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JOB ADDRESS: PERMIT N: LICF,NSED CONTRACTORS DECLARATION I hereby affirm that 1 we licensed anchor the provismnsof Chaprcr')tahmnuncin.with Section 70M)ofDwision 3 of the Business and Penfer ows Cad, and my liceac is in full force and effect. (items a Exp.:Dote_ Dau Caloaeur OWNER-BUILDER DU LARATiON I I healthy affirm that I am eaempd from the Cnnwnor's license Law for dhc following ramon(Sec.7031.5.Business and Professions Code:Any ens a- runny which requires u permir to mnamee.alcor.improve.dennalbt.io n:par any aoueuse,poor to its issuance.also requires the npplicmt formal pentW to IIIc a aigrcd w statement dont he is licensed puram to the provisionmtt s of she Conomme"LicI aw((211",9 commencing with Seohiw 7000)or )III-in3 of the Buuncss and Prefessisms QvItt)or that hies exempt ne rumansdshebamsIn,the alleged exemption. AhyvwIMinn of Smrmn7fNl1hy aryapplimntfwapernnitsubjeas'Mapplic t(oaciWpeWtyofn,x mmed nfisehundreddnllaa (g500): ❑L c owned/tlu property,ur my employax with wa6e-s as hhdrrnk�ampenadim.will do toe wmk,and the Nrvctorc is corn inRnded a nfkrcd fur sale (Sat.7lNN.Buuncss and Pmfesunns L1de:The Conwnar's Licenm Ww shwa ma apply man owner of property won builds or imprmes ht.vers, rich who finessuchwork himulfhithrough hisawnemployeesep wnr,l chis it h4rovemcotsarcfor lin,that hndid no ba sale. If.prove fr.the pare. g f Improv<men[la said within one ycer ofcnn:olaion,the owner-buddy will have roc ouNen o[pmuin6 mad be did not build Or improve for the purpu¢of I salt.) Ci L u fw'ti Ur M I-vu dy,um'apply in y cunoal o(pro th li hit huonuxma to. hcrelrhe rod who cocheart,for such pmjmts with ion Code:The Cnaeemr'..iceose be Cdoes crwmlm'apply ly to an owner of pnpesry won huil,N w improves lrereun.and who cmhrxa nor such pmle:ts with s connrxmr(a licensed pursuam to the Convacror'a I kevse Low.) Ol am cement order See. ,R d P.C.for this demon I Darc Owner I — — WORKERS'COMPLNSATION DMARATION I hereto M.that 1 have awnific ca of c mocot in self-iasum.or I em,ficaa of Workers'Commoratioo Insurance,m a cerriried copy thereof(Sm.3801 Lab.C). I kap.Daft _Compmy ❑CeniHW copy e,ha ny fi mishud i O Cenifiel copy is filed with the CouNy Building Inspection Divisive CERTIFICATE OF EXEMPTION PR ObI WORRF.RS'COMPENSATION IN'SURAN'CE (This section need not be mnglcmd of the Pasoan is to one Knottier,collo,IS 101))in las) I mealy that in the pereernmre of the work fix which this ymm n Issued.I shall nod emp:oy any p1son Or any ns•'mner so as w became vubiect rat be Workers'Coel'inaim Uw .(California i Dwe___.Applican ' NOTICE TO APPLICANT.If-after making this 1--tniftcsrc of Exemption.you should become sapjat is dorworkers-Coomati'mmn pmvisians of tha LehorCnda,you null lnn)wtrh comply with auto pmvlaium or this permir shall be demoud revoked CONSTRUCTION LENDING ACF.NCY � I herby affims drum dura is a moderation lending age e,let perfasnumv of the work for which hhix pensions issued(So.3M7,Civ.C1, I!I feldel'.Norn<___ 1 I Lender's.Address I DIVISION OF INDUS'fRUL SAFETY PENMIT CERTIPICATIUN: O s herby certify lhat no recavayon Ise Ol m more feat in de all into which a peaan ie required to descend,will bra mukc in..is..is.with work :othorized by the permit.and that rehuildinyrocas,scaffeldi".falsewnrk.he demolidan m diaaunlinF thcrelf.will be mere sten thirty-sis Old treat dFh. (Clop.3.2.Uy 2.An A Sec.Ml.Tide S.C.A.C.). D M owne-bodda,l will or employ a...to de work which wmrld rrywr.a Permit from the Division of Induudal Sultry,ee rov'd shove,(ales sued l Person has sperms no do such work from the chis i... { O Division Of Industrial Pclmit Nn. f unify mat[haverend Nis applicadmsatawareriatheabmeindbwrnn ah=rc Iuesee rami offIwi th fillcityandcon the ordinance tam saelaws alining m well mnstmeuon and or sewage syamm construction,and AeeM amours rcpmsenotire of Ibis city m cora upon the above-munrioned prupeny for inzpenbn Purposc<. Dote Appficmt