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s ooms: c�tiu��, PERMIT#. LICENSE)CONTRACTORS DECLARA=N i hereby affirm that I am ticensed under the provisions of Chapters(commencing with Section 70o0)of t)ivision 3 of the Business and Professions Code and my I-rconse is in f A force and effect License of �SY� �/4. /Expiration Date 1()/31/14 Date d COittrdct4r l� Yr,/l4c�0/LLL t MER-BUILVERDECL.ARAMON I hereby affirm that t am exempt from the Coniracrofs License Law for the following reason(Section 7031.5,Susineas and Professions Code: Any city or courtly which requires a permll to construct,atter,improve,demolish.or repair any structure,prior to its issuance, also require)thn appiicant for such permil to filo a sigrhed slatemenl that he is ficensed pursuant to go provisions of the COntractorS License law(Chapter 9(eomnrencirM with Secion loot)of Division 3 of Rhe Business and Professions Code)or that he is exempt herekom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appl-icant to a civil penalty of not more than five hundred dollars($500)): 17 1,as owner of the property,or my employees vnih wages as their sole compensallon,VAR do Ere work.and pre structure Is not intended or offered for sale(Section 7044,Business and Professions Codm The contractor's Umnse Law does not apply loan ovmer of property who builds of improves thereon.and who does such work himself or through his own employees,provided that such improvement are nil intended or offered for sale. It however, the building or Improvement it;sold vbthin one year of completion,the owner-bujdar wig have the burden of proving that he did not build or improve for the purpose of sato-) 171,as orrrrer of the property,-.m exod+MNPtY contracting WM licensed contractors to construct the projecl(Secdon 7044.Business and Professions Code(BBpq: The Contractors Lh mnse t hew does not apply to an ovrner of Property Who builds or improves hereon. and who constnrcts for snide projects troth a conu>xcor(s)rwxffsed pursuant to tie Contractor's License Law.) 171 am exempt under Section , BaPC for this reason Date_ fawner: — ip(ORjaa SW COUPEN"71CIN DECLARATION I Hereby affirm that 1 have a certtHicate Of c0nsertt to set€ersEsre or a cmWcste of Workers'Cornpensation insurance,hx a veit w copy t-'eof(Section 3WO.Labor Code). Exoration Date2� 5/14 C.Q1rA�1817jf tial lull tLii risry i T" �0 ®Cetttfled copy is..e+�+1..�kin)IShed El Car5fred caW is filed vAh x#12 i=rlYtrDrCnenfal 1'lealM Departetent CERTIFICATE Of OcOWMCK MOM WORKERS'DOWENSATIONN 1NSURMCE ffbis s=cVron need not be completed if ft Permit is for one hundred dollars(5100)ori I=Ilk that in the peffotmance of the work for Wfuct flits pe M;S Isaued.1 shall not ernpioy any Person of any manner so as to become subject to rhe Workers'Corrrper>s'W—Laws of C-M-62. Data: APPilcartf Y--dwutd txecome sulirect to the t11r01k!!'3'Compensation p ovWxx s o APPl1CllCo K.atter uSt o p this CarbTivle hf FXegh!>>ior!,_er er7_p__A ehae eo dee.ned.evoked. provaicxrs of bee Labor Cada.you muni radlnrW h temper W!e•evil.p_vi. CONS-f UCTION 1.EMNG AGENCY (hereby afiam Utah there,is a construction lerxfing agerlvl for The perfL UWCe of the work for which(his permit 15 issued (Section 3097,CIA Code). Lender's Name Lendee Addfti:ss DIVISION OF INDUSTRIAL SAFELY axERMITCER'"CATION i7 1 hereto r ert7Y that no excavation In (5)or mare feet in depth Into vxhich a person is required to descend.wal be made it connection�x that o*Yz2ed by the permit and that nor buadin0 structure.scatloldlnrt.falsetvork,of demolition or dismanifing (hereof,wifl be more than thirtY•snc(35)feel high.(Chapter 3,2.Croup 2.Ardcte 7.Section 341,Thte 0.Ca4domia Adminisiraiiva Code). EI As oxmer-b aider.I,mill pct empiey anyone to do work which would require a Permit from the n'wision of Industrial Safety,as rho above unless tarts person Etas a permit to do Gtech work from W e div tion. I7 Division of indushlal Safely permit it Iced in and state that the above kile"nailon is correct.1 agree to comply vrith at city and county 1 cerffy that 1 have read Rhes eppi a tem oonsiructwn.and hereby authorize representatives of this ordinances and state laws relating Lowell construction and or sewag sys couray to enter Upon the above-merltloned property for inspection purposes Applicant UaLe IXENSM MNMCroq DECLA-11G" Eco asor �a5o�