoes License Law does nol apply to an owner of property who builds or improves hereon,
<br /> and who constructs far sueh.projects with a contractor(s)licensed pursuant to the Contractors License Law.)
<br /> ❑I am exelript under Section B&PC far this reason
<br /> Date; owner
<br /> WORKERS'COMPENSATION DECLARATION
<br /> I hereby affirm that I have a ce,bficate of consent to seMinsure ora certimcate of Workers'Compensation Insurance,or a autified copy
<br /> thereof(.Section 3800,Labor Code).
<br /> Expiration Date Company J T,
<br /> LJ Certified copy fs hereby furnished
<br /> ❑Certttted Copy Is filed with the Environmental Health Department
<br /> CERT1FICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> (chis section need not be completed if the permit is for one hundred dollars($1040r.lost),
<br /> I certify that in the performance of fhe work for which this permit Is issued,I.Shall not employ,Any person in any manner so as to
<br /> become subject to the Workers'Compensation laws of California.
<br /> Pate: Applicant
<br /> NOTICE TO APPLICANT: If,after making this Certificate of Exemption,you should.become subject to li,e Workers'Compensation
<br /> provisions of the Labor Cade,you must forthwith comply with such provisions or this permit shall be deemed revoked_
<br /> CONSTRUCTION LENDING AGENCY
<br /> I hereby affirm that there is a construction lending agency for the performance of the.workfor which this permit is issued(Section 3097,
<br /> Civil Code).
<br /> Lender's Name
<br /> Lender's Address
<br /> 01VISION OF INDUSTRIAL SAFETY PERMIT CERTIFIC4TION
<br /> ❑ i hereby certify that no excavation five (5) or more feet in depth into which a person is required to doscond,will he made in
<br /> Connection with work autho152ed by the perrrmii,and that no building structure,acartolding,falsework, or demolition or dismantling
<br /> thereof,will be more than thirty-aix(36)feet high.(Chapter 3.2, Group 2,Article 2,Section 341.Title 8,Califomia Administrative
<br /> Code)-
<br /> (3 As owner-builder,I will not employ anyone to do work which would requirea permft from the Division of Industrial Safety,as noted
<br /> above,unless such person has a permit to do such work from the division.
<br /> ©Division of Industrial Safety Permit#
<br /> I certify that I have read this application and state that the above Information is correct. I agree to comply whh all city and county
<br /> ordinances and state laws relating to well construction and or sewage system construction,and hereby authorize representatives of this
<br /> county to enter upon the abova-mantioned property for inspection purposes.
<br /> Date AppllCant
<br /> EH4430b007 LIGENSCO GONTRAGYOft6 DECLARATION
<br /> &2FrOb
<br />
|