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<br /> i I hereby affirm that I am licensed under the,provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business
<br /> and Professions Code and my license is in full force and effect. - s•`'�,: f.. ��
<br /> License# - e3 3 ExpiratI. to -'zo
<br /> `�?4 9. 1 .
<br /> Date ContractorW"Q
<br /> _OWNER-BUILDER D-•CLAAA;TION—'`
<br /> I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and
<br /> Professions Code: Any city or county which requires a permit-to construct, alter, improve, demolish, or repair any structure, prior to
<br /> its issuanIc, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the
<br /> Contractof's License Law(Chapter 9(commencing with Section_7000).of Division 3 of the Business and Professions Code)or that he
<br /> is exemptiherefrom and the basis for-the alleged exemption:�Any violation of Section 7031.5 by any applicant for a permit subjects
<br /> the applicant to a civil penalty of not more than five hundred dollar's
<br /> ($500)):
<br /> 1 O 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 contractor's License Law does not apply to an owner
<br /> ' of properly who builds or improves thereon, and who does such work himself or through his own employees, provided that such
<br /> improvements are not tended or offered for sale._If, however,_the building or improvement is sold within one year of completion,
<br /> 'the,owner.-builder will have the burden of proving that he did not build or improve for the purpose of sale.)
<br /> ❑I, as oTrrrer of the pFv�rty.,.arr�.exclusively contracting with licensed contractors to construct the project(Section 7044,Business
<br /> and Probe ions-Code.(B&PC): The Contractor's License Law does not apply to an owner of property who builds or improves hereon,
<br /> and who donstrugts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
<br /> D I am exempt under Section B&PC for this reason
<br /> Date: Owner
<br /> WORKERS .COMPENSATION DECLARATION
<br /> I hereby affirm that I have a certificate of consent to self-insure,or a certificate of Workers' Compensation Insurance,or a certified
<br /> ? copy thereof(Section 3800,Labor Code).
<br /> I _ I •
<br /> ExpirationDate Company Cy.
<br /> • E3 Certified copy is hereby furnished
<br /> Certified copy is filed with the Environmental Health Department
<br /> CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE
<br /> (This section need not be completed if the permit is for one hundred dollars($100)_or lest
<br /> I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to
<br /> } ' become subjecfto the Workers' Compensation Laws of California.
<br /> Date: Applicant
<br /> NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
<br /> Compensation provisions of the Labor Code, 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 work for which this permit is issued(Section
<br /> 3097,Civil Code).
<br /> Lender's Name
<br /> Lender'Address -
<br /> DIVISION OF INDUSTRIAL SAFETY PERMIT CERTICATION
<br /> I hereby certify that no excavation five (5) or more feet in depth into which a person is required to descend, will be made in
<br /> connection with work authorized by the permit, and that no building structure, scaffolding, falsework, or demolition or dismantling
<br /> thereof, will be more than thirty-six (36) feet high. (Chapter 3.2, Group 2, Article 2, Section 341, Title 8, California Administrative
<br /> I
<br /> 13 As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as
<br /> noted above,unless such person has a permit to do such.wmk from the division.
<br /> O 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 with all city and county
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