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JOB ADDRESS: PERMIT A: LICENSED CONTRACTORS DECLARATION 1 hereby affmm thin I and licemed nodes'the psovisiars ofChapia 9(cammsming with Schon 7000)of Division 3.f the Business and Picfessions Code. and my'heave him NII f«c and eHeet. LimneN pap.;pine Dar-Cont.or OWNER-BUILDER DECLARA TION I M1emhy off trot I am exemp from d,c Cantramar's License Law far the fallowing rcamn(Sec.]031.5.Business and Profcsions Cade; Any city or county which demon is Perrmno comtmch alms',improve,demolish or repair any etrocmm,prier to its issuance.also rov ulms the applicant for such permit to fit..signed summenuhal he is licensed pursuant to rhe provision of the CAntraaei s Liccnx Law(CM1ager 9(commencing with Section 7(sl of Division 3 of the Business and Professiddi Cede)m shat he is exempt he efrom and the basis for the alleged uxerrarimt. Any violation of Section 9031.5 by any applicant for a permit subjects the applicant to a civil penalty of trot more than five hundred dollars (5500)): O 1,as owner of the pmpcny,or my employees with wages m thew sole compensation.will do the work,and dm amours is not intended«offered for sale (Sec.7014,Business and Professions Cede:The Cmaditor's License Law does not apply to an owner of property whirr builds«improves thereon,arld who does such work himself or tM1rough his own employees,provided Net welt improvemenu arc n«intended m nHemA far sok, If.however.the building or irsgtmvemcru is sob within one year of t nmpletion.the owner-builder will have the burden of proving that his,did not build m improve for the purpose of oak.) O I,as owner of the property,am exdusivety contorting with lieenaM enntrsatad to construct the project(Sec.704s,Business and Profession Cade:The C.Mund ms's License law does tett apply to an nwncr of property who builds or improves thereon.and who contracts for such projects with a coNracs«(a) licensed pursuant to the Conuact«i Lt.law.) ❑1 am exempt urld«Scc. ,B A P.C.forthis reason - Date Owner WORKERS'C-OMPENSATION DECLARATION I Washy Affirm that 1 have a certifcam of consent to self-imurt.a e oc, ficins of werives Compensation Insurance,«a certified copy thereof(Ses.MID, Lab.Q. Exp.Dam Comluny •. O Ceniied copy is hereby furnished ❑Certified copy is filed with the County Building Inspection Division II CERTIFICATE OF EXEMPTION MOM WORKERS'COMPENSATION INSURANCE (This section Weed oat lK cunnpleled.if the permit is f«ane hundred dollars($100)or ons) 1 certify that in the Peifrwila.of the wart for which this permit is issued.I shall not empty any person in any eunna so m to become subject rot he Workers'Compensation Laws of Coliforms. Date Applicant NOTICE TO APPLICANT:IL afros'making this Certificate of Bxamption.you should became sub*l to he WorkersCmd site inion provision of the lsbor Cade,you muss f«thwith comply will,such pnwour ,or this Pemdt shall be domed nav ked. CONSTRUCTION LENDING AGENCY I herby affirm thou these is a crmwcrfon b_nding agency for the performance of the wells for which this pursuit is issued(Ser.3097.Cis.Q. Lender's Name Lender's Address DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 1 bereby certify the no excavation rive(5)or more feet in depth into which a person Is deputed in dowead,will be snake in connection with with auth rrlaed by the permit,and that no building srmcmrt,scaffolding,falsework.or demolition or dismantling thereof,will be more than der y-six(36)facr high. ((2hap.33.Grp 2.Art 2.Sec 361.Title R.CA.C). m ❑As ower-builder,)will nos employ anyone mo do week which would d,uim a permit from[be Division of lydustrial Safaty.as Waited above,unless such person has a permit to do such work From the division. ❑Division of In husin.l Per.No. I artily that I have read this application and mare that the above information is co m s. I agree ro comply with all city and county oNinnces and sum laws relating to well construction and or sewage system comuvetinn,and hereby suth«ix representatives of this city to enter upon the above-da tinned property for inspassm purposes. Dam. Applicant